{UAH} Patient Complications Have Profound Effects on Surgeons

Patient Complications Have Profound Effects on Surgeons

November 22, 2013

By James E. Barone MD

NEW YORK (Reuters Health) Nov 22 - Surgeons have emotional responses to major patient complications, but most of them feel support mechanisms are inadequate for their needs, says a new study from England.

Lead author Dr. Anna Pinto from Imperial College London said, "Surgeons are perceived as quite tough-minded and indeed there is some evidence which supports that. Our finding that the psychological effects of serious adverse events on surgeons can be quite strong under certain conditions was a very interesting and, to some extent, unexpected finding."

Dr. Albert W. Wu, Professor of Health Policy & Management, Medicine, and Surgery and Director of the Center for Health Services and Outcomes Research at the Johns Hopkins Bloomberg School of Public Health, said, "Surgeons are commonly affected adversely by the same incidents that harm patients--they are 'second victims.' However, their colleagues and institutions fail to appreciate how important and pervasive the problem is."

Dr. Pinto and colleagues talked to surgeons from two different teaching hospital trusts in London, in 45- to 60-minute semi-structured interviews. The researchers asked how surgeons dealt with complications and what sort of support was needed and available.

Of 41 consultants and registrars approached, 27 agreed to participate. They had been in their current positions for an average of seven years. Only five were women.

All but one surgeon acknowledged that surgical complications had an impact on them emotionally and that it could last for years.

The most common effects mentioned were guilt by 15, loss of confidence by eight, worry about their reputation by eight, and six each described worry about the patient, anxiety, and anger at themselves, or if they were trainees, at their supervisors.

Dr. Wu, who was not involved with the study, was surprised that more surgeons did not mention sadness about the patient and said, "I wonder if it may have been a result of how the interviews were framed."

Because the interview questions were open-ended, a list of emotions was not provided, and worry for the patient may not have been at the forefront of most surgeons' minds during the interviews, explained Dr. Pinto. "Other emotional reactions like guilt and anxiety were more prevalent," Dr. Pinto said.

Dr. Pinto said the one surgeon who did not admit to suffering an emotional impact was "a rather senior consultant with many years of experience in clinical practice." He acknowledged that he had suffered the emotional impact of complications as a younger surgeon and complications still affected him on a personal level but "did not describe any particularly strong emotional reactions in the aftermath of serious incidents that may occur in his practice at present."

Two-thirds of the study participants admitted that complications affected their clinical practice most often by making them more conservative and risk-averse. One surgeon commented that such a change might not always be best for every patient.

Dr. Pinto said that because of a negative experience, a surgeon might prolong a patient's hospital stay or use drains even if not necessary. One interviewee mentioned that "after a serious complication, he avoids taking on high-risk operations for quite some time."

The reaction of surgeons to complications depended on whether the complication was unexpected or expected, preventable or not, and whether the case was elective or urgent, with the latter factor being somewhat easier to cope with in all three instances.

The interviewees noted that surgeons' personalities and levels of experience were important, as were the outcomes of patients and reactions of families to the complications.

Ten surgeons felt they worked in a hospital with a culture of blame, and 12 said their institution's morbidity and mortality conference was negative and non-supportive.

Dr. Wu feels that the blame culture also exists in the U.S. He said, "Even if there is not overt blame, there is a subtle, internalized tendency to blame colleagues for their bad outcomes."

Surgeons coped with complications by discussions with peers, reviewing the circumstances of the complication, and openly talking with patients.

Most (19) surgeons believed that support from their institution was inadequate and needed improvement.

"Recently, a few studies have been published that show that healthcare professionals may suffer emotionally in the aftermath of healthcare-related adverse events," said Dr. Pinto. "However there is a lack of research on how best to support staff to deal with these incidents constructively."

She added, "Some suggestions that our interviewees made include the need to introduce formal mentoring systems, the need for surgical leaders to systematically review M&M meetings and to ensure that they function as learning forums rather than opportunities for personal rivalries, as well as the need to enhance teamwork practices within surgical teams."

Dr. Wu agreed with those proposals. He said hospital leaders and surgical directors should pledge support for their staffs after adverse events. Surgeons can be helped by peer support like the "Resilience in Stressful Events" program at Johns Hopkins. M&M conference formats can be changed, and the change can be modeled by senior surgeons.

And as senior surgeons can sometimes be the least supportive of their junior colleagues, Dr. Wu added, "Retirement is very helpful. Aside from this, the chair explicitly declaring a change in emphasis, the reasons why, and demonstrating what to do and not to do can be enlightening."

The study was reported online November 14 in the British Journal of Surgery. A podcast discussing it is available athttp://bit.ly/1882QKU.

SOURCE: http://bit.ly/1fVezMe

Br J Surg 2013.

 

Reuters Health Information © 2013 

Cite this article: Patient Complications Have Profound Effects on Surgeons. Medscape. Nov 22, 2013.