Recently, TEDxToronto picked the brain of Dr. Brian Goldman, one of last year's speakers. At the conference, Dr. Goldman spoke about the taboo against making mistakes in medicine. His talk was one of two chosen from TEDxToronto 2011 to be featured on TED.com.
Dr. Brian Goldman is an emergency room physician who has worked at Mount Sinai Hospital in downtown Toronto for more than 20 years. He is also a prominent medical journalist and the host of CBC Radio’s White Coat, Black Art. In Dr. Goldman’s first book,The Night Shift, published in 2010, he shares his experiences of working during the witching hours at Mount Sinai and at other hospitals, where he has spent his long career.
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Q: In presenting this talk, did you hope that it would resonate with people in other fields, or was it specific to medicine?
A: You don't give a talk at TEDxToronto without wanting to engage everybody. So, you know, I wasn't necessarily thinking of other specific fields. I just wanted to engage people because everybody has a connection to healthcare.
You know, I think that there's a message for doctors who make mistakes and don't like talking about them, and I think there's also a message for patients — for people and their families — that they should understand that doctors are human like everybody else and cut them some slack, but also go in knowing that if you expect that things are gonna be perfect all the time … (you'll) be in for a very unpleasant surprise. So that was what I set out to do. I wanted to kind of unburden myself to my colleagues, in front of fellow health professionals and the rest of the world.
Everybody is grappling with this hidden message that you're never supposed to make a mistake, that we don't necessarily want to glorify mistakes, although some people do … I notice that when my talk made it to the TED website, the other TED talks that were aligned with it were about the value of making mistakes and learning from your mistakes, which I thought was really interesting — and they weren't healthcare; they were other fields. And that's an emerging idea out there: that people don't remember their greatest successes and dissect them and try to figure out "How did I do what I did that was successful?" They tend to learn more from their mistakes.
Q: Is there a greater stigma against making mistakes in medicine, versus in other fields?
A: Yes, I think there's no question a big difference between medicine and it's not just medicine — all health professions, anybody that's involved in healthcare — and other professions and other services. With healthcare, there's an assumption that you're always trying your best at all times, and you are always at your best at all times, that you never put yourself in a position to be anything but at your best at all times. All that is an ideal. But it doesn't track with reality.
The reality is that sometimes you go in to do a night shift when you're tired, or you go into work in the intensive care unit during the day when you had an argument the night before with your partner, and you didn't sleep well at night because you're troubled by it. That's why we want to acknowledge that that can happen, and where do we go from here? Well, we build a system that acknowledges that mistakes are made, but also does things that make the system safer.
Q: You discuss many subjects on your CBC Radio show, White Coat, Black Art. Why did you decide on this topic in particular for your talk?A: 'Cause this one came from the heart.
On White Coat, Black Art, the best shows that I've done are the ones in which I've let myself be more vulnerable and it occurred to me that I had done a lot of shows on medical errors where I let other people talk about their mistakes, but I hadn't talked about mine. And I felt like, you know what? I needed to unburden myself of years of being afraid and being found out. And that's why I did it.
Any time you feel like you gotta come clean on something, you know, you're definitely speaking from the heart and that has the potential of being a true TED talk. I understand that a TED talk isn't throwing up a bunch of slides and talking about something. It's talking about something that you really feel you have to talk about. You have a need to talk about it.
Q: Have you been approached more frequently since giving your talk?A: Oh, yeah. I've been so gratified on so many different levels.
I give lots of speeches to medical students and residents that said they've shared it on Facebook. Whenever I'm coming to town, they've all seen it, and they all want to engage me. I get all kinds of students that come up to me at the end of the talk, and say, "I just want to shake your hand."
I've had residents or I've had young health professionals starting out practice who tell me that they've made a terrible mistake and haven't been able to get past it. And so, many people have reached out to me because of that talk that it's just been without a doubt, the top two — among the top two or three gratifying things in my entire life — and I owe that to TED.
Q: How did you feel when you found out that your talk had been featured on TED.com?
A: It was such a rush. It was such an exhilarating thing. When I got the news and I saw it there, I was like "Oh my God." And then, when I started to see the comments that people were writing in — you know, I live for engagement and it was engagement on such a huge scale. It's moved me to write my comments in response to their comments, and we've started different streams of comments.
I've been so impressed with the level of discussion and it's not all people agreeing with me. I've had a lot of people commending me for my courage, but I still hear that strong message: "Well, but you are supposed to be more accurate. You are supposed to be closer to perfect. You aren't supposed to make a mistake" … But that's fine with me. You put the talk out there and let people react.
Q: Why did you want to participate in TEDxToronto?
A: It appealed to me because I like new challenges.
I have a lot of experience telling stories on White Coat, Black Art. I've been a radio documentary producer for more than 20 years, and at every stage of your life, you should be striving to do things to push the envelope and to do things that take you out of your comfort zone.
Q: Were you nervous before your talk?
A: Oh, yeah. There was nerves. But you have to be nervous. People ask, "Are you nervous when you're giving a speech? Are you nervous before giving a speech?" And I say, "If you aren't, then how will you succeed?" That nervous energy is propelling you. I was lucky that I had my partner Tamara in the audience, so I knew that there was one person who was deeply in my corner.
I knew from the moment after I gave the baseball analogy, "So how do you think a doctor/surgeon's supposed to bat?" And somebody in the second or third row said, "Bat 1000," I knew I had them. I knew they were answering me.
Q: What did you gain from the experience, personally?
A: I can accept challenge and I can do it. I have been very fortunate on the radio show. I had a producer who pushed me out there and said, "Don't be afraid to be vulnerable." So I've learned that sometimes the most powerful moment comes from being vulnerable, and so I learned that was good reinforcement. I learned that I don't have to go overtime badly. You know, you can say something very powerful in a short period of time … You don't have to go on and be verbose to have impact.
Q: Who was your favourite speaker at TEDxToronto?
A: I loved them all. I loved David Miller because it's so unusual — I mean, he was polite, but his message about transit and Transit City made so much sense.
Q: What is your favourite TED talk?
A: (Deb Roy's The birth of a word). That made me cry.
This interview has been edited and condensed.