EP 6: To Err is…

Episode Description:

In this episode, listen as Dr. JB explores the occupational hazards and stress in healthcare and its potential consequences.

Transcript:

Dr. JB: Ever wish for a safe place to have conversations that need to be had? A place where you could say the things that need to be said? Well, welcome to Hope 4 Med. This is Hope 4 Med, med. New day for med, med. For us, by us, and just for us. This is Hope 4 Med, med. This is Hope 4 Med, med. New day for med, med. For us, by us, and just for us. This is Hope 4 Med, med.

[00:00:38] Hi everyone. Welcome back to the Hope4Med podcast with me, Dr. JB. This month is National Post-Traumatic Stress Awareness month and what better way to start off the month than to have a podcast focused on PTSD? As you are all aware, PTSD is a delayed or protracted response to a stressful event or situation of an exceptionally threatening or catastrophic nature which causes pervasive distress.

[00:01:14] Whenever we mention PTSD, what’s the first thought that comes to your mind? It’s military personnel, right? Returning home after combat? It’s true. The rates of PTSD in military personnel is high. Research has shown that the rate of PTSD in those who have been traumatized by war or torture is 20 to 45%. But, did you know that the rate of PTSD in healthcare professionals isn’t too far behind those numbers? Research has shown that the prevalence of PTSD in physicians, for example, is 14.8% higher than in the general population where the rate is 3 to 4%. A main factor in developing PTSD is the daily occupational hazards we experience as healthcare professionals, which leads to occupational stress.

[00:02:15] According to the National Institute of Occupational Safety and Health, occupational stress is defined as the harmful physical and emotional responses that occur when the requirements of the job do not match the capabilities, resources, or needs of the worker. Do any of these things sound familiar? Inadequate staffing levels, long working hours, time pressure, exposure to infectious diseases and/or hazardous substances, needle stick injuries, sleep deprivation, and the threat of malpractice litigation, to name a few. Experiencing one or more of these can result in psychological, behavioral, and even physical reactions.

[00:03:12] By psychological, what I’m talking about is irritability, job dissatisfaction, depression, or even anxiety. Behavioral reactions could include things like insomnia or absenteeism and physical reactions can manifest as chronic headaches, nausea, um, hypertension, and other physical ailments. If the underlying cause of the occupational stress is not addressed, then healthcare professionals can develop work related post-traumatic stress disorder. Truthfully, traumatic stress can be a normal reaction to an abnormal event. Usually these feelings are transient, right? They diminish over days, weeks, or even a few months without any interventions. However, when that transient timeline has come and gone and you continue to experience intrusive or negative thoughts, or you steer clear of activities or situations that trigger distressing memories, you may be experiencing symptoms of PTSD.

[00:04:32] However, occupational hazards are not the only factors contributing to work-related PTSD. What about medical errors? We’re all familiar with the book “To Err is Human.” In that book, the main assertion was that the problem of medical errors in medicine is not bad people in healthcare, but good people working in bad systems that need to be made safer. Yes, the occupational stressors are part of that bad system that contribute to good people making medical errors, but medical errors can have consequences. When the holes of that Swiss cheese model all line up and the error actually reaches the patient, the outcome can be tragic, even deadly. So in situations like that, what happens to the healthcare professionals who were engaged in or were witness to the tragic events?

[00:05:42] Not only can these healthcare professionals develop PTSD, but they may become second victims. The second victim phenomenon or syndrome is a term used to describe the suffering and stress healthcare professionals usually experience after a traumatic event, such as a medical error, adverse patient event, or patient related injury. However, the event or medical error does not have to kill or injure someone for the healthcare professional to experience the second victim syndrome.

[00:06:24] This concept was first introduced in 1954 when two surgeons shared their bad emotional experience after an unfortunate adverse event, but it wasn’t until the year 2000 that Dr. Wu coined the term “the second victim phenomenon.” This is truly an emotional storm that healthcare professionals experience with feelings of guilt, anxiety, depression that can both plant and/or water seeds of self doubt, incompetence that can ultimately negatively affect one’s self-esteem and self-confidence. Sadly, the second victim has often been treated as someone who deserved punishments and abandonment rather than compassion and psychological help.

[00:07:31] It’s an interesting paradox where the standard of healthcare is perfection with error-free facilities, but to err is human. Humans trying to morph into a culture of time-efficient “can’t forget those metrics” perfectionism is so distressing and can lead to burnout, but let’s not go on a tangent. Going back to the second victim phenomenon, it is composed of six unique stages that each have their own timeline and psychological effects until the second victim feels recovered, similar to the stages of grief. So let’s go through them briefly.

[00:08:23] Stage one: chaos and accident response stage. This occurs directly after the mistake occurs, the healthcare professional experiences a flood of both internal and external emotions. Internally they’re fighting feelings of guilt, self doubt, and confusion while simultaneously providing the patient with the required resuscitation and calling out for help from both colleagues and our consultants.

[00:08:52] Stage two: intrusive reflection stage. This is the stage when the healthcare professional realizes how challenging his or her daily work is. The stage is filled with periods of isolation and internal questions, especially of one’s competence to do his or her job.

[00:09:16] Third stage: restoring personal integrity. At this stage, usually the healthcare professional is feeling helpless and drained due to his or her consuming doubt regarding their future and career in healthcare, and may seek help from a trusted friend or colleague.

[00:09:37] Fourth stage: enduring the inquisition stage. During this stage, the healthcare professional begins to wonder about the consequences, job security, and future litigations.

[00:09:54] Fifth stage: obtaining emotional first aid. This stage is really challenging. The healthcare professional is trying to find help but at the same time is unsure who they can and cannot confide in, and sometimes attempts at even seeking professional help can fall short.

[00:10:19] The sixth and final stage: moving on, surviving, or thriving stage. In this stage, the healthcare professional makes a resolution in one of three paths. One: they leave their current work environment or the healthcare profession altogether. Two: the healthcare professional continues to work in their current environment, providing the appropriate care while trying to meet the expected quality performances, but all the while remaining preoccupied with the traumatizing event. Or three: they grow and learn from their mistake, even take the traumatizing event and turn it into a long-term sustainable change in their performance patterns. Neither path is wrong, it’s all a matter of personal choices. Sometimes the consequences of making a mistake could be even more tragic.

[00:11:21] Allow me to highlight a story some of you may be familiar with, the story of a nurse called Kimberly Hiatt. Kimberly was a critical care nurse at Seattle Children’s Hospital. One day, she was the nurse in charge of a critically ill eight month old infant. She gave the infant the wrong dose of calcium chloride. Instead of 140 milligrams, she gave the infant 1.4 grams. Five days later, unfortunately, the infant passed away due to complications of the overdose of calcium chloride. According to the investigation record, that was Kimberly’s first medication error. Kimberly was known to be a veteran nurse with an excellent reputation for 25 years. She wasn’t secretive about her error either, but on the contrary, she logged it in the hospital’s electronic reporting system. She said, “I messed up. I’ve been giving calcium chloride for years. I was talking to someone while drawing it up. I miscalculated in my head the correct milliliters, according to the milligram per milliliter. First med error in 25 years of working here, I am simply sick about it. Will be more careful in the future.”

[00:12:55] After the incident, Kimberly was placed on administrative leave and was eventually dismissed by the hospital. In the following months, Kimberly battled to keep her nursing license valid, hoping she could continue working. And to satisfy the state nursing disciplinary board, she had to pay a fine and abide by other conditions. One of them was submitting to a four-year probationary period, and during those four years, she would be supervised whenever she was giving medications to patients in any nursing job she held. However, no job offers were forthcoming. In April 2011, about seven months after Kimberly’s unfortunate medical error, Kimberly Hiatt died by suicide.

[00:13:45] Kimberly’s story is just an example of the second victim phenomenon and its potential consequences. The infant as well as her nurse died in a tragic series of events. This story highlights that healthcare professionals are greatly affected too when these types of unfortunate incidents take place such errors often result in an intense period of professional and personal anguish. In coming across Kimberly’s story, I tried to find other stories of her that weren’t about this unintentional error, but I couldn’t find any. I couldn’t find the stories about the hours she dedicated to being a nurse or the lives she saved during her 25-year career or the family she bonded with, the ones she sat with, cried with, consoled. The families who looked forward to seeing her and wishing she was working when they had to bring their loved one to the hospital. Where are those stories? This was a tragic story on so many levels and it brings up many questions. Is to err truly human? Did Kimberly deserve a second chance? If Kimberly were alive today, where would she be? Would she ever have a job? Would you hire her? Would she give Ted talks about how the mistake affected her life, how it felt to accidentally contribute to the death of another person, the death of a child? Was suicide her only option

[00:15:58] Today, we continue to experience healthcare professionals leaving the medical field, some are searching for a sense of relief from the occupational stress, trauma, and ever-present risk of becoming a second victim existent in the field of medicine. Do you think the culture of medicine is punitive? Does it encourage perfectionism? Why do some of us order labs and imaging that are not necessary? Are we concerned about getting sued or even worse, losing our licenses?

[00:16:34] Hope4Med aims to be a place where healthcare professionals who make errors are not ostracized and left to suffer in silence. Instead, it’s a supportive and understanding community of your peers. One that if an unintentional error is made, the healthcare professionals are engulfed in an environment of support. An environment that allows for a safe place of reflection and growth. One day, the culture of medicine will follow suit, but for now, let it start here. Let it start with Hope4Med.

[00:17:16] Yeah. Who says a doc can’t rap? D O C T O R J B. The greatest doctor to ever touch the mic, the greatest podcast ever broadcasted or prerecorded. Come learn some, each one, teach one. I’m done.

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