Forgiving ourselves for being human: Normalizing the isolating experience of adverse events

by Jo Shapiro, MDHikers climbing on rock, mountain at sunset, one of them giving hand and helping to climb. Help, support, assistance in a dangerous situation

Practicing medicine can be both deeply satisfying and, at times, extraordinarily challenging. As physicians we tend to be perfectionists, holding expectations for ourselves that seem entirely appropriate given the often very high stakes for a flawless outcome. Yet physicians are human. We are prone to human error and we work within complicated systems that are also prone to error. The bottom line is that mistakes will happen. And while we do and must work toward minimizing both system and human error, it is critically important that we also attend to the emotional and psychological needs of physicians involved in adverse events. The challenge is, of course, how best to do this.

What I have helped to build at my institution, Brigham and Women’s Hospital, and what I advocate for at other institutions, is a peer-to-peer support program. Almost 10 years ago, several colleagues at our institution recognized that we needed to support clinicians involved in medical errors. We had outside training for a multidisciplinary group of us, and we began to develop a group peer support program. After about one year, we recognized that the program was working well for most of the members of teams impacted by adverse events, but that physician team members were not as well served by this program as the other professionals.

Being involved in an event that has caused patient harm can be emotionally devastating. The experience commonly results in feelings of sadness, shame, fear and isolation. One reality that we’ve discovered is that physicians are generally reluctant to proactively seek out support , our culture does not naturally support them. For this reason our program is structured such that we reach out to them. Whenever we hear of an adverse event (from risk management, safety reporting or from colleagues) we make an outreach call.

This involves training a core of physician supporters who are available as a resource when an adverse event occurs. Why physician colleagues and not mental health providers? It seems that physicians, when asked, prefer to receive support from a colleague who has “been there” and truly understands the nuances of the experience. And indeed we have found that discussing personal vulnerability and overcoming feelings of isolation are best accomplished through interaction with a caring, trained colleague. These interactions can be brief. Their significance and impact comes from normalizing what feels like a unique and isolating experience.

It’s important to say that when errors occur, our number one priority is to care for our patients and their families. Knowing this, we must not overlook the importance of also caring for ourselves. We cannot be fully available to our patients when we ourselves do not feel supported. And if this reality fails to make intuitive sense, there is ample evidence that emotional burnout has a direct and negative impact on patient care. And if we need more reason to care for the emotional needs of doctors, we need only look at the sobering statistics regarding the high rates of physician burnout, depression and suicide.

The need for adequate physician support to mitigate the impact ofadverse events seems clear to me. I have been approached by healthcare organizations across the country and as far afield as The Netherlands who understand this problem. They all see the need for institutional changes in order to create formal structures and programmatic initiatives to support physicians. There is tremendous healing power in true, empathic listening and sharing of a painful experience. This power can extend beyond the individuals involved and it can, over time, transform an institution’s culture.

My hope is that the physician culture will evolve to a place where we are more naturally supporting each other in informal ways, where we are less entrenched in our current ways of interacting.  As Parker Palmer expressed so eloquently in The Courage to Teach: Exploring the Inner Landscape of a Teacher’s Life: “Relational trust is built on movements of the human heart such as empathy, commitment, compassion, patience, and the capacity to forgive.” Connecting our painful experiences with empathic others is, I believe, the first step toward forgiving ourselves for being human.

jo shapiroDr. Shapiro serves as Chief, Division of Otolaryngology in the Department of Surgery at Brigham and Women’s Hospital (BWH) and is an associate professor of Otology and Laryngology at Harvard Medical School. She is also the founding director of the BWH Center for Professionalism and Peer Support.