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.
Saturday, November 7, 2015
Sharing stories
I mentioned in my last post the notion of Second Victim for health care
providers who have experienced an adverse event. Every physician has been
there. Whether as a result of something we did, or as part of the disease course,
sometimes patients have bad outcomes. Those patients stick with us, their
memories intruding at inopportune times, making us wish for a do-over, making
us think maybe we don’t have what it takes.
There’s a certain pressure to be perfect, coupled with stakes of life and death, that make the Second Victim Syndrome almost ubiquitous among doctors. Yet we often hide our insecurities after such an event, not wanting to admit our human frailty, not wanting to be judged. Isolation can become the norm.
The training session that I went to this week for our new Peer to Peer Support Network aims to break through this isolation in the hopes of preventing some of the PTSD-like symptoms that doctors suffer after an adverse event. The program allows doctors the chance to emotionally debrief with a colleague who knows exactly how they are feeling. Sounds kind of touchy-feely, right? But it works.
As part of the training session, we each shared a story of an adverse event in a small group, and the other doctors just listened. It was incredibly therapeutic to open up and to have three faces of complete understanding looking back at me, nodding, knowing. They knew exactly what it felt like to get news of a poor outcome and have to wonder what you could have done differently, if you could have changed the course. They knew all too well that intrusive voice saying, “You’re not good enough. A better doctor would have done this right. You’re going to mess up again.” They know the panic of seeing that patient’s mom again, wondering how she remembers you. And they don’t even have to say anything, because I know they know.
As we shared our stories throughout the morning, you could see shoulders become less tense, faces become less masked, and affects become brighter. There is amazing potential for this program, and it’s exciting. It’s exciting because I think we’re accepted Second Victim Syndrome and burnout as inevitable for too long. We assume that doctors are capable of bearing these burdens silently and still being flawless. We expect the high rates of depression and suicide as a hazard of the job. But it doesn’t have to be that way.
This Peer to Peer Support Network, and others like it around the country, is changing the norms. Isolation and shame can give way to understanding and healing, just by talking about it. And that can make us better doctors, more able to learn from our mistakes, bounce back from setbacks, and not carry our work home with us.
There’s a certain pressure to be perfect, coupled with stakes of life and death, that make the Second Victim Syndrome almost ubiquitous among doctors. Yet we often hide our insecurities after such an event, not wanting to admit our human frailty, not wanting to be judged. Isolation can become the norm.
The training session that I went to this week for our new Peer to Peer Support Network aims to break through this isolation in the hopes of preventing some of the PTSD-like symptoms that doctors suffer after an adverse event. The program allows doctors the chance to emotionally debrief with a colleague who knows exactly how they are feeling. Sounds kind of touchy-feely, right? But it works.
As part of the training session, we each shared a story of an adverse event in a small group, and the other doctors just listened. It was incredibly therapeutic to open up and to have three faces of complete understanding looking back at me, nodding, knowing. They knew exactly what it felt like to get news of a poor outcome and have to wonder what you could have done differently, if you could have changed the course. They knew all too well that intrusive voice saying, “You’re not good enough. A better doctor would have done this right. You’re going to mess up again.” They know the panic of seeing that patient’s mom again, wondering how she remembers you. And they don’t even have to say anything, because I know they know.
As we shared our stories throughout the morning, you could see shoulders become less tense, faces become less masked, and affects become brighter. There is amazing potential for this program, and it’s exciting. It’s exciting because I think we’re accepted Second Victim Syndrome and burnout as inevitable for too long. We assume that doctors are capable of bearing these burdens silently and still being flawless. We expect the high rates of depression and suicide as a hazard of the job. But it doesn’t have to be that way.
This Peer to Peer Support Network, and others like it around the country, is changing the norms. Isolation and shame can give way to understanding and healing, just by talking about it. And that can make us better doctors, more able to learn from our mistakes, bounce back from setbacks, and not carry our work home with us.
Monday, October 19, 2015
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.
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.
Wednesday, October 7, 2015
Those who are healthy
Working in urgent care and emergency rooms, we see whatever walks through the door. That means whatever. It means the 64-year-old with appendicitis (yes, at the Children's ER), the 8-year-old who ran over his ankle with a motorized scooter and has severed nerves and blood vessels, and the toddler who had a black marker stain on his foot. At one in the morning. True story.
In the midst of all the real emergencies, it's so easy to become cynical towards the families bringing their kids in with marker stains (and trust me, it happens WAY more often than you would think!). It's so easy to judge parents, grandparents, foster parents who I think should know when to bring their kid in and when it's okay to watch at home. I get frustrated that after motrin, a popsicle, and a sticker, they look just peachy and ready to go home.
Then I read in the Gospel of Luke about the call of Levi, where Jesus tells the similarly judgmental Pharisees that "Those who are healthy do not need a physician, but the sick do." Can you see the 2x4 shaped mark on my head? Obviously no one wants to bring their kid to the Urgent Care at three in the morning. No one wants their kid to be crying and sick and miserable. They came because they need a physician. Even if all that physician needs to do is reassure them, give their kid a popsicle, and tell them what to expect for the next few days. Even if all that physician needs to do is check for an ear infection, eyeball a rash, or, yes, clean off the marker stain with an alcohol wipe.
And what a privilege it should be to treat those kids. What a privilege it should be to offer a little bit of hope, help, or healing. No matter what.
The last few days I've tried to remember that as I walk into my shift, to bring compassion to every patient, not just the ones who I think are sick enough to see me. After all, they wouldn't be there if they didn't need something.
In the midst of all the real emergencies, it's so easy to become cynical towards the families bringing their kids in with marker stains (and trust me, it happens WAY more often than you would think!). It's so easy to judge parents, grandparents, foster parents who I think should know when to bring their kid in and when it's okay to watch at home. I get frustrated that after motrin, a popsicle, and a sticker, they look just peachy and ready to go home.
Then I read in the Gospel of Luke about the call of Levi, where Jesus tells the similarly judgmental Pharisees that "Those who are healthy do not need a physician, but the sick do." Can you see the 2x4 shaped mark on my head? Obviously no one wants to bring their kid to the Urgent Care at three in the morning. No one wants their kid to be crying and sick and miserable. They came because they need a physician. Even if all that physician needs to do is reassure them, give their kid a popsicle, and tell them what to expect for the next few days. Even if all that physician needs to do is check for an ear infection, eyeball a rash, or, yes, clean off the marker stain with an alcohol wipe.
And what a privilege it should be to treat those kids. What a privilege it should be to offer a little bit of hope, help, or healing. No matter what.
The last few days I've tried to remember that as I walk into my shift, to bring compassion to every patient, not just the ones who I think are sick enough to see me. After all, they wouldn't be there if they didn't need something.
Wednesday, September 23, 2015
Into the desert
Today marks the beginning of 40 Days For Life, a world-wide initiative to fast and pray and peacefully demonstrate for the end of abortion. I'll be honest, I've been remiss in the past, largely ignoring these events and just shooting up a couple of private prayers every time it came up. However, thanks to the myParish app (weird, but true), I found out about the opening Mass across from Planned Parenthood, said by our own Fr. Greg, and lo and behold, had the day off with no excuse to miss.
One thing Fr. Greg said that struck me was regarding the Israelites in exile, and how exile was a "severe but merciful" response from God to wake them up to the fact that they had already turned away from Him in their hearts. The exile was merely an outward manifestation of the inner truth, but it ultimately led to repentance and redemption as the Israelites were shocked out of their complacency and sin by physical suffering.
As we are also celebrating the Pope's visit to America and the World Meeting of Families, and in the midst of some of the most despairing times in terms of religious freedom and anti-Christianity/Catholicism, it would not surprise me if these 40 days signify an exile for our country as well. It's obvious that we could use a wake up call. That the hearts of our citizens are turned far from God's plan for us. That we are in dire need of "severe but merciful" action by our Creator.
It may not be pleasant. In fact, it's almost certainly not going to be. But in the cross is victory. He has conquered the grave and won the battle. We have only to turn to Him, to not be ashamed to wave His banner, to fight under His protection and not fear death. So I pray for the unborn, and I pray for our country. That we will wake up and recognize our pride and selfishness and realize our need for God, our need to become who He created us to be.
One thing Fr. Greg said that struck me was regarding the Israelites in exile, and how exile was a "severe but merciful" response from God to wake them up to the fact that they had already turned away from Him in their hearts. The exile was merely an outward manifestation of the inner truth, but it ultimately led to repentance and redemption as the Israelites were shocked out of their complacency and sin by physical suffering.
As we are also celebrating the Pope's visit to America and the World Meeting of Families, and in the midst of some of the most despairing times in terms of religious freedom and anti-Christianity/Catholicism, it would not surprise me if these 40 days signify an exile for our country as well. It's obvious that we could use a wake up call. That the hearts of our citizens are turned far from God's plan for us. That we are in dire need of "severe but merciful" action by our Creator.
It may not be pleasant. In fact, it's almost certainly not going to be. But in the cross is victory. He has conquered the grave and won the battle. We have only to turn to Him, to not be ashamed to wave His banner, to fight under His protection and not fear death. So I pray for the unborn, and I pray for our country. That we will wake up and recognize our pride and selfishness and realize our need for God, our need to become who He created us to be.
Wednesday, September 9, 2015
Looking back
The other day I was grabbing a quick bite at Wahoo's when my attention was drawn to a large gathering of (pretty loud) young adults. Not unruly, just festive. In the midst of them was a grandfatherly man with a very recognizable white mustache. Dr. French was my medical school pharmacology professor and powderpuff referee. Apparently 8 years later, he's still going strong, celebrating the first exam of the Neurology block with the students and his co-block director and co-referee Dr. Ojemann.
In a fit of rare extroversion, I said hi to the students and my former professors. (Yes, the profs did remember the only first-year team to ever beat the second years!) The students were jubilant with the prospect of an evening without studying (hence the volume of their gathering), and excited to meet an alum who survived. It brought back lots of memories and nostalgia--those of powderpuff were infinitely more positive than those of memorizing The Oje's neural pathways.
The profs commented that it must be nice to be done with schooling and residency and into my real doctor life. And how! Although I would do it again if given the chance, I'm extremely grateful to be done with that part of my life.
It's a rite of passage for sure, but there is a light at the end of the tunnel.
Little lights of dinners out at the end of exams, sure, but also bigger lights of realizing why it is that you spent so long memorizing all of those details. The light when you use that knowledge to treat a patient, when you actually get to do what it is you trained so hard to be able to do.
And the light of still being able to play flag football. That, too.
In a fit of rare extroversion, I said hi to the students and my former professors. (Yes, the profs did remember the only first-year team to ever beat the second years!) The students were jubilant with the prospect of an evening without studying (hence the volume of their gathering), and excited to meet an alum who survived. It brought back lots of memories and nostalgia--those of powderpuff were infinitely more positive than those of memorizing The Oje's neural pathways.
The profs commented that it must be nice to be done with schooling and residency and into my real doctor life. And how! Although I would do it again if given the chance, I'm extremely grateful to be done with that part of my life.
It's a rite of passage for sure, but there is a light at the end of the tunnel.
Little lights of dinners out at the end of exams, sure, but also bigger lights of realizing why it is that you spent so long memorizing all of those details. The light when you use that knowledge to treat a patient, when you actually get to do what it is you trained so hard to be able to do.
And the light of still being able to play flag football. That, too.
Saturday, August 22, 2015
True love (but for real)
I don't have anything brilliant to add to this saintly wisdom. Even if I did, I wouldn't say it as well. This is from Karol Wojtyla's "Love and Responsibility" (written before he became pope, and a solid foundation upon which was built his "Theology of the Body"). Much of the first part of the book talks about different types of love, and asserts that attraction and affection are not sinful, or even inferior types of love, just incomplete, as they are meant to lead us to a more complete love.
In this part, he speaks especially towards sexual attraction as a key component for betrothed love (he even goes so far as to say betrothed love is not possible without it), but that it grows into a more authentic love as it points towards the value of the person as a whole. Read carefully. And then read it again.
"True love, a love that is internally complete, is one in which we choose the person for the sake of the person, -that in which a man chooses a woman or a woman chooses a man not just as a sexual 'partner' but as the person on whom to bestow the gift of his or her own life. 'Sexual' values, vibrantly present in their sensual and emotional reactions, contribute to the decision and make it a more intense psychological experience, but it is not they which determine its authenticity."
"We are bound to recognize that the choice of a person of the other sex as the object of betrothed love, and a the co-creator of that love by way of reciprocity, must depend to a certain extent on sexual values...[but] the choice of a person is a process in which sexual values cannot function as the sole motive, or even - if we analyze this act of will thoroughly - as the primary motive."
"So that if we consider the whole process by which a man chooses a woman or a woman a man, we can say that it is set in motion by recognition of and reaction to sexual values but that in the last analysis, each chooses the sexual values because they belong to a person, and not the person because of his or her sexual values."
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| This guy knows what he's talking about |
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