—Albert W. Wu, MD, professor of health policy and management, Johns Hopkins University, Baltimore
What Hospitalists Can Do
Healthcare is changing its culture so reporting adverse events is easier, without an emphasis on assigning blame.
Support is available by phone, disclosure protocols have been created, and practitioners work with risk management personnel to involve patients and families in discussions and apologies. These processes can give physicians a healthy way to be transparent about what happened and also to know that their institutions support them.
Mixed emotions are common after a bad choice or outcome, but the stakes are particularly high in hospital-based specialties.
“Physicians who practice in hospitals are at particular risk for being involved in instances where patients are harmed, partly because of the acuity of patients and partly because they are repeatedly in this environment,” Dr. Wu says. “In a way, for some physicians and nurses, it is like working in a war zone. It is necessary for you to return to that zone to work, even after something bad happens. That, in itself, can be traumatic.”
Experts accentuate the importance of providing hospitalists, especially young ones, the tools to help them recognize and manage post-event emotional baggage. These tools can serve as a roadmap on how to work through their experience.
Periodic debriefing with peers helps hospitalists discuss what’s going on in their practice. But if a hospitalist has not established this trust and support beforehand, it may be difficult to locate the right support after an event occurs.
“There is a healing that goes on when you are able to share with your colleagues who can tell you about their own experiences with this,” says Dr. Shanafelt.
Dr. Feldman agrees. After a couple of bad patient outcomes this year, he needed to talk as much as possible in a few forums, including with his hospitalist group leader and his peers. As the associate program director at his institution, he also checked in with his residents.
“I know how I’m feeling, which is horrible,” Dr. Feldman says. “You know if you’re doing it, your residents are probably doing the same thing.”
Teaching hospitalists can help change the culture by making them willing to share their own experiences with trainees.
“For supervising physicians to say, in effect, to medical students and residents, ‘In my own career, these are things I have experienced and how I’ve worked through them,’ can help young physicians recognize that identifying and working though the consequences of errors on both a professional and personal level is an important part of being a mindful physician,” says Dr. Shanafelt.
Open and humble sharing means trainees can act similarly.
“When we were first presenting our data to the residents in one of our early studies, I often felt like a priest with physicians coming me to confess their mistakes,” Dr. Shanafelt says. “After having this experience repeat itself over and over, I recognized that sharing this was a cathartic event for them.”
The most helpful thing hospitalists can do for each other is listen without judgment.
“We need to realize it is going to happen to each and every one of us, and be prepared to offer a shoulder to cry on to help your colleague work through it,” says Dr. Feldman.