A failed treatment, a surgical complication, a medical error, a patient death. When the going gets tough, even the toughest clinicians should get help.
Physicians and nurses who feel personally responsible for a medical error or a patient’s injury face an immediate quandary—their next patient. In the midst of your angst and guilt, do you suck it up and soldier on? Quit medical practice? Work overtime to avoid having time to think about it? Take time off until you’re not distracted? Keep quiet and protect your career? Talk to a colleague and protect your sanity?
A sea change occurred in the medical community when credible malpractice studies exposed the reality that medical errors are common: that doctors and nurses are not infallible. But, as researchers took interest in the aggregate errors that harm patients, the health care community has been slower to recognize that individual clinicians isolated by their involvement in such events are at risk from their mental turmoil. With the ramifications of a serious error in the back of his or her mind, a clinician may be more vulnerable to subsequent slips. Consequently, patients encountering an atypically distracted doctor or nurse in the aftermath of an adverse event may not be seeing that clinician at his or her best.
Unfortunately, the period of vulnerability can be prolonged. In addition to the private anguish, a clinician directly responsible for a patient harmed in the course of medical care may formally revisit those events multiple times: a patient disclosure, family meetings, M & M rounds, etc. If the clinician is named as a defendant in a malpractice case, closure might take years.
Analysis of recently closed malpractice cases filed against Harvard-affiliated clinicians indicates that, on average, a lawsuit is filed 33 months after the precipitating event; then takes, on average, 42 months to be resolved. Thus, defendant physicians and nurses may spend more than six years after an adverse event dealing with the legal repercussions. Of course, there is no time limit on the emotional impact.
Since stoic perseverance is no longer thought to be the best response to a bad patient outcome, clinicians need help from their employers and peers. Nurses and doctors with access to effective support programs when they most need them are more likely to make the right personal choice about how to handle a situation for which no one can prepare. Institutions that provide and promote programs in support of traumatized clinicians are more likely to preserve competent and emotionally stable caregivers.
Around the country, a variety of provider support models are beginning to serve as valuable tools in helping doctors and nurses maintain or recover their professional skills and focus. Here are four programs highlighted in a film, Healing the Healer, produced by Harvard’s malpractice insurer, CRICO.
Brigham and Women’s Hospital: Center for Professionalism and Peer Support
Johns Hopkins Hospital: Care for the CareGiver
University of Missouri: The forYOU Peer Support Team
MITSS: Medically Induced Trauma Support services
Jock Hoffman is the Patient Safety Education Program Director for CRICO, the malpractice insurance provider for physicians and hospitals affiliated with Harvard Medical School.
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