emDOCs Podcast – Episode 20: Perspectives on Failure with Rob Orman

As emergency physicians, we experience a great deal of success, and failure, in our journeys. What can failure and success teach us, and how can we best use these to grow? Today on the emDocs podcast, Brit Long, MD (@long_brit) interviews Rob Orman (@emergencypdx), host of ERCast, the Stimulus Podcast, and Essentials of Emergency Medicine. This first part will look at Rob’s perspectives on failure and how to learn from it. In the second part, we will cover success in EM and life.

Rob Orman’s bio: Rob Orman is an emergency physician and multi-award winning educator. He is founder of the ERcast and Stimulus podcasts, and host of Essentials of Emergency Medicine.

For some amazing emergency medicine content, please see ERCast.

The Stimulus Podcast deconstructs ideas and strategies to live and work with intent.

Finally, Essentials of Emergency Medicine is one of the premier emergency medicine conferences. Don’t miss out!

We discuss:

1. Defining failure [02:39]

  • Internal dialog is often negative when you fail (anger, shame, etc.). May feel some finality, but “life is a series of commas, there’s no period”.
  • The process is the purpose.
  • Rob views failure as not acting in accordance with his internal compass.
    • Story on failure securing an airway
    • Importance of dedication to mastering a skill or technique (cognitive skills, technique), rather than using bravado.

2. Origin of our fear of failure [09:03]

  • We are critical of ourselves. We project who we ‘should be’, but ‘should’ is one of the worst words in the English language.
  • Drive for perfection is present in medical school, residency, post residency. Perfectionism is often rewarded, but it exacts a heavy toll.
  • We want to be seen as the best, no matter the setting, and this is reinforced in training.
  • ‘Sponge’ quality, or continuing to be a lifelong learner is important to improving your care.

3. Handling failure [11:43]

  • It is almost impossible to not be upset in the immediate moment of failure, but when you calm, acknowledge the failure and think about why it happened.

4. Recovering from failure [13:38]

  • Time is a great recovery technique. The only way to truly recover is to grow from the failure; take a hard look at why you failed and how you can apply the lesson the next time.
  • Losing is very hard for us.

5. Obstacles in recovering from failure [16:04]

  • Lack of self compassion is a major obstacle; it’s hard for us to go easy on ourselves.
  • We need an internal mentor… the ideal figure is patient, non judgmental, sometimes reflective, sometimes giving advice, calm, available, and they really love you.  Need to have internal dialogue and visualize this mentor and how he/she can guide you.
  • Jocko Willink approach in the moment, after a hard knock –> “Get up, dust off, reload, reengage, and go out on the attack … because the onslaught is still coming.”

6. What can we take away from failure? [21:11]

  • The only constant in the universe is change.
  • Look back on the event and ask yourself what is it about this that is or was in my control, and what wasn’t. Don’t worry about the stuff that isn’t in your control. You can’t do anything about that. For the things that are in your control, commit yourself 100%.

7. How has failure made you better? [23:32]

  • Need to be honest with yourself when making decisions. “Not with what you think you should be doing or what you think it should appear to others that you do but when you ask yourself, what is the right answer for you.”

8. How do you deal with “Hey, do you remember that patient”? [27:53]

  • Typical initial reaction is intense sinking feeling… “How did I screw up?”
  • Once the initial feeling calms, try to dissect the case to see if there was anything that could have been done differently. If there was, learn from it and apply to the next case.
  • If an option, call the patient.


Stay tuned for Part 2 with Rob, where we discuss dealing with success!

*Post production review by Drew Long, MD.

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