Surgeon Wellness & Medical Errors: Practice Gap discussion at Update Course 2018

All right, next one. A well respected surgeon has increased his call schedule and patient load after some members of his practice have retired. This never happens. They have been unable to hire replacements. Also never happens. He admits to being emotionally worn out and fatigued. One of his patients has a surgical complication, and the adverse event results in patient harm, and the patient dies a week later from the operative mishap. Which of the following is true about surgical stress, burnout, and medical errors? The surgeon is unlikely to have problems. The event will have little long-term influence on performance. The surgeon will likely experience a physiologic response. 1% of fatigued surgeons report having, having had a medical error in the last 3 months, and most hospitals have well organized support structures for recovering surgeons. I know that I have a physiologic response. I have a physiological response to that, to this question. Yeah, yeah. Does now, does your, does Buffalo Children's Hospital have a support system for hypothetically you having a physiologic response? Uh, well organized, highly structured support system, probably not. I think there's a difference between having A support system or even having a well organized support system and having an effective support system and. You know, I, I, I think that, you know, Kurt Heist talks about the second victim syndrome, and I think it's, it's real, and, um, and what we do is we have all kinds of M&Ms and we have all kinds of safety reports and, you know, we, we have these, these evaluations and so on and so forth, but what we don't do is we don't. Um, take care of the, it's not just a surgeon, it's any practitioner. We don't take care of them. We don't understand or recognize or acknowledge the effect that it has on them, um. Mark Rowe was just talking to me about his career and he was talking about complications, and he said, he said, all of us have in our brains this, this place, this, this cemetery of our mistakes that we go to every so often, and, um, and, you know, Mark's 80 something and, and he still remembers those really bad complications. They have great effects and I think in our Society in our, in our medical field that we really have not um uh acknowledged that and done. Be effective about doing something about it. So I'm, I'm, see is it, there's no doubt about it, you know, it's not just physiologic, it's, it's, it's mental. It's, and, and our surgeons are such huge, we've done so, um, invested so much into them. And um and they're, they're highly valuable and so we have to keep them safe and keep them effective. Well, and there's tremendous pressure for them to ignore it. Go on. There are some really, for those of you into data, there is just for me at least some really telling numbers about this. Obviously surgeon wellness has an effect on patient safety and care. Uh, in my case, I admit it, many surgeons are unprepared for the emotional response to a medical error. We don't cover this at all in training, right? There's a 40% burnout rate among American surgeons and 25% of American surgeons have clinical signs of depression. Suicidal ideation was experienced in 6% of general surgeons in an ACS survey, twice the level of the American population in general. 9% of surgeons have experienced a medical error in the last 3 months, and the chances that they'll have symptoms of burnout is twice as high. There are 4 phases of response to a medical error. First is the physical and physiologic, the emotional response, then recovery and long-term adjustment, and I'm still in the long-term adjustment phase. Most healthcare systems do not have systems set up to support care providers when an adverse event occurs as a as a. I don't know if I should call you an administrator, but as somebody in charge of a lot of surgeons, does Children's Mercy have a policy about what happens to somebody after they've had a bad event like this? Uh, there's no policy. However, we actually have a reasonably structured wellness. Center wellness approach for those physicians doesn't have to be surgeons, but those physicians who seek, uh, seek this, this type of help, it's, it's better, it's more robust than than I thought it was. Do you think it's often dependent on the surgeon recognizing it themselves, right? So the surgeon itself, it's self referral, right? Yeah. And the other common thing I think surgeons do under emotional response. Is if you do something a certain way and you have a complication they go I'm not doing that again and so and they changed their approach to care because of that and they're jumping around with every complication trying to land in the right spot. Well, I would have experienced pretty extreme burnout, which Craig Lihi will attest to, um. There's a robust support system in Children's Hospital that is absolutely of no good. And the reason is because first you have to confess publicly. It's like being an alcoholic. If you don't confess publicly, That you want to keep your job, you better keep quiet. And then what comes out in is behavior which is noticed by everybody. I'm, I'm disruptive as a baseline and it just accelerated. And so I don't think it does a lot of good to sit around and talk about policies and support if the surgeon who's going through this. Can't access it in a, in a fashion which is supportive. In fact, exactly the opposite, but I got more and more punished and more and more shit thrown at me and more and more time spent. We have a sensor on the on the podcast. So what would you, so we've talked, there's a problem, we reck we all, if you're in this business long enough, you recognize the changes. What do we do to Get over it or to, or to, more importantly, so that that surgeon can go on and deliver eventually quality care rather than being in a, so if we address ourselves as resources, then how can we optimize our care delivery. But right now at this table 2 or 3 of us are experiencing burnout, right? So and none of us will admit to it. So that's the first thing and and it's got to lose its taint. It's got to stop being a bad thing. It's got to be, you're going through a bad time. I mean, the other thing I just, I don't know if he's mentioned yet, and I don't know if it was on this, yeah, suicide, so. There were two annals of Surgery articles, both with the same survey population of 8000 surgeons, a 30% response rate to a survey back in 2008, and the suicidal ideation was significant, and there's been non-zero number of pediatric surgeons who have committed suicide. So and When you talk to people who see this, the suicide rate among physicians in general is significantly higher than the general population. It's it's a major issue. The other point I want to make for all the hospital CEOs that are listening in on this podcast is that this is we are a resource and to have us go down because of a wellness issue is a Much bigger cost to your hospital trying to recruit another surgeon. This scenario is not unrealistic that someone's burned out because they can't find another surgeon and it makes the problem worse. But the administrative response is always more every year we have more and more administrative overlays, which takes away our time, which is the one resource we have to recover. A couple of comments on the channel. One of my partners and I, I, I knew that that was, that's his question, uh, that he must have, uh, contributed to the committee. Uh, I'm sure he contributed a lot more than that. But, you know, Kurt was very passionate and is very passionate about this, and we've set up a robust system that I think, I think, I don't know, Rusty, did you say something or maybe what you said that you had, somebody had to go to the program. What we've done is, so whenever there is an error or something happens and you know when the patient safety team gets called and we have our daily safety calls, when things come up on that, there's multiple channels to that. If there is somebody that had a bad complication, resources get mobilized so that one of the leaders goes to that person, not to say, you know, hey, what the heck did you do here, but to say, how are you? And we proactively go to them and it needs to be a proactive system because people, there's a lot of stigma around this. And people, they feel terrible. It's like, I mean, I, you know, I, we all know how it feels when you have something bad happen. It's like you, the last thing you want to go out there and just tell everybody about, but to have somebody come to you and just say, how are you? Some people say, you know, I'm fine. I'm doing OK, and that's OK because different people handle this differently. But other people you need resources and then if they say no, I'm not OK, you need to have something to say, OK, an employee assistance program or something. We all have those, but somebody you can refer them to. But it is a real problem. And you know, Dave, you mentioned the suicide rate. The other piece of that is, well, I think for male physicians it's about with burnout, it's about twice as high for female physicians, for our, for our women colleagues, their suicide rate is like. 20 times. I don't remember the number. I've got a slide on it on my dock, but it's, you know, it's, it's really remarkable how this is a real problem that's been unrecognized and unaddressed for so long. So this is, we have to move on and I think we saw there, Dave, that this is, you, you hit on a nerve here, obviously, and something. Very real to all of us. So probably have to do something about this more in the future, maybe a podcast because I think this is very, very big problem, and I think this is a good example of the PDC kind of getting a little out of the box. I mean, this isn't pancreatitis, this isn't TEFs, but by God, this is a real gap and this is a real problem. It's good you're doing it. Yeah, fantastic.