Permission to Fail

As featured in Dentistry Magazine 23 Apr 2019

You can’t scroll through social media news feeds without coming across references to failing.  learning from failures, failing fast and the fear of failure. Which is great, it lends itself to a growth mindset and self improvement.  


Unfortunately, somewhere along the way as a dentist I stopped applying this to my professional life and I don’t think I’m alone.  In a career that attracts perfectionists, we all too often see less than perfect outcomes as incompetence. We equate incompetence with complaints, remuneration, loss of reputation and/ or standing and potential  loss of professional registration. In short, an act of incompetence can be career ending and financially devastating. It should be of no surprise then that the language we’ve been trained in using from dental school takes failure out of our vocabulary along with painful, hurt and other undesirable words.  We find that amongst our new found medical language, we refer to complications, discomfort and stinging sensations. They’re kind of white lies, but the general adult population doesn’t want white lies, doesn’t want protecting from the truth. By reacting this way, should outcomes lie short of perfect, we’re unintentionally encouraging distrust.  This in turn increases the risk of complaints, an ever present anticipated source of stress for dentists.


David Hilfiker, wrote in his heart wrenching article for the New England Journal of Medicine in 1984. ‘ The degree of perfection expected by patients is no doubt also a result of what we doctors have come to believe about ourselves, or better tried to convince ourselves about ourselves.  This perfection is a grand illusion, of course, a game of mirrors that everyone plays. Doctors hide their mistakes from patients, from other doctors, even from themselves. Open discussion of mistakes is banished from the consultation room, from the operating room, from physicians’ meetings. Mistakes become gossip, and are spoken of openly only in court. Unable to admit our mistakes, we physicians are cut off from healing. We cannot ask for forgiveness, and we get none. We are thwarted, stunted; we do not grow.”


This concept isn’t new and both medicine and dentistry seem stuck in time.  When did our permission to fail get taken away? Our vocation requires us to be human but the expectations of our performance somewhat superhuman.  There is a book I’d highly recommend that explores this concept further, ‘Black Box Thinking’ by Matthew Syed it presents a strong case for applying the attitude to failure from the aviation industry to many other areas including medicine.


I think we often forget that we were allowed to fall short of perfect in dental school, the pass grade wasn’t 100%, we didn’t all graduate with honours.  I’d argue that the most useful learning throughout our careers has been from the cases that weren’t perfect, from the patients that weren’t textbook to work on and from the times the ideal equipment and tools weren’t on hand.  That some of our best work has been on the back of other dentist’s failures and what hasn’t worked for that particular patient in the past. Practice makes perfect is true for us too, practicing our craft, our art form, our profession means falling short of perfect many times, learning from what could’ve worked better and improving.  It’s a shame that this is largely an individual experience, rather than an environment where we can share failures judgement free, so that we may all advance together as a profession.


In conclusion, don’t rush to be so hard on yourself for perceived imperfection and likewise, don’t rush to judge the work of the last dentist.  These are all learning opportunities, opportunities for personal and professional growth.