Peer-to-peer support and the second victim syndrome [PODCAST]

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“The COVID-19 pandemic has impacted everyone, especially those of us in health care.  Our way of practicing medicine has been changed; some would say forever. We find ourselves affected not only clinically but also emotionally.  As a result, clinicians are experiencing more stress and anxiety than ever before. These feelings are not new but have been heightened in the face of the pandemic.

Physicians are perceived as self-reliant, emotionally stoic, and pillars of the medical community. Society expects perfection from our health care system and turns to us in times of medical crisis. As clinicians, we need to recognize our humanity;  doctors are people too, with the same emotional needs as any other individual.  In fact, one could argue that medicine demands require an even greater level of emotional support than other professions.”

Susan Wilson is an emergency physician and physician coach.

She shares her story and discusses her KevinMD article, “Peer-to-peer support and the second victim syndrome.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Susan Wilson. She’s an emergency physician and physician coach, and she wrote the KevinMD article “Peer-to-peer support and the second victim syndrome.” Susan, welcome to the show.

Susan Wilson: Thanks for having me, Kevin. It’s great to be here.

Kevin Pho: So we’ll get into the article in a little bit, but first off, can you share your story and your journey to where you are today?

Susan Wilson: Sure. I actually have practiced emergency medicine for 25 years. I was in the Milwaukee area, and in June of 2019, I actually had to retire. I had a progressive retinopathy that affected my vision to the point where I just really couldn’t work anymore. So I retired in 2019 and really still wanted to be involved in medicine, and so I started to soul-search and realized that coaching, and coaching health care professionals, could really allow me to still be involved.

So I got my certification as a coach, and I’m focusing really on areas of job satisfaction and burnout for health care professionals. And then, as my coaching path has kind of evolved, I realized I’m super interested in the whole concept of second victim syndrome and providing peer support. So actually, I have kind of moved more toward really trying to provide as much peer support as possible.

Kevin Pho: So tell me some of the challenges you overcame in making that transition from clinical medicine into the coaching world.

Susan Wilson: Well, I think, certainly, I loved medicine. I feel very fortunate that I was not burnt out, and so I really loved medicine. I think, going to coaching and certainly talking to health care professionals, you’re talking about issues in medicine, but you’re still not actually right there on the front lines practicing. So I think that was kind of the change for me: I’m talking about it, I’m thinking about it, but I’m not actually doing it. So that was a little bit of a challenge, but I realize that with my visual issues now, it’s a good thing for me.

Kevin Pho: As being a physician, has that helped or hurt you as you transition into a coach?

Susan Wilson: You know, I really think it helps, especially with the area that I’m focusing in, because I know inherently what people go through in medicine. And certainly with the pandemic, even though I was not working clinically, I can totally relate to what’s going on in the emergency department, and I can only imagine how stressful it is. So I think as a physician coach, I really have an advantage of understanding both what’s going on in the hospital and just in the medical environment itself.

Kevin Pho: All right, let’s transition now into your KevinMD article, “Peer-to-peer support and the second victim syndrome.” Now, for those who haven’t read the article, can you just walk my audience through it and share the story of why you decided to write it?

Susan Wilson: Well, yeah. So as I said, I’ve really become very interested in this whole concept of the second victim syndrome. Interestingly, I heard a lecture about this in 2017 and realized I had never heard this term before, but this was what I had been living in for 25 years of my career. And so, actually putting a name to this phenomenon that I experienced myself, I realized so many people experience this and just don’t know what it’s called. So that then prompted me to want to write this article. I think one of my big motivations now is trying to do outreach and education to people in health care, because I realize so many people don’t know what this entity is.

So I wrote the article. The definition is a health care provider that’s involved with a traumatic adverse event, and although the patient is the primary victim, the health care professional becomes traumatized and is a secondary victim. And so there’s actually a lot in the research that I’ve done about both the physical and the psychological consequences of these kinds of situations. There’s a very well-described six-stage pathway that people go through in terms of the processing of these incidents, and then finally the whole concept of getting help for the issues. So that was kind of the gist of the article: walking people through what it is, how to get help, and what the help is that’s available.

Kevin Pho: So tell me how the second victim syndrome manifests specifically in clinicians, and maybe, perhaps, if you could share a story or an example of that in play.

Susan Wilson: Oh, sure. I can think of so many incidents myself where I’ve experienced this in my career. So there are physical symptoms, and I’m sure many of your listeners can relate to this. Something bad happens, whether you have a complicated procedure, whether you miss a diagnosis, whether somebody dies in front of you, and you feel physically sick. So, elevated heart rate, you feel nauseated, people may even throw up, have diarrhea, sleep disturbances; those kinds of physical symptoms occur. And then there are a lot of psychological things: this whole concept of feeling shame, grief, feeling loss of confidence, being irritable. Certainly people become depressed and can even go on to have suicidal thoughts related to these kinds of events.

Kevin Pho: So if a clinician recognizes some of these symptoms in himself or herself, what would you advise them to do as the next step?

Susan Wilson: Well, I think it’s really important for people to recognize that when they have an event like this happen, they seek out emotional support as quickly as possible. And the specific term that we use for that is peer support, and it’s something that I think more and more people are now becoming aware of. And especially with the pandemic and all of the issues surrounding the pandemic, these kinds of second victim scenarios, I think, are becoming more prominent. So it’s really important to be able to seek help immediately.

A lot of institutions have put together peer support programs for their employees, but it’s not universal, and so getting a program like this in your institution, or knowing where to get this help, is, I think, really vital. I can say, both from the standpoint of being a coach and coaching people through these incidents, as well as someone that’s experienced these incidents, that having someone to talk to, to talk through the incident and talk about your feelings specifically and how you’re coping, is so important. It’s really vital, then, to be able to get on with your career and to get through the episode.

Kevin Pho: Now, what’s the connection between second victim syndrome and clinician burnout? Is it just a reframing of what burnout is? And if not, what are some of the differences between the two?

Susan Wilson: Well, I kind of see second victim syndrome, those events, as really acute. They’re critical events. And I see burnout as more of a chronic process. I don’t think somebody wakes up one morning and they just suddenly are burnt out. It’s just all of these issues that they deal with on a day-to-day basis in their career that kind of build up gradually over time, and so it’s more of a chronic process.

I think that if someone has repeated second victim events or critical incidents that occur, and they really don’t get any support for those over time, those will lead to burnout. They don’t have to lead to burnout, but they definitely increase the risk of somebody becoming burnt out. So I kind of see the analogy as peer support for these acute events being like: You cut your finger, you have to go to the urgent care and get that taken care of. And burnout I kind of see more as, sort of, the coaching for that is more of a preventive kind of thing, where it’s more of the long-term preventive medicine, if you will.

Kevin Pho: We’re talking to Susan Wilson. She’s an emergency physician and a physician coach, and she wrote the KevinMD article “Peer-to-peer support and the second victim syndrome.” Susan, we’re talking in the first couple of weeks of January, and we’re in the midst of possibly the worst wave of the pandemic. And like you said before, there are a lot of frontline clinicians who are feeling burnt out and just simply exhausted by what’s going on. Now, can you share a few tips and suggestions that they can do to help prevent any progression to burnout?

Susan Wilson: Well, certainly, there are, I think, a lot of strategies that we have traditionally tried to teach people with burnout. So, the concepts of self-care; self-care is really important. Mindfulness, using meditation. I do think that, as I said, the concept of peer support and just having someone to talk to and talking about your emotions is really important.

And certainly now, with what’s going on with the pandemic, moral injury, I think, is really getting to be much more of an issue. I don’t think anyone in this country, up until now, has ever even thought that we needed to think about rationing resources, and so that’s become a huge issue. There are definitely thoughts that once we get through this pandemic, there will definitely be people affected with PTSD types of symptoms. And so having emotional support through those things is really key: the emotional exhaustion, the compassion fatigue. So yeah, the traditional things that we teach people with burnout coaching, I think, certainly will still apply now too.

Kevin Pho: And for those physicians who practice in silos and may not have access to readily available peer support, what kind of resources do you recommend for them?

Susan Wilson: Well, I actually am personally offering, through my coaching, peer support, which is more of this acute kind of access. And so I know that I personally am offering this. I do think there are a lot of coaches out there that are offering these kinds of services.

I do think that if your own health institution doesn’t have a peer support system set up, I think going to the administration and letting them know that this is really important. I think there has traditionally been a disconnect between the physicians that are working clinically and hospital administrators in terms of what’s really needed to keep the system afloat. So I think emphasizing to administration at this point, “Hey, we really need wellness, we really need this kind of support for our clinicians,” is really important.

Kevin Pho: For a clinician who wants to go online looking for a physician coach, what are some of the things that I should look out for, and what are some red flags that should warn me about whether this physician coach is who they say they are?

Susan Wilson: First of all, most coaches will offer a quote-unquote free discovery session, and so that is a time when you can actually talk to the coach directly about sort of what services they offer. You can talk a little bit about what kind of training they’ve had or what their philosophy is. And so I think you can learn a lot about the coach just talking to them.

And certainly, I think the most important thing, you know, there are so many people out there that are certified coaches and have had formal training, but I think the bottom line is, when you’re talking about having discussions like this with someone, do you connect with them? So I think having a discovery call with someone and deciding: Are your personalities in sync with each other? Does it sound like this person is going to be someone you’re going to want to talk to and help you through? I think those kinds of things are really important.

Kevin Pho: Hey, my final question, Susan: What’s your take-home message you want to leave with the KevinMD audience?

Susan Wilson: Well, I think the thing I’m really focused on right now is the fact that I want people to know about this concept of second victim syndrome. I think that the vast majority of people in medicine have experienced this one way or another and maybe just don’t even know it. I think it’s important for everyone to realize that if something like this does happen to you, you’re not alone. So many people have experienced this, there is help out there for you, and relying on colleagues to provide you some support is really going to be very helpful in the long run and really help you to get through the event.

Kevin Pho: How can people find you?

Susan Wilson: So I have my own personal website. It’s sjwprofessionalcoaching.com. And I’m also available via email at [email protected].

Kevin Pho: Thank you so much for sharing your time and insight, and thanks again for being on the show.

Susan Wilson: Kevin, thank you so much. It was great to be here, and thanks again.

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