From
StayCurrentMD
Surgeon Wellness & Medical Errors: Practice Gap discussion at Update Course 2018
Chapter 1 of 3 · Case-Based Learning
Vignette introduction
Clinical vignette and initial responses to surgeon stress
Expert statements on this page
No expert statements were drawn from this page.
Host summaries · secondary, not cited in answers
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
Kurt Heist talks about the second victim syndrome, and it is real.
Hospitals have M&Ms, safety reports, and evaluations, but do not take care of practitioners after adverse events or acknowledge the effect on them.
The medical field has not acknowledged the mental and physiologic effects of complications on surgeons or done anything effective about it.
There is tremendous pressure for surgeons to ignore emotional responses to medical errors.
Surgeon wellness has an effect on patient safety and care.
Many surgeons are unprepared for the emotional response to a medical error, and this is not covered at all in training.
There is a 40% burnout rate among American surgeons.
25% of American surgeons have clinical signs of depression.
Suicidal ideation was experienced in 6% of general surgeons in an ACS survey, twice the level of the American population in general.
9% of surgeons have experienced a medical error in the last 3 months, and the chances they will have symptoms of burnout is twice as high.
There are 4 phases of response to a medical error: physical and physiologic, emotional response, recovery, and long-term adjustment.
Most healthcare systems do not have systems set up to support care providers when an adverse event occurs.
Children's Mercy has a reasonably structured wellness center approach for physicians who seek help, which is more robust than initially thought, but there is no formal policy.
Wellness support at Children's Mercy is often dependent on the surgeon recognizing the problem themselves and self-referring.
A common response surgeons have under emotional stress is to change their approach to care after a complication, jumping around with every complication trying to land in the right spot.
Buffalo Children's Hospital has a support system, but it is of no good because surgeons must confess publicly to access it, and if they want to keep their job, they keep quiet.
When surgeons cannot access support in a supportive fashion, their behavior is noticed by everybody, and they may become more disruptive and face more punishment.
Burnout must lose its taint and stop being seen as a bad thing; it should be recognized as going through a bad time.
Two Annals of Surgery articles from 2008 surveyed 8000 surgeons with a 30% response rate and found significant suicidal ideation.
There has been a non-zero number of pediatric surgeons who have committed suicide.
The suicide rate among physicians in general is significantly higher than the general population.
Surgeons going down because of wellness issues is a much bigger cost to hospitals than trying to recruit another surgeon.
The administrative response to surgeon burnout is always more administrative overlays every year, which takes away surgeons' time, the one resource they have to recover.
Kurt Heist is very passionate about surgeon wellness and helped set up a robust support system.
When an error or adverse event occurs and the patient safety team is called, resources are mobilized so that one of the leaders proactively goes to the person involved to ask how they are, not to interrogate them.
A proactive support system is needed because there is a lot of stigma around complications and people feel terrible, making them unlikely to seek help on their own.
Different people handle adverse events differently; some say they are fine, while others need resources like an employee assistance program.
For male physicians with burnout, the suicide rate is about twice as high as the general population; for female physicians, the suicide rate is approximately 20 times higher.
Surgeon wellness is a real problem that has been unrecognized and unaddressed for a long time.
Mark Rowe described all surgeons having a mental cemetery of mistakes they revisit, and at age 80-something he still remembers really bad complications.