Severe Trauma and Medical Mistakes

Some of us acknowledge that we are not great under pressure, but the reality is that pretty much all of us perform worse when we are under more pressure. The more stress, urgency, and high stakes consequences of the moment, the less likely we are to perform well. Whether we are on a cooking show, officiating a contentious sporting event, or trying to save someone’s life in the emergency room, the more pressure and faster things have to be done, the worse our outcomes will be.
In Grunt Mary Roach addresses this reality in relation to combat medics. “bleeding out is the most common cause of death in combat. This is the grim calculus of emergency trauma care. The more devastating the wounds, the less time there is to stabilize the patient. The less time there is and the graver the consequences, the more pressure medics are under – and the more likely they are to make mistakes.”
Give yourself a pass if you have performed poorly in a high stakes and high pressure situation in the past. If you have had to make quick decisions with people yelling at you, with things on fire, or with people unpredictably sick and injured, you probably didn’t perform well. Based on the research that Roach shares, that is to be expected. We perform well in situations where we can practice a lot, where we get immediate feedback, and where we have good aids to help us with our decision-making. The kind of high pressure situations that Roach describes are hard to practice, sometimes don’t have immediate feedback that is of any use for us, and don’t come with any aids to our decision-making. They are fast, confusing, and chaotic.
I would suggest that we simply accept that we will be in these kinds of situations at some points in our lives. If we are in a profession where we are expected to perform in such situations, then we probably do need to find a way to practice under pressure and stress, but don’t beat yourself up for repeatedly failing in practice. Failure under enormous pressure is something we can expect based on our physiological responses to stress and anxiety and our mental challenge of decision-making in such situations. Hopefully most of our actions and decisions can be mostly routinized, setting ourselves up for success rather than chaotic failure.

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