Introspection and Safety

Medical boards seek out and study positive and negative factors and parameters affecting the delivery of health care. One human factor that is accepted as a significant negative factor is the lack of introspection. Introspection is defined as the contemplation of one’s own thoughts, feelings, actions and sensations. In a broader sense, and in this context, it is self-examination that should continue throughout the career of the provider, just as continuing medical education should become an integral part of the physician’s life. When any provider fails to admit or understand — or simply ignores — the human condition of imperfection, no effort will be made to improve and to “do it better” the next time — and no progress or advance will be achieved.

In the field of aviation, there is a particular aircraft, and a very good one, that is known as the “flying casket” because physicians (and surgeons in particular) have developed a reputation, deserved or not, for crashing the aircraft in almost unbelievable situations and manners. Flight instructors believe that they have identified a distinct pattern here. So well known is this sad reputation that professional pilots and flight instructors cringe and roll their eyes when the words “pilot” and “surgeon” are said in the same sentence.

Some years ago, there was a well-known, talented and respected surgeon who learned to fly. This surgeon’s remarkable ability in his chosen career was unquestioned, and his personal contributions to the field of medicine were widely recognized as enormous. Albeit brilliant, this surgeon also had a persona that was interpreted by most of those who knew him as arrogant. The time came when he chose to fly an aircraft that was beyond his experience level in weather conditions that were far beyond his skill level. On that occasion, he was briefed by the weather service and was told that flying into the prevailing poor weather conditions under visual flight rules was not advised. He paid no attention, and his medical brilliance did him no good from that point on — or down. The flight lasted less than four minutes and abruptly ended a distinguished career. Despite crashing into a congested area, he did not kill anyone he had so thoughtlessly and arrogantly placed at risk on the ground.

Two generally unrelated groups, medical regulators and flight instructors, have collectively reached the same independent conclusion regarding behavior patterns and safety. Confidence, or the state or quality of being certain, is an asset. Arrogance, or the state of self-assumption and presumption, is a detriment. It is a recurring theme and pattern in medicine and aviation. The story of the prominent surgeon whose flight lasted less than four minutes, based on a report from the National Transportation Safety Board database, illustrates a particularly tragic intersection of the two.

I believe many professional medical societies and other health care groups and organizations recognize the potential danger that can result from arrogance and a lack of introspection, and I know some have published statements warning of the serious problems those personal weaknesses can cause. All groups and organizations in the field of health care should address such issues, and every person involved in health care should encourage and support the process.

At the same time, while we know the physician who always reports perfect results and the pilot who always reports perfect flights share serious and sometimes fatal flaws, and that both are dangerous to others and to themselves, it is important to remember that neither is common.