When pop darling Olivia Rodrigo released her sophomore album Guts (2023), she leveraged teenage angst and confusion about growing up to critical and commercial success. Much of the acclaim she received centred on the mix of introspection and social critique in her album, whereby Rodrigo takes accountability for the harm her past actions may have caused.
Guts serves as a stark departure from Rodrigo’s saccharine Disney brand that could have served her career well (a la Selena Gomez). Rodrigo instead swears and vows to centre the ‘messy emotions‘ and mistakes that have paved her path to adulthood.
Every good thing has turned into somethin’ I dread / And I’m playin’ the victim so well in my head / But it’s me who’s been makin’ the bed
‘making the bed’ (Track 6, Guts)
But not everyone is willing to acknowledge their mistakes. Doctors, in particular, can often do the opposite — remain silent or whisper quietly about mistakes they may have made or harms they may have caused to patients in the course of their profession. Sometimes doctors respond this way because their professional power and highly specialised role in society requires them to keep silent. But this code of silence reinforces a binary power relationship (powerful practitioner versus vulnerable patient) such that the patient’s susceptibility to harm precludes doctors from recognising their own role in medical errors.
Reviews of errors, most notably the Institute of Medicine’s report To Err is Human (2000), even encourage hospitals to focus on the situation rather than searching for the person(s) responsible for the error. While this approach recognises the complex contextual and systemic factors that contribute to errors in health care, it may not pay sufficient attention to the contribution of individual doctors and their decisions. Just as importantly, this construction of error may limit opportunities for practice reflection or quality improvement, protecting doctors within the sanctuary of their workplace and discouraging them from seeking help. In this regard, maybe doctors and the healthcare system could learn something from Olivia Rodrigo.
ballad of home-schooled doctors
In contrast with the lack of openness and transparency that often characterises errors in health care, Rodrigo is candid. She finds emotional liberation in sharing her insecurities and social faux pas unprompted. Listeners can revel in the universal experiences of teenage humiliation, brattiness and frustration — all the emotions that come with growing up and falling short of impossible expectations.
Each time I step outside, it’s social suicide / It’s social suicide, wanna curl up and die
‘ballad of a homeschooled girl’ (Track 5, Guts)
For doctors, a sense of professional fallibility is often first experienced when a complaint is made against them by their patients or peers. Consequently, professional vulnerability becomes characteristic of an adversarial or disciplinary process. In this context, self-critique or accepting responsibility for one’s role in medical errors becomes akin to punishment.
when will everyone have any reason to call all my bluffs?
This no-blame (or no-fault) approach to error is not confined to medicine, and supports a structured response to mistakes. However, it is also arguable that the medical industry is worse off for not adopting features of Rodrigo’s learning environment that could contribute to sustainable improvements in patient safety.
1. Consistency
When writing Guts, Rodrigo did not wait for inspiration to strike but treated her natural talent as a muscle to be trained. She turned up every day, enrolled in college poetry courses and wrote over 100 songs before settling on the track list. Rodrigo credits her creativity and professional growth to this consistency, even sharing one of her homework assignments in fan-favourite track ‘Lacy.’
Health organisations must be similarly disciplined in their compliance with safe work procedures, as unrevised routines can habituate health professionals to box ticking (as Atul Gawande notes). Habituation can also lead practitioners to adopt safety recommendations in clinical practice, irrespective of whether they have the expertise or experience to carry them out. Part of enhancing this routine would be to standardise safe work procedures to reduce uncertainty and fear, as well as to ensure that rules are uniform, enabling visiting health professionals to expect the same treatment across the industry.
Likewise, individuals or teams who fail to address reportable concerns should be held accountable, as there is no imperative to transform clinical practices when there is no enforcement of performance standards or rules.
2. Participatory
Equal participation in decision-making flattens vertical hierarchies that otherwise prioritise the perspective of senior health professionals; one of the many factors that contributes to inpatient harm. Contrast this to Rodrigo, who — despite her growing celebrity status — continues to center the contributions of her producer Dan Nigro and other collaborators.
3. Iterative
One last lesson doctors could learn from Rodrigo is a willingness to grow — not only through reflection on previous challenges or problems, but also by thinking ahead to what the future may hold. In looking to the future, doctors should consider what may be done to mitigate the potential risks and harms that lie ahead. While Rodrigo is enjoying another career high with her second number one album, being named Billboard’s Touring Artist of the Year and multiple Grammy nominations (including the much-coveted Album of the Year), her song-writing reveals that she is already bravely reckoning with the fear of crumbling under expectations:
Yeah, they all say that it gets better / It gets better, but what if I don’t?
‘Teenage Dream’ (Track 12, Guts)
Given the status that doctors enjoy — but also recognising their vulnerability to losing that status should they fail to meet professional standards and public expectations — it is arguable doctors should take a lead from Rodrigo. Doctors must start treating learning as a continuous, iterative process that incorporates regular review of their performance and incorporates proactive steps to identify, prevent and manage substandard practices. Participation in these activities should become reflexive and should occur independently of medical error. They should also be approached with a mindset that says ‘acknowledging your mistakes can be a professionally rewarding experience.’
it (does) get better the more you grow
Guts is self-discovery at its finest, and Rodrigo has been critically praised for her open and honest reflections on making mistakes. Doctors should be encouraged and supported to do the same — lest good healthcare remain a teenage dream.
Kavisha Shah is a PhD student in the Faculty of Medicine and Health and an affiliate member of Sydney Health Law.
Acknowledgments: I would like to extend my gratitude to Professor Ian Kerridge who worked through multiple iterations of this article, and my wider supervisory team for their input.
Funding support: This publication is supported by Digital Health CRC Limited (‘DHCRC’). DHCRC is funded under the Commonwealth’s Cooperative Research Centres (CRC) Program.
Conflict of interest declaration: No conflicts are declared.
How to reference: Kavisha Shah, ‘Spill your guts, it could be good 4 u: Three ‘lessons’ doctors can learn from teenage girls’, Sydney Health Law (Blog Post, 16 October 2024).
Cover photo: Kevin Mazur/Getty Images for Acrisure Arena
Sources cited via hyperlinks
- K Atkinson et al, ‘How Does Olivia Rodrigo’s Guts Debut Compare to Our Post-‘Sour’ Expectations?’, Billboard (19 September 2023) https://www.billboard.com/music/chart-beat/olivia-rodrigo-guts-first-week-performance-sour-comparison-1235416112/.
- C Battan. ‘Olivia Rodrigo’s Star-Making Guts‘, New Yorker (12 Septmber 2023) https://www.newyorker.com/culture/listening-booth/olivia-rodrigos-star-making-guts.
- L Snapes, ‘I have all these feelings of rage I couldn’t express’: Olivia Rodrigo on overnight pop superstardom, plagiarism and growing up in public’, The Guardian (2 September 2023) https://www.theguardian.com/music/2023/sep/02/olivia-rodrigo-overnight-pop-superstardom-plagiarism-growing-up-in-public.
- Health Care Complaints Commission v Orr [2015] NSWCATOD 124, [137]–[150].
- M Wakefield et al, To err is human: An Institute of Medicine report’ (2000) 31(3) Professional Psychology Research and Practice 243-44 https://doi.org/10.1037/h0092814.
- RM Wachter and J Pronovost, ‘Balancing “No Blame” with Accountability in Patient Safety’ (2009) 361(4) New England Journal of Medicine 1401-6 https://www.nejm.org/doi/full/10.1056/NEJMc0910312.
- A Gawande, The Checklist Manifesto (Picador, 2010) https://atulgawande.com/book/the-checklist-manifesto/.
- M Davidson and PA Brennan, ‘What has an Airbus A380 Captain got to do with OMFS? Lessons from aviation to improve patient safety’ (2019) 57(5) British Journal of Oral and Maxillofacial Surgery 407-11 https://doi.org/10.1016/j.bjoms.2019.02.012.
- C Willman, ‘Olivia Rodrigo and Dan Nigro Use Intimate Storytelling Show in LA to Recall the ‘Toil and Jubiliation’ of Making Guts: ‘I Was Really Scared’, Variety (10 October 2023) https://variety.com/2023/music/news/olivia-rodrigo-dan-nigro-guts-intimate-conversation-amex-1235750784/.
Sydney Health Law 
Leave a comment