On Failure
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REFLECTION
On Failure Kunal K. Sindhu 1
# American Association for Cancer Education 2020
Abstract In this article, the author discusses his experiences with failure in medicine. He also describes how what he has learned influences his practices today as a radiation oncology resident. Keywords Education . Failure . Residency . Radiation oncology
Growing up, I rarely found it difficult to assess whether I had failed. Most of the meaningful outcome metrics I encountered in adolescence were binary. I won the game, or I did not; I got good grades, or I did not; I learned how to play a song, or I did not. Failure in adolescence was invariably a painful experience. But I eventually found that it yielded a surprising benefit: it gave me a better appreciation of my weaknesses. And with this knowledge, I could devote my time and effort to addressing them. As much as I strove to avoid it, failure could be rejuvenating, a powerful stimulant of necessary personal growth. But the ramifications of failure were never truly significant growing up. Getting a poor test score or losing a soccer match, for example, would not materially impact the trajectory of anyone else’s life. In medicine, however, the stakes are considerably higher. Early in my first year of medical school, working in a primary care clinic, I saw a series of patients who were suffering from severe sequelae of poorly controlled chronic conditions. While their respective paths to this point were not clear, I viewed their cases, fairly or not, as examples of what could happen when failure crept into the clinic: patients did not get the treatment they needed. The consequences, to a malleable
* Kunal K. Sindhu [email protected] 1
Department of Radiation Oncology, Mount Sinai Hospital, Icahn School of Medicine, 1468 Madison Avenue, New York, NY 10029, USA
physician-in-training, were devastating: preventable and unnecessary patient suffering. In retrospect, these experiences had a major influence on my development as a clinician. Striving to avoid unnecessary suffering at all costs, I found myself adopting a defensive, paternalistic philosophy towards the practice of medicine in which my main concern was whether a patient received medically indicated therapy. The goals, preferences, and values of my patients, I hate to admit, were subjugated to this allencompassing goal. Failure, in this sense, was recognizably binary—either I succeeded in controlling a patient’s disease and preventing suffering, or I did not. Reducing all of the complexities of an individual patient encounter into a simple “yes” or “no” assessment of my performance held a certain seductive appeal. It was, in a way, pragmatic: not only did it provide me with a form of instantaneous feedback, but it also largely mirrored how I was assessed in medical school. But when combined with my newly adopted views towards the practice of medicine, this rigid approach smothered potential opportunities for growth. Having seen firsthand the consequences of poorly managed chronic disease, I struggled to cop
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