Moving Away from Second Victim Syndrome

A recent article published on kevinmd.com titled “Second victim syndrome: a doctor’s hidden struggle” outlined the concept of second victim syndrome and its impact on physicians experiencing burnout. In this article, I’d like to offer my perspective on this concept and how we can better approach it to prevent burnout and promote well-being.

 
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What is “Second Victim Syndrome?”

Second victim syndrome is a term coined in 2000 by Dr. Andrew Wu that refers to the psychological trauma that a physician may experience in cases of medical error. In a case of medical error, the patient is the first victim and the physician or healthcare professional is the second victim.

Severe cases of harm can lead to severe feelings and thoughts. Mild and moderate cases of harm still stir these feelings and are generally under appreciated for long-term effects. In these cases, the hospital performs root cause analyses and tries to determine ways to prevent errors in the future, while the physician is left alone to deal with the psychological trauma.

These analyses are appropriate if there are lessons learned. Often the system wants or insists that a new lesson is learned. Most frequently the root cause is not new to the system, though it may be new to that physician. To many physicians, the root cause analysis prioritizes the process and even the analysis rather than the humans involved. When lessons are learned, this is a great thing. When NOT, they may not realize the additional harm that is caused to the humans in overanalyzing the medical error. Whether an error actually occurred is not as simple as you might think. Similarly, who made the error makes it even more confusing. Internally, human minds are processing this information very rapidly, while the system processes at a different pace. The humans are further isolated and the feelings are can be GREATLY exacerbated.

So what can we do to help physicians deal with second victim syndrome?

Changing the Language from “Second Victim Syndrome”

First, what if we change the language of "Second Victim Syndrome?"

Many physicians don't want to be considered a victim (nor should we be). Healing, recovery, and learning is strengthened by the concept of moving out of the victim mindset. What if we just call these “adverse outcomes?” What if we appreciated that all involved in the adverse outcome have needs to heal, recover, and learn?

Emotional First Aid & Employee Assistance

Second, the best programs are not in place for surgeons and physicians to leverage when they need assistance. We need to get past “solutions” that are essentially just lipstick on a pig, and invest in real education and resources. For instance, we don't teach healthy empathy and very little attention is placed on emotional intelligence or skills in our training.

Few physicians are even aware if an employee assistance program exists or they might not have access if they are not employed by a hospital or system. Even when available, surgeons are internally and culturally least likely to reach out for support or "feel" that the support "doesn’t get us." Physicians and surgeons are not trusting of confidentiality and safety, as often these have been violated by the system. Lastly, physicians might accept support, but only after repeated offers. We have much more training in giving versus receiving care and support.

We need to offer peer-support that is built around the individual. Each situation is unique, and right now our healthcare system isn’t offering the support physicians need. Too often the support is lacking adequate funding, scheduling conflicts with clinical or personal time, and clarity of physician purpose and goals. There are best practices for peer-support, and we all have to be willing to embrace them.

We all know there’s a long way to go in creating the change our system requires. When medical errors do happen, what if we started with a truly confidential physician-to-physician conversation with someone who understands what we are going through?

With a vast array of resources, including physician coaching, advocacy blogs and podcasts, health and exercise guidance, and resilience training, SurgeonMasters provides a supportive, nonjudgmental, and enriching environment for self-development. Coaching is one avenue that provides an environment for confidential peer-to-peer connections.

Reach out to Team@SurgeonMasters.com to learn more.


How to Ensure Physician Wellness Programs are NOT Like Lipstick on a Pig

In her KevinMD.com article entitled “Physician wellness programs are lipstick on a pig” Linda Drozdowicz, MD argues that physician wellness programs are essentially lipstick on a pig, and do not address the underlying issues that lead to burnout. She goes on to state that these programs can act as a form of unintended victim blaming - giving the impression that doctors just need to take better care of themselves to not feel burnout. In this article, we are going to discuss how physician wellness programs are NOT like lipstick on a pig when the right conditions and commitments from stakeholders are met.

 
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Physician Wellness Requires the Right Tools

Dr. Drozdowicz brings up some salient points about the state of the healthcare system and how it is set up to lead doctors down the path to burnout. However, I would like for her and others to consider that physician wellness programs can be effective when deployed correctly and when victim blaming is avoided.

Physician wellness efforts are not inherently bad. They tend to be ineffective when they don’t have adequate funding or are seemingly intended to just check a box. They work best if certain conditions are in place. These include:

  • Education and Resources - Education designed to raise awareness and offer next steps is a great start. No program provides a magic elixir. Let’s offer helpful resources without shame and blame. Since we all view wellness a little differently, we can expect that a successful wellness program will have a menu of items from which to select.

  • Leadership AND Grassroots Support and Input - It is critical to have leadership active in the conversation, AND active input from the players most directly impacted. Dialogue isn’t nearly enough - those directly involved in patient care need to feel like their voices are being heard in the actions taken by the leadership.

  • Financial and Administrative Investment - Healthcare is not free, and neither is the care of healthcare professionals. What is invested upfront in our well-being will be paid back in multiple ways, including improved patient safety, outcomes, and satisfaction, as well as lower litigation risk, physician turnover, and dissatisfaction.

  • Effort to Control the Causes of Stress and Frustration - There’s no doubt about what is frustrating physicians most - everything in the system that isn’t directly about patient care! Let’s make REAL efforts to minimize the impact of these causes - like EHR and paperwork - and we’ll start to see our environment improve.

With these conditions in place, wellness programs can go a long way to preventing burnout and encouraging healthy lives for physicians both at work and at home.

Awareness Resources

If you are interested in more physician wellness resources, SurgeonMasters has you covered. We regularly post blogs, podcasts, and webinars with helpful tips on how to prevent burnout and sustain a thriving surgical career. Interested in 1-on-1 coaching, or coach training?

Reach out to Team@SurgeonMasters.com to learn more.


How to Help Recognize the Signs of Burnout

It is well known these days that burnout is a widespread point of discussion in the medical community – especially among surgeons. As much as we talk about it, many physicians don’t even realize that they’re burned out. We talk a lot about how surgeons can prevent and treat symptoms of burnout when they arise, but an essential first step in that process is getting the burned out surgeon to realize that they are experiencing burnout. In this article, we are going to address this issue and offer some tips for helping surgeons recognize the signs and symptoms of burnout so they can take appropriate action.

 
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Demands of the Job

The system and culture expects a lot of our physicians – too much, in fact. Many of us were trained to power through adverse situations and solve problems on our own, without asking others for help. The strategy of working harder and longer does nothing to improve our situation. Rather, it leads to unprocessed anxiety, stress, and fatigue – classic symptoms of burnout.

Burnout is not typically caused by a single event. It usually builds slowly over the course of months or years, much like the frog in the boiling pot – making it even more difficult to recognize and address. When we do finally exhibit the signs, it is important to effectively identify them as such.

Recognizing the Signs

Keeping an eye out for red flags is an important first step. Even asking simple questions can bring heightened awareness to our current situation.


Here are three simple questions you can start with.

Do you find yourself or a colleague “checking out” or disengaging from patients?
Do you find yourself or a colleague overwhelmed and disengaging from family, friends, or colleagues?
Do you find yourself or a colleague losing the joy of your (their) career and accomplishments?

These signs can be hard to recognize in ourselves, so it’s also important to keep an eye on our friends and colleagues as well. If you notice any of these red flags in a friend or colleague, go beyond asking them how they’re doing and if they need any help. Most will say they are fine and “no thanks.” Come at it from the side of compassion. You could offer support in ways that you might want others to give it to you, or you could share with your colleague one of our resources, blogs, or podcasts that really resonated with you.

SurgeonMasters Wellness & Resilience Services

At SurgeonMasters we are focused entirely on the wellbeing of surgeons and physicians. We offer a variety of educational resources (educational programs, coaching, articles, podcasts, etc.) aimed at equipping physicians with tools and strategies to improve well-being and increase resilience. We are building a community of surgeons and physicians offering support and camaraderie. If you are not currently subscribed, add your name to the mailing list and send us a note to say hello or provide your thoughts.


Source - Helping Physicians Recognize They're Burned Out, Steph Weber, Physicians Practice, April 9, 2018

Eye on Wellness - Simple Burnout Prevention Steps

Are you overwhelmed at work to such an extent that you feel deflated, depleted, and emotionally drained? You may be experiencing burnout – and you’re not alone! Burnout can ruin careers and lives, but only if we let it. What many don’t realize is that burnout has a positive side. The key to managing burnout is to leverage the positive side over the negative. In this article, we are going to offer up a few tips that can help save your career from the perils of burnout.

Focus on Sleep

Many surgeons simply do not get enough sleep. Me included! I am very well trained in sleep deprivation. Until fairly recently, I was proud of this ability. One way to train FOR the worst case scenario is to train IN the worst case scenario. While I am still able to turn on my system in the middle of the night in ways others might not understand, I now see some changes in my ability to handle periods of frequent middle of the night call duties. I am continuing to address my performance and self-care. Start to recognize how much sleep you get every night, and see where you can add more if needed. Power naps and changes to improve quality of sleep are other ways to improve our sleep recovery.  It may seem like you need to burn the midnight oil to get your work done but being well-rested can improve your proficiency at work – allowing you to get more done in less time. Where is your threshold?

Strategically Disconnect

With social media, constant texting, and email updates continually ringing in our pockets, many people feel the need to respond immediately and always be available. It’s no wonder we feel drained! Do your best to strategically disconnect. Strategically is the keyword here. Obviously, you shouldn’t disconnect yourself from everything if you’re on call, but when you can – turn your phone off, don’t respond to emails, and schedule time for yourself to do leisure activities that give you pleasure and recharge your batteries.

Don’t Feel Defeated

Remember that you are not “giving up” in recognizing that you are feeling the effects of burnout. There is no defeat in recognizing that you need to make some changes to improve your wellness. It generally means that you have not allowed yourself enough physical, mental, and emotional rest and recovery in between the bursts of intense performance for our patients.

Connect with the SurgeonMasters Community

If you or a physician you know are experiencing warning signs of burnout, SurgeonMasters is here to help. We are a wellness and coaching organization focused on helping surgeons combat burnout and build sustainable practices. How do we do that? By providing a variety of educational materials, including podcasts, blogs, webinars, and meetups. Join a community of like-minded surgeons helping each other build lifestyle-friendly practices. Contact us today to learn more or join our mailing list to get the latest updates.

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Purpose, Fulfillment and Shared Goals

In this article, I would like to review a recent blog written by SurgeonMasters contributor Kristin Long, MD, FACS. Dr. Long recently returned from a two week surgical mission trip to rural western Kenya, where she and her team performed 62 surgical procedures and treated upwards of 475 patients in 4 clinical days. Upon her return she had many insights into the overwhelming nature of such trips and what she had to deal with when she got back to her job.

Exhaustion & Emotional Fulfillment

“Thinking back on the incredible levels of stress and exhaustion we all endured, I’m even more amazed by the scope and quality of work we were able to accomplish,” Dr. Long writes. “Within a few short days of returning, I found myself digging through a backlogged email inbox, EMR in basket, and life in general.  Among my favorites were the administrative email noting that I had one week in which to complete my “respiratory fit testing” or my hospital privileges would be revoked, as well as a reminder of a delinquency for the annual online HIPAA training module.”

When our hard and exhausting work appears to have purpose, we are fulfilled emotionally, even though we may be drained mentally and physically (as well as emotionally). The overall experience is POSITIVE!

In contrast, her "productive" work getting caught up on emails, EMR in-basket, and administrative tasks? These activities were lacking in purpose. The results were almost completely a drain or feeling of "empty" when the tasks were completed.

When the purpose is trivial to us, it is not fulfilling. These burdens are typically not about providing care to patients. There may be a purpose to those who created the rule or policy. However, the presentation as mandatory or that we are delinquent immediately puts us on the defensive. Often the training is common sense, and little effort is placed on the value of our time and goals. This is counterproductive to decreasing burnout and creating wellness. In fact, it creates disillusionment. 

Receiving Inspiration Through Shared Goals

“We came together, working for a common goal, and let that guide us,” Dr. Long remembers of the mission in Keyna.  “Everyone stayed late, everyone checked in on one another, and NO ONE uttered the phrase “that’s not my job.” The spirit of camaraderie and dedication was enough to remind each of us why we went into health CARE in the first place.” 

What Dr. Long describes here is her Passion for Performance Improvement. It’s easy to lose sight of this during our day to day work as surgeons. Sometimes we need to take a step back and re-examine our situation, and the world at large to find our center again and continue doing the important work that we do.

At SurgeonMasters, our goal is to help physicians create sustainable and lifestyle-friendly practices. We are a collective of like-minded surgeons offering educational resources (articles, podcasts, webinars and more) to help physicians prevent burnout and improve well-being.

 

The original article, “What If We Were Friends?” was published September 6th, 2018 in KenyaRelief.org.

Author Bio

Kristin Long, MD, FACS is an assistant professor in the Division of Endocrine Surgery and the Division of General Surgery in the Department of Surgery at the University of Wisconsin School of Medicine and Public Health. She specializes in treating both benign and malignant disease of the thyroid, parathyroid and adrenal glands. She is an active member of several specialty societies, including the American College of Surgeons, the American Association of Endocrine Surgeons, and the Association for Academic Surgery. Dr. Long is particularly interested in the surgical treatment and management of thyroid carcinoma and hereditary endocrine disorders such as Multiple Endocrine Neoplasia syndromes. She is also interested in global surgery, particularly in developing countries, and improving access to specialized care for patients with unique endocrine disorders.

 
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