Do We Learn More From Mistakes or From Lucky Saves?

Introduction: Two Patients, One Lesson

You miss a diagnosis, and the patient deteriorates.
You feel it for weeks. You dissect every step, every click, every assumption. The case lingers in your mind like a cautionary ghost.

A week later, you make another shaky call—but somehow, the patient walks away just fine.
You breathe. You’re relieved. And you move on… right?

But should you?

In clinical medicine, both mistakes and lucky saves hold up a mirror to our practice. But which one teaches us more?
And are we only paying attention when outcomes go badly—or are we equally reflective when we’re fortunate?

Let’s explore the untapped value of success, the emotional weight of error, and the potential to grow from both.

1. The Culture of Mistake-Based Learning

From the earliest days of medical training, the morbidity and mortality (M&M) conference is framed as a sacred ritual.
It exists to ask three central questions:

• What went wrong?
  
  
• Why did it happen?
  
  
• What can we do better?

Mistakes are dissected, sometimes painfully. They become reflective essays, case reviews, journal entries—and sometimes, cautionary tales repeated for years.

This system exists for a reason.

Mistakes are emotionally sticky.
They trigger guilt, self-doubt, overthinking, and re-evaluation. As Nobel laureate Daniel Kahneman wrote, “We learn little from success, but a lot from failure.”

At least, that’s the theory.

2. When Lucky Saves Go Unnoticed

A lucky save is when you make the wrong decision, but the patient ends up okay anyway. Common examples include:

• Missing a diagnosis that turns out to be self-limiting
  
  
• Administering the wrong dose but encountering no adverse effects
  
  
• Delaying an essential test or referral without consequence
  
  
• Nearly making a procedural mistake that doesn’t result in harm

In other words: you were wrong—but nothing bad happened. So the event slips away, undocumented and unexamined.

This is the trap.

Lucky saves often don’t evoke guilt or generate discussions. There’s no conference about what didn’t go wrong. No documentation. No peer review.
But the absence of harm doesn’t mean there’s no lesson.

3. The Hidden Risk of Outcome Bias in Medicine

One of the most dangerous cognitive traps in healthcare is outcome bias.
We tend to equate good outcomes with good decisions, and bad outcomes with poor decisions.

But that logic is flawed.

If a risky, unsupported decision turns out well, it is sometimes praised. If a thoughtful, evidence-based decision yields a poor result, it may be questioned. This happens in clinical meetings, chart reviews, even litigation.

It’s why we hear things like:

• “It worked, didn’t it?”
  
  
• “Well, the patient’s better now.”
  
  
• “No harm, no foul.”

But here’s what that ignores:

• Was the good outcome due to strong clinical judgment—or blind luck?
  
  
• Was it the patient’s resilience, the natural course of disease, or a silent near-miss?
  
  
• Was the decision repeatable and reliable—or just fortunate?

When we only reflect on bad outcomes, we let some of our most dangerous habits slip through undetected.

4. Why Mistakes Leave a Deeper Mark: The Emotional Brain

Cognitive science supports what many doctors feel instinctively: we remember our errors more vividly.

Mistakes have emotional consequences:

• They shake our confidence
  
  
• They activate stress hormones
  
  
• They challenge our identity as competent professionals
  
  
• They demand attention and deconstruction

This “emotional salience” means we replay the scenario endlessly. Our brain tags the event as important and logs it deeply.

But while this emotional tagging can make errors powerful learning opportunities, it can also go too far:

• Some clinicians become hesitant or defensive in decision-making
  
  
• Others fall into overtesting, overtreatment, or catastrophizing
  
  
• A few suffer burnout, self-blame, or even leave clinical medicine

So while mistakes teach, they can also traumatize.
And lucky saves, which produce no such emotional surge, are quietly forgotten.

5. How Lucky Saves Reinforce Faulty Cognitive Shortcuts

The irony of a lucky save is that it often rewards poor thinking.

Imagine these scenarios:

• You skip a full physical exam. The diagnosis is still made from labs. You conclude it wasn’t necessary.
  
  
• You jump to a narrow differential. It happens to be right. You start repeating this shortcut.
  
  
• You rely on a CT scan for reassurance rather than clinical signs. Nothing’s missed—so you continue the habit.

These small victories feel good. They build confidence. But they also build bad habits.

Lucky saves can quietly reinforce:

• Anchoring bias
  
  
• Confirmation bias
  
  
• Availability heuristic
  
  
• Overtesting
  
  
• Under-reflection

Over time, these shortcuts become clinical norms—until, inevitably, one decision doesn’t end in a save.

6. Reflection: The Bridge Between Mistake and Mastery

What really teaches us is not the mistake or the save—it’s the reflection.

A mistake without reflection only yields guilt.
A lucky save without reflection only breeds arrogance.
But either, when reflected upon, can lead to growth.

True reflective practice means asking hard questions, no matter the outcome:

• What was my thought process?
  
  
• Was I rushed, emotional, or anchored?
  
  
• Did I miss anything in my assessment?
  
  
• Would I approach the same case differently now?

This kind of internal auditing requires humility.
It also requires space, time, and safety—things often missing in high-volume, fast-paced systems.

But without it, neither our successes nor our failures teach us what they should.

7. Case Studies: Same Decision, Different Outcome, Same Lesson

Consider these parallel scenarios:

Case A: A 23-year-old man presents with sharp chest pain. You assume it's musculoskeletal. He’s discharged. Three days later, he returns with a large pericardial effusion. You missed pericarditis.

Case B: Same presentation, same decision. You send him home. His pain resolves. Nothing further develops. Case closed.

Only one outcome triggers reflection. But both cases had the same flawed reasoning.

In both situations, you failed to:

• Ask about recent viral illness
  
  
• Consider pericarditis in your differential
  
  
• Order a basic EKG or troponin

So why does only one generate self-assessment?

Because medicine judges the outcome—not the process.
And that’s where learning suffers.

8. Institutional Blind Spots: Success Is Not Reviewed

Hospitals and institutions often claim to be committed to continuous learning.
But their review systems reflect a bias:

• Mistakes get M&M
  
  
• Complications get flagged
  
  
• Near misses are investigated
  
  
• Malpractice cases are dissected

But good outcomes?
They’re often passed over entirely.

Rarely does anyone say, “This patient survived, but let’s double-check if the care was sound.”
We don’t routinely audit random cases for decision-making integrity.

This selective review culture reinforces the belief that outcome equals quality.

But if we only analyze failures, we miss countless opportunities to improve and refine our practice.

9. What Medical Students and Residents Need to Understand

To all trainees:

Not all good decisions lead to good outcomes.
And not all bad decisions lead to bad outcomes.

Clinical wisdom isn’t about collecting wins. It’s about collecting insights.

Whether your patient recovers or deteriorates, ask yourself:

• Was my plan sound?
  
  
• What influenced my thinking?
  
  
• What assumptions did I make?
  
  
• What will I do differently next time?

One of the most powerful habits you can build during training is maintaining a personal learning journal—not just for mistakes, but for close calls and surprises.

The goal isn’t perfection.
It’s pattern recognition. It’s sharpening your instinct through structured reflection.

10. Final Thoughts: Patterns, Not Pain, Are the Teacher

So—do we learn more from mistakes or from lucky saves?

The answer is neither.
We learn from what we stop to analyze.

Mistakes slap us awake. They jolt us into awareness. But they can also discourage and drain us.

Lucky saves, on the other hand, are quiet. They don’t demand anything. But they offer a chance to course-correct, without the pain.

Great clinicians don’t just remember what went wrong.
They study what went right—and ask why.

They recognize that clinical growth doesn’t require disaster.
It requires curiosity, humility, and discipline.

Because medicine isn’t just a science of pathology—it’s a profession of decisions. And the best decisions are made not just from training or luck, but from lessons truly learned.