Taking Care of Doctors Helps Patients

Taking Care of Doctors Helps Patients​

By Carrie Barron, David Ring and Matt McGlone

An ER Doc attempted suicide after a young patient he cared for died. http://news.doximity.com/entries/6601735.   It seems that he followed protocol but the hospital relieved him of his duties. He was, as any feeling person would be, deeply tormented and saddened by her death.  But the thing that seems to have put him over the edge was being blamed and punished.

It is one thing if you’re reckless, careless, negligent, or feckless. It is quite another to be accused of such when you were not. Even the slightest insinuation can be hurtful. Supporting our colleagues when things go wrong creates a culture wherein mistakes can be openly discussed, morale is maintained and patient care is optimized.  Some adverse outcomes are due to human or system error and others to circumstances beyond our control. Many are a mix of the two.  It is helpful to understand the vicissitudes of inevitable errors.  After an adverse event, reach out, make sure the team is OK and help those involved elucidate the learning points and growth areas, both personal and professional.

One of us worked in quality and safety for 15 years.  Most problems arose from human error or from drift: inadvertently losing safe habits.  We can develop systems to catch human error before it causes harm.  We can build a culture of coaching one another to maintain safe habits (a culture of safety).  Punishment is rarely necessary or helpful.  Subpar situations are almost never due to recklessness, and when they are they often stem from profound personal problems such as substance misuse.  Even the punishable deserves the human touch.   

People who choose medicine are devoted to helping.  They volunteer for challenging training; they run towards danger, seeking out stressful situations from a desire to make a difference. They search for meaning in work is incomparably manifest among medical professionals.  An accusation of conscienceless or criminal behavior (e.g. in a bill of particulars malpractice document or indirectly via leadership interpreting an adverse outcome or an error as a personal indictment) runs so counter to the reasons people choose medicine that it feels like a crushing blow.

For people who have a robust propensity for shame, guilt, and integrity, such an accusation can be devastating. If taking care of people in the best way you can is not enough, what can you do? How can you forgive yourself and grow—which is hard enough on your own--when those who should have your back pile on the negativity?

In this ever increasing blame culture, it can feel like no one is safe. The fear of error creates anxiety about judgment and dismissal as well as harm.  Giving people voice and exploring grievances are essential. But things get complicated when dealing with an accuser who is not measured or who has a psychological need to malign. Leadership that honors the complainer at all costs, especially if the person is a donor, a public figure, a newspaper reporter, may damage the milieu.  

Who will support the doctors? A critique by any client, venerable or disadvantaged, is an opportunity to learn and grow. Honoring demands and complaints as inquiries, curiosities and concerns –with respect– is the right thing to do. However, when the accusations and punishments do not fit the crime, all are undermined, fearful and even confused. Excess anxiety can lead to poor concentration and more mistakes.   An opportunity for positive change is lost when the doctor is humiliated, let go, shamed, or blamed. We need to take care of our own.  Loyalty, when it is called for, protects all. http://www.nejm.org/doi/full/10.1056/NEJMp1615141

It's a Sunday: Creative Commons T H TanIt's a Sunday | Image Source: Flickr.com |Taken 4/8/2012