Self-Reflection

Every day, we do things that are very familiar to us, but do you think about what you are doing and whether it could have been done better? This is called self-reflection, and apparently few of us do it.¹ Self-reflection can be described as a conscious assessment of one’s strengths and weaknesses in order to learn more about personal abilities and to discover where improvement can be made. This is a “skill” that I have practiced ever since I began to do most anything. Every time I practiced the piano, my mother insisted that I figure out how I could do it better. In playing basketball and tennis, every shot was an opportunity to assess an outcome and improve the action for the next time. When operating during my residency and for the 40 years of practice since, every case has presented an opportunity to reflect on what I had done and work on how to make it better or easier the next time. With self-reflection being such a strong part of my life and career, I was stunned to find that a recent study¹ of surgical residents revealed that nearly 60% of them did not utilize self-reflection as a learning method to better themselves as surgeons. When analyzing the residents’ practice, based on their level of training, it was found that senior residents utilized self-reflection only 26% of the time compared with 49% for all levels of junior residents.¹ Now, not just to pick on surgeons, another study² found the use of self-reflection by primary care physicians also decreased significantly with their level of experience. 

I cannot imagine why someone would not want to reflect on a task that has just been done in an effort to improve. This should be especially true in health care when people’s health and lives are at stake. An example that comes to mind is the task of applying a compression bandage to an extremity. Most of us have done this innumerable times — some have told me they can wrap a leg in their sleep. Maybe you can, but does your patient get the best results from the compression bandage when you do it in your sleep? After applying a compression bandage, do we stop to evaluate how the patient feels about the bandage? Is it comfortable yet of the appropriate compression? Is the pressure evenly distributed from the toes to the knee? These are questions that come to mind every time I complete a compression bandage. Could I have done it better? If so, how? Have you ever used a device to measure sub-bandage pressure to see if you have the appropriate compression? One study³ showed that 56% of nurses with more than 10 years of wound care experience applied compression bandages with less than 20 mm Hg pressure (recommended is 30-40 mm Hg pressure). No wonder their patients might be seeing less than optimal results with their compression therapy!

This is just an example of what can happen when we as health care providers do not thoughtfully reflect on what we are doing and try to improve every action and task. We need to reflect on every treatment and every procedure to be sure it is the best one for the patient at that time and that it is being done correctly. It is much more comforting to determine for yourself what you can do better than to have someone tell you. Self-reflection about everything we do is an important learning tool, but it is especially important when the health and lives of our patients are at risk. Reflect on that!