Back in the Saddle
When Tait Shanafelt, MD, and his colleagues at the Mayo Clinic in Rochester, Minn., investigated whether medical residents who rated high on burnout also delivered lower quality care, they found an interesting correlation: Physicians who reported errors experienced more burnout, and burned-out physicians made more errors.1
“While the patient safety issue is paramount, there is also a pretty substantial personal cost to physicians when they perceive that they have made an error,” says Dr. Shanafelt, an assistant professor of medicine.
Whether or not a bad outcome stems from “errors,” hospitalists may experience a psychoemotional aftermath. They often suffer in silence, imagining that few other doctors make errors. This common experience has historically been covered by a veil of silence.2
Silent Struggle
Caregivers are largely hesitant to discuss their involvement in adverse events.
“Their reluctance to discuss this with their colleagues is a common barrier to work through this in constructive ways,” Dr. Shanafelt says.
Though clinical decisions have systems and individual components, when mistakes happen it’s the latter with which hospitalists struggle silently—and often dysfunctionally.
“Every serious adverse event has at least two victims: the patient and family; and the caregiver,” says Albert W. Wu, MD, a professor of health policy and management at Johns Hopkins University in Baltimore.3-5
Although there is merit in analyzing the mistake and learning from it, doing so without facing the personal consequences is insufficient.
“Even if there was a system factor that can be identified, physicians still feel personally responsible for their patients and they often carry a sense of guilt around with them,” Dr. Shanafelt says.
That feeling of responsibility is not necessarily a bad thing.
“It is important to recognize that everything is not a systems error,” says Lenny Feldman, MD, an assistant professor and hospitalist with the Division of General Internal Medicine at Johns Hopkins Hospital. “Individuals want to be able to take responsibility for the bad things that have happened, and there is a value to that.”
The medical profession has just begun to fully acknowledge the inevitability of errors and the need for clinicians to be trained to manage them. Emotional responses to bad outcomes or medical errors include fear, guilt, anger, embarrassment, humiliation, and depression, which can last days—or years.
“The cognoscenti of coping know that there are adaptive and maladaptive ways of coping,” says Dr. Wu. “Adaptive would be reframing and growing and learning from the incident, channeling the energy into trying to do better next time. Maladaptive strategies include denial, turning to alcohol, and becoming angry.”
