The physician’s achilles heel—surviving an adverse event

Abstract

Background Of hospitalized patients in Canada, 7.5% experience an adverse event (AE). Physicians whose patients experience AEs often become second victims of the incident. The present study is the first to evaluate how physicians in Canada cope with AEs occurring in their patients. Methods Survey participants included oncologists, surgeons, and trainees at the Foothills Medical Centre, Calgary, AB. The surveys were administered through REDCap (Research Electronic Data Capture, version 9.0: REDCap Consortium, Vanderbilt University, Nashville, TN, U.S.A.). The Brief COPE (Coping Orientation to Problems Experienced) Inventory, the IES-R (Impact of Event Scale–Revised), the Causal Dimension Scale, and the Institutional Punitive Response scale were used to evaluate coping strategies, prevalence of post-traumatic stress, and institutional culture with respect to AEs. Results Of 51 responses used for the analysis, 30 (58.8%) came from surgeons and 21 (41.2%) came from medical specialists. On the IES-R, 54.9% of respondents scored 24 or higher, which has been correlated with clinically concerning post-traumatic stress. Individuals with a score of 24 or higher were more likely to report self-blame (p = 0.00026) and venting (p = 0.042). Physicians who perceive institutional support to be poor reported significant post-traumatic stress (p = 0.023). On multivariable logistic regression modelling, self-blame was associated with an IES-R score of 24 or higher (p = 0.0031). No significant differences in IES-R scores of 24 or higher were observed between surgeons and non-surgeons (p = 0.15). The implications of AEs for physicians, patients, and the health care system are enormous. More than 50% of our respondents showed emotional pathology related to an AE. Higher levels of self-blame, venting, and perception of inadequate institutional support were factors predicting increased post-traumatic stress after a patient AE. Conclusions Our study identifies a desperate need to establish effective institutional supports to help health care professionals recognize and deal with the emotional toll resulting from AEs.