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.


Reflecting on the Power of Coaching

This past weekend SurgeonMasters hosted its inaugural coaching conference, Harnessing the Power of Surgeon Coaching. It was a great opportunity to further explore the untapped power of coaching in medicine. There are many reasons to engage in coaching. Maybe you want to improve your communication skills with patients. Perhaps you’re trying to advance your leadership abilities to exert greater influence in your hospital. No matter what your goals are, coaching can help. In this article, I will outline what coaching is, how it works, and where I see it going.

What Is Coaching

There are many models and styles of coaching - and they’re not all the same. However, in essence, coaching is a process that helps bring out the best in you. When defining something it’s often good to start by talking about what it is NOT.  Regardless of the challenges coaches work with, the same is true across the board - coaching is often misconstrued for something it is not, including:

  • Sports Coaching - Often this is where our mind goes first - the image of the sports coach on the sideline barking orders. Sports coaching is focused on win-lose scenarios, and less on individual progress toward self-define goals. When coaching is combined with many other skills, such as teaching, managing, and more, you can create a very successful leader. When you look at the portion of their leadership that helps athletes reach their maximum potential in competition and in life - that’s coaching.

  • Consulting - Consultants have an agenda and provide answers. They are experts in their field, just like many coaches. Consulting relationships usually end before implementing action plans, and rarely is there an ongoing relationship that allows for further adjustments to the plan. Coaching understands that the answers lie within the coachee and the longer relationship allows the process to be conveyed and practiced.

  • Mentoring - Having someone to lean on that has done it before and to model your behavior after is beneficial to your career. There is typically a hierarchy in this relationship skewed toward the mentor over the mentee. In coaching, there is more objectivity and detached involvement from the coach, and the understanding that the coachee will not necessarily do what you would have done in the same situation.

  • Therapy - A therapist functions to help clients fix problems and overcome issues. Coaches try to refocus “problems” as opportunities and don’t practice mental health without the proper training, credentials, and licensing. Therapy is often rooted in the past, whereas coaching focuses on the present and future.

It’s important to frame surgeon and physician coaching properly. Physician and surgeon coaching is more akin to executive coaching, and involves a process of reflection, goal setting, and incremental adjustments in behavior to accomplish self-defined goals.

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How It Works

Coaching moves ideas, plans, and steps forward. Atul Gawande has been advocating and observing this concept in action for several years. In describing the most effective coaches, he states "mainly, they observe, they judge, and they guide." "Good coaches speak with credibility, make a personal connection, and focus little on themselves... listen more than they talk...They are 100% present in the conversation....They parcel out their observations carefully." Coaching can help you reach your maximum potential in your career. Alternatively, you might want to learn coaching skills to apply in various aspects of your surgical practice or leadership position.

Where I see it Going

There are endless applications of coaching and coaching skills. In the future, I envision coaching skills being taught in medical school and training. Future leaders will rely on coaching skills to bring the best out of each member of their surgical team. Doctors will utilize coaching skills to instill a sense of resilience in their patients on the road to recovery. And surgeons will have an empathic peer listener to whom they can go for help processing a difficult outcome.

SurgeonMasters is building a community of surgeons and physicians interested in learning and applying coaching techniques to help surgeons and physicians manage the ups and downs of a successful career in medicine. A coaching mindset and skills are powerful tools. They enhance our ability for to help ourselves and others. If you would like to learn more about coaching and joining a peer support community of like-minded surgeons and physicians email Team@SurgeonMasters.com.

The Hook Model and the Power of Coaching

Note: this is part 4 of our ongoing series on Habits & the Power of Coaching. Read part 1 here, part 2 here, and part 3 is here.

In the fourth and final installment of this series, we examine the Hook Model, created by Nir Eyal.

The Hook Model

In his book, Hooked: How to Build Habit-Forming Products, Eyal outlines the Hook Model, in which he explains why we habitually use certain products over others. There are four steps to the Hook Model:

  1. Trigger. An internal or external prompt to perform a certain behavior. Facebook initially triggers you with notifications to open the app, but eventually, you begin to associate using it with internal triggers, like boredom or anxiety.

  2. Action. A simple click, a tap, some scrolling, or whatever gets the user to interact with the product.

  3. Reward. Finding a funny video in an otherwise boring feed gives you a little dopamine hit. Varying rewards at different times make us curious and spark a desire to come back — over and over again.

  4. Investment. Now that you’re happy, companies ask you for something in return: time, data, and money are some examples. Ideally, you’ll even load the next trigger yourself, for example by commenting on a friend’s photo, to which they’ll surely reply and get you to come back.

Applying this framework to our own lives, we can get a better understanding of the products and services we’re addicted to (even though we may not even realize it).

  • If you find yourself mindlessly scrolling through Facebook several times a day but you’re not sure what brought you there… You may be hooked.

  • If you find yourself scrolling through your preferred BREAKING NEWS website 30 minutes after the last time you checked in on the world… you may be hooked.

  • If you find yourself curating your Instagram feed instead of preparing for your next important case… you may be hooked.  

Staying connected with friends and family. Being informed about our world. Partnering with influencers to share a message. We can find positives in most of the things we do. However, if the activity is distracting you from being productive in other areas, then there might be an opportunity for improvement. The trick is to identify and eliminate the trigger for this addiction. In an April 2018 blog SurgeonMasters contributor Jonathan Cabin detailed several strategies that can help us eliminate the action once we have identified our trigger.

How Coaching Supports the Hook Model

Bad habits are easy to come by, and difficult to break. Coaching can support, or more appropriately break, the Hook model in two important ways. One way coaching breaks the Hook model is by raising awareness around our triggers, actions, and rewards. It can be difficult to identify why we engage in a certain behavior, but this is an important first step in eliminating any habit. Coaching supports the process of guided inquiry and goal setting.

Why are we engaging in this behavior? What “need” is it fulfilling? If we can identify our internal triggers then we can take the next step.

Our next step is to terminate the action. Coaching supports this process of action planning and even constructive feedback on our actions. Is there another action we can take when we feel compelled from boredom to check out our timeline? Can we structure the action to create a similar reward or a proactively determined alternative reward? If we are able to identify our trigger and adjust the action, we are on our way to breaking the model and eliminating the habit. Of course, this is much more difficult than it sounds. With the assistance of a coach we flatten the learning curve.

You can learn more from Nir Eyal online, Resources for Hooked: How to Build Habit-Forming Products.


Harnessing the Power of Surgeon Coaching

Not everyone is ready or wants to work with a coach as there are very few examples of this in medicine. Most professional talents work with a coach (or coaches) on a regular basis to get to and stay on top. Surgeons can work with a coach (or coaches) to maximize their physical, mental, and even emotional skills. Working hand-in-hand with a coach can significantly increase your ability to create and maintain healthy habits. At SurgeonMasters, we offer coaching services to surgeons in all specialties. Let us help you create healthier habits and a more lifestyle-friendly surgical practice.

Want to learn more about surgeon coaching, perhaps to do a little of this rewarding activity on the side? Sign up for our inaugural training program on January 20, 2019 at the Kona Kai Resort & Spa in San Diego.


The Four Tendencies and the Power of Coaching

Note: this is part 3 of our ongoing series on Habits & the Power of Coaching. Read part 1 here and part 2 here.


In the third installment of this series, we examine The Four Tendencies, created by Gretchen Rubin, for creating habits. Gretchen is a four-time New York Times best selling author of The Happiness Project where she spent a year thinking about happiness and setting up networks of like-minded people pursuing happiness. Her work focuses on habits and what makes people happy.

The Four Tendencies

Before we get any further, let’s briefly outline The Four Tendencies framework. In this framework, Gretchen describes four types of people, broken down by how they respond to expectations (both inner and outer):

  1. Upholders. Upholders meet inner and outer expectations readily. They love rules, always have a clear plan, and are self-motivated and disciplined. They struggle in an environment that lacks structure.

  2. Questioners. As skeptics, questioners meet their own expectations, but resist outer ones. Questioners need to see purpose and reason in anything they do. Clarity as to why they should do something is all-important.

  3. Obligers. This is the most common type. Obligers love satisfying other people’s expectations, but struggle in prioritizing their own. Being held accountable by a friend, coach, or boss helps them a lot.

  4. Rebels. This category defies both inner and outer expectations. Freedom to choose feels most compelling to rebels. They want to be challenged, but not pressured into doing things.

If you’re interested in seeing which category you fall into, take this short quiz.

When it comes to creating new habits or changes in old habits, it is helpful to know how we respond to inner and outer expectations. When you understand which category you fall into, you can adjust your environment to better suit your tendencies. This process of reflection bearing out awareness is the first step in creating any habit.

How Coaching Supports the Four Tendencies

Personality tests are often scrutinized because our personalities can change over time. I also believe our personalities might change depending upon the situation. Therefore, the reproducibility of the test can vary depending on the surrounding circumstances. Ultimately, the purpose of using a personality test for habit change is not to give someone a label. It is to create an opportunity to explore whether incorporating the strategy increases your likelihood of success. If it works for you, this is a powerful tool! If it doesn’t, we cross this off the list and try another resource.  

Let’s look at physicians as an example. Most physicians fit the tendency of Obligers. As an Obliger, habits that relate to better service to others tend to be much easier to implement. If it creates efficiency and better patient care, the rewards are fantastic. However, the Obliger struggles to meet internal expectations. Being held accountable from a close colleague or coach can increase the odds of success for creating those healthy habits that seem to impact the Obliger most. It can also be very helpful to show the Obliger why the seemingly selfish habits are in fact unselfish because they meet the outer expectations of their friends, family, and patients indirectly (especially over time).


Take this The Four Tendencies Quiz and then consider how this might impact the most effective way to end old habits and begin new habits that are positive and create sustainability. We invite you to mail us what you found out! What is YOUR tendency? Did you reinforce what you already thought? Or was it different than you expected? Let us know your habit change, motivations, situational factors, and how it is going for you. Our team will follow-up with coaching questions to aid your self-inquiry. Your comments in private or on social media will also add to the conversations that we all need to be having.


Harnessing the Power of Surgeon Coaching

Working hand-in-hand with a coach can significantly increase your ability to create and maintain healthy habits. At SurgeonMasters, we offer coaching services to surgeons in all specialties. Let us help you create healthier habits and a more lifestyle-friendly surgical practice.

Want to learn more about surgeon coaching, perhaps to do a little of this on the side? Sign up for our inaugural training program on January 20, 2019 at the Kona Kai Resort & Spa in San Diego.