Hidden costs of diagnostic mistakes: A descriptive study of guilt, shame, and scapegoating among sonographers practising in the United Kingdom

Introduction

Mistakes are part of ultrasound practice, but the emotional impact of mistakes on sonographers remains poorly understood. This study explored the emotional consequences of mistakes among UK sonographers and identified strategies to mitigate their effects.

Methods

A cross-sectional online survey was conducted in the UK from December 2024 to February 2025. Fifty-three sonographers were recruited through professional networks and member platforms. The survey, hosted on the JISC platform, included quantitative items and open-ended questions. Quantitative data were analysed using descriptive statistics and non-parametric tests in SPSS 28, while qualitative data were coded thematically using Braun and Clarke's framework in NVivo 12.

Results

Thirty-nine respondents reported at least one diagnostic-type error at some point in the past year. Mistakes occurred across all settings (p = 0.107) and experience levels (p = 0.624). Guilt (45.3 %), shame (25 %), and perceptions of scapegoating (33.3 %) were common. Most participants (69 %) reported receiving emotional support after making mistakes (N = 52; no response = 1). Coping strategies varied, though none were significantly associated with setting or experience (p > 0.05). Four themes emerged from qualitative analysis: workplace culture and interpersonal dynamics, emotional and psychological impact, reporting and learning from Mistakes, and recommended support and mitigation strategies.

Conclusion

Diagnostic mistakes are common and emotionally challenging for sonographers. Existing institutional responses are perceived as insufficient. A just culture that prioritises psychological safety, non-punitive reporting, prompt debriefing, and access to counselling supports staff wellbeing, retention, and patient safety.

Implications for practice

Organisations must move beyond policy statements and provide confidential, non-punitive reporting pathways, easily accessible psychological support, and managers trained in empathetic communication to ensure responses to mistakes prioritise learning rather than fault.

Data required for this study may be made available by the author(s) upon reasonable request.