From Hindsight to Insight: How Clinicians Can Change Their Script
Many of us can remember a case that stayed with us long after the clinical details have faded.
A missed diagnosis.
A delayed diagnosis.
An unexpected outcome.
A complaint.
Often, what remains is not only concern for the patient, but a profound sense of personal responsibility.
I should have known.
I should have done more.
It is my fault.
As clinicians, we are trained to take responsibility seriously. That is an important and necessary part of safe practice. But after adverse events or complaints, responsibility can sometimes feel like an unrealistic burden. We may begin to believe that we should have been able to prevent all harm, achieve certainty, and never miss important details.
How do I make sure this never happens again?
Questioning ourselves is understandable and appropriate. Reflection, learning, and accountability matter deeply in medicine. Yet beneath this, there are often quieter and more difficult questions.
Am I a bad clinician?
Can I trust myself to practise safely in the future?
Does this mean I am a “bad person”?
What does this say about my professional values or morals?
As a result of my 35 years as a General Practitioner, I have developed a deep interest in the wellbeing and sustainability of clinicians. Building on my extensive experience in clinical practice, my focus is now on providing coaching, mentoring, and professional supervision to clinicians through Script for Change.
I have become increasingly aware that difficult events often affect far more than clinical confidence. Clinicians frequently arrive carrying intense guilt, fear of future mistakes, and a profound loss of self-trust. Often, what is needed first is not advice or reassurance, but simply space to think clearly with someone who understands. A space to process what has happened, to explore the assumptions and expectations that have been activated by the event, and to begin to regain perspective.
These clinicians do not need to be “fixed.” They need space to think clearly again.
After complaints or adverse events, some clinicians become increasingly fear-driven and over-cautious in their practice.
Consultations become longer.
Uncertainty feels intolerable.
Decision-making slows.
Over-investigation and over-referral increase.
Many begin carrying an exhausting sense that they alone must prevent all possible harm. Paradoxically, this can sometimes move clinicians further away from sustainable and grounded practice.
Reflective practice in medicine has traditionally focused on what could have been done differently. This is important. But there may also be value in asking deeper reflective questions.
What assumptions am I holding about responsibility?
What does being a “good clinician” mean to me?
Am I equating fallibility with failure?
What level of certainty do I believe medicine should provide?
These questions go beyond simply asking “what should I have done differently?” They explore the deeper beliefs and expectations we hold about responsibility, uncertainty, competence, and our professional identity.
Alongside complaint processes and medico-legal guidance, a combination of coaching, mentoring, and professional supervision can offer space to reflect on the wider impact of complaints, adverse outcomes, and other professionally challenging situations. This helps clinicians process these experiences in ways that support learning, perspective, and self-compassion rather than ongoing self-condemnation.
This is not about avoiding accountability, minimising harm, or lowering standards. Rather, it supports clinicians in responding to these situations in ways that are thoughtful, ethically grounded, and sustainable, rather than driven primarily by shame, fear, or perfectionism.
Medicine will always involve uncertainty, complexity, and responsibility. Support from a fellow clinician who understands the realities of healthcare work and is also trained in coaching, mentoring, and professional supervision can help create space for thoughtful reflection, clearer thinking, and more sustainable ways of working within increasingly pressured systems.
The support I provide is not limited to one approach. I integrate elements of coaching, mentoring, and professional supervision to support reflection, perspective, and practical thinking. Increasingly, clinicians are seeking this kind of support for many of the everyday challenges of healthcare work, including managing workload pressures, navigating workplace dynamics, and addressing concerns about burnout.
Perhaps one of the most powerful things we can discover is that struggling after a difficult event does not mean we are weak, failing, or alone. Often, it simply means we are human, working within an increasingly complex profession that asks a great deal of us.
Alongside my colleague Dr Jo MacGregor, I offer one-to-one coaching, mentoring, and professional supervision sessions for clinicians through Script for Change. Sessions are provided via Zoom throughout New Zealand.
We also offer a free short introductory “Chemistry Conversation,” giving clinicians the opportunity to meet us, ask questions, and explore whether this kind of support may be helpful.
Dr Sandra Spilg
MBChB, FRNZCGP
Member of the International Coaching Federation (ICF)
If you would like further information or wish to book a session, we can be contacted via email or through our website: