How to deal with the doctor in your life

Everybody has bad days at work, I won't argue with that. But in medicine, it's a little bit different. We can’t come home and vent our frustrations with just anybody. As part of the training I did this week as a peer supporter, we were discussing coping mechanisms, like talking things over with friends and family. Specifically non-doctor friends and family. The facilitator asked, "What does it look like when you go to a family member, or a friend, someone outside medicine, and they are able to help you cope?"

We all looked down at our papers, back up at her, thought about it. Finally, one of the anesthesiologists spoke up. "It's never happened. I always get blank stares, or horrified looks at what we deal with every day."

We all nodded. No one disagreed.

I’m sure it’s similar with fields like the military, first responders, law enforcement—where they see things the rest of us can only imagine. While any non-medical person could sympathize with a parent or patient yelling at me, an incompetent co-worker, too many demands on my time, or any number of other hassles of the day to day, they can’t understand what it’s like when a kid you sent home to get better comes back horrifically sick and has permanent damage. They can’t understand what it’s like when you have to tell a parent their child has cancer. They can’t understand when making a mistake really is life or death.

I’m fortunate to have two sisters in medicine and a host of friends from residency, as well as supportive co-workers that I can go to when I have a rough day. But the truth is that most of my family and friends aren’t that helpful in getting past those adverse events. It sounds harsh, I know, but it’s true. It’s not their fault, and I know they love us and want to support us.

With that in mind I’d like to offer a few tips for you non-medical people who know and love us doctors (God bless you).

Please don’t be offended. We still love you, and we appreciate that you’re not in medicine because that can often be a much needed distraction (when we want that, you’re the perfect person!). Just because we don’t come to you first about work stuff doesn’t mean we don’t value your support.

Don’t try to understand the medicine. It can be even more stressful to have to explain the jargon and physiology when we’ve had a bad event. The details of it are not as important as the fact that it makes us feel awful, so if we do talk about it (and we may not), don’t interrupt when you don’t know what a word means, or miss a piece of the story. Don’t try to figure out what it was that went wrong and offer suggestions. Just listen and offer a simple, “That sucks, I’m sorry.”

Don’t compare. This one seems unfair, I know, like my problems are bigger than yours. In general, I want to hear about your good days and your bad days. And when I have a story about a crazy parent, go ahead and one-up me with your crazy client story. When I have a co-worker driving me crazy, please tell me you do too, so it doesn’t seem like the worst thing in the world. But when I have a truly bad outcome, it’s just not helpful to hear about how much grading you have to do, or how you had to work through lunch. I still want to be supportive of you, but it’s not the same, and I need you to understand that.

Pray for us. We’re not perfect. We don’t handle stress perfectly. God’s grace is always appreciated.

The Second Victim

I recently had at work what we call an "adverse event". These are cases where something goes poorly, either because of an error, or just the natural progression of disease, but everyone feels it. A kid is very sick, or passes away, or is harmed in some way, and it shakes all of us out of our happy pediatric comfort zone. I obviously can't go into details, because HIPAA, but it hit home for me a concept that I wanted to share.

In 1999, when the Institute of Medicine published their famous (infamous?) "To Err is Human", detailing the widespread prevalence and effects of medical errors, a brave physician from Johns Hopkins thought to go one step further. In his sentinel paper, "Medical Error: The Second Victim", Albert Wu outlined the idea that medical errors, and all adverse patient events, harm more than just the patient and their families. He observed that "although patients are the first and obvious victims of medical mistakes, doctors are wounded by the same errors: they are the second victim".

I can feel the cynicism rising up right now: How can doctors even compare their "suffering" to a patient death? Shouldn't they feel bad if they've done something wrong? Shouldn't we focus on the medical errors and stopping them instead of telling doctors "it's okay" after they mess up?

Those are all valid questions, and the answers to the last two are surely "yes", but that's not the whole story. Second victims have symptoms very similar to PTSD, experience higher rates of depression and burnout, and can have impaired performance due to maladaptive coping behaviors, decreased confidence, or fear of making a further mistake. I will attest that these are not theoretical; they are very real. And I think we can all agree that if we can avoid these effects, that's a win.

We are about to launch our own Peer to Peer Support Network at work to help second victims, and this experience has taught me a lot of things that I hope to carry forward..

I've learned that adverse events are going to happen, and that we all make mistakes. Let me repeat that: We all make mistakes. It just so happens that in our job, mistakes can range from forgetting to bring someone a blanket to causing a death, and that's terrifying. We make hundreds of decisions every day in a very stressful environment. We set up our systems to try to prevent as many errors as possible, but you can't remove the human element. We have to learn from our mistakes instead of letting them cripple us.

I've learned that I work with amazing people. One of the nurses I work with found out I was upset about the patient and said, without hesitation, "You know we all stand behind you because we know the kind of doctor you are." The other doctors, who had every right to critique the situation, instead offered their support and acknowledgement that our jobs are very difficult and we all have these days. It makes all the difference in the world to be able to have that support at work, which makes me excited to train as a peer supporter.

I've learned it's important to take a deep breath and remember why we do this. It can be so easy to get caught up in a busy day and miss the small details, miss the opportunities to really meet our patients where they are and be part of that encounter. Yesterday, with this fresh on my mind, I spend a few extra minutes in each room, talking to families, being thorough, not letting the 18 patients in the waiting room get to me. And I could feel it make a difference. I was a better doctor because of it. Hitting that reset button every now and then, without waiting for an adverse event, is crucial.


Finally, I've been reminded that I'm not doing this of my own accord. God called me to this profession, has given me the things I need to succeed, and can decide what to do with me from here on out. And that's okay. I don't have to be perfect, because He is. He is bigger than the adverse events, than the mistakes, than the bad outcomes. He also cares for His children and gives us the tools we need to move forward if we let Him.