Dr. Wu believes clinicians need to examine their capacity to offer such support.
“We are not as reassuring as we could be,” Dr. Wu says. “I think we tend to hold back, maybe because we are so fearful of the whole idea. Really admitting that this is a normal, common event frightens us too much.”
What Hospitalist Groups Can Do
Cleo Hardin, MD, section chief of pediatric hospital medicine at the University of Arizona in Tucson, says her department deals with post-event distress several ways. Her doctors talk with her, share in their departmental morbidity and mortality conference, and don’t ignore errors and bad outcomes.
“Anytime there is a bad outcome,” Dr. Hardin says, “it is very important for the leader of the group to meet with the individual to ask, ‘What do we need to do to reduce the likelihood that you’re going to develop post-traumatic stress disorder and that you’re going to question everything you do in the future? You are a good doctor. How do we keep you being a good doctor?’ ”
A show of support by the whole team is of utmost importance.
“There is a tremendous amount of camaraderie in the group, and we all understand [that clinical practice] is not an exact science,” Dr. Hardin says. “There’s a lot of art in medicine.”
An expression of that art showed up several years ago in her hospital’s pediatrics unit when a child died on Christmas Day.
“On the day an event happens, I think the person is reeling and in shock and can’t hear anything,” Dr. Hardin says. “I called the hospitalist to ask whether he needed coverage. He declined, saying he was afraid if he got off the horse, he would never get back on.”
The following month they discussed the event at their mortality and morbidity conference; the entire hospitalist section was there.
“We sat together, and it was very clear to the hospitalist involved in the event that he was not there alone,” Dr. Hardin says. “We told him how much we appreciated him and respected him, and we were there to be his support.”
What Leaders Can Do
As the director of the hospitalist program at Johns Hopkins Hospital, Daniel J. Brotman, MD, FACP, understands that the level of upset after a bad outcome can be dramatic.
“Whether or not it was your fault, and independent of any medical-legal ramifications, although those certainly exist,” he says, “there’s a personal sense of just being a human being; of wanting to go back; questioning whether you made a right decision, a wrong decision; and facing whether you would change anything if you could do it again.”