Eyeworld

OPHTHALMOLOGY BUSINESS 170 April 2017 by Liz Hillman EyeWorld Staff Writer to more than a year, according to the study. One of the most import- ant needs second victims cited in this report was to talk with some- one. "In such conversations, the informants could share the emotion- al burden and receive personal and professional reassurance," Ullström et al., wrote. Scott Wilkinson, MD, Wilkin- son Eye Center, Pontiac, Michigan, said much of the anxiety physicians experience in an adverse medical event comes from fear that the pa- tient will blame them. As such, first and foremost, he is straightforward with the patient about the situation, explaining it transparently and in layman's terms as best as he can. "I find that sometimes if you do that, patients will do much to eliminate your anxiety. They'll reassure you that they understand these things happen and they don't harbor animosity toward you, but it starts with being very honest and transparent," Dr. Wilkinson said. He also suggested sharing ad- verse experiences with colleagues. "Chances are that all of us at some point or another have these can set them up to be less attentive and function less well than you would like them to as a doctor," Dr. Wu said. Even with these feelings, Dr. Wu said physicians tend to keep a stiff upper lip. "[Doctors] feel like they are en- couraged to be stoic," Dr. Wu said. There are dozens of studies about the concept of "second victim." One out of Sweden inter- viewed 21 healthcare professionals from one hospital—10 of whom were physicians—who reported emotional reactions such as sadness, anxiety, and having flashbacks of the event. 2 Guilt, shame, and shock were other emotions expressed. Some participants interviewed for the study said these feelings led to health problems, including clinical depression. On a professional level, the study revealed that many felt insecure after an adverse event. In a third of cases, the emotional aspect of the event made work more difficult. The effects of this adverse event lasted anywhere from a few months those who cared for the child felt like while the hospital was forth- right, transparent, and admitted fault, they were thrown under the bus. "They had not received the kind of support one would need, and they felt like the institution had not supported them. We felt like that was a missed opportunity," Dr. Wu said. There are different stages for physicians in coping with a medical mistake. There is the immediate aftermath when they realize they've made a mistake and are faced with handling that situation in the mo- ment. "You might feel helpless, upset, agitated, and basically incompetent. This can make you lose your con- fidence. The other emotion that is very pervasive is fear. You're fearful for the patient's health and afraid there might be consequences for you," Dr. Wu said. There can be lingering effects like shock, guilt, and paranoia. "People have nightmares, they withdraw, become very depressed, and can become distracted, which How to move past an adverse medical event "M aking an error is an inevi- table part of practicing medicine," said Albert Wu, MD, professor of health policy and management, Johns Hopkins Bloomberg School of Public Health, and internist, Johns Hopkins Hospital, Baltimore. Obviously, the patient experi- encing an adverse medical event is the victim of such a situation, but back in 2000, Dr. Wu coined the term "second victim," referring to the effect on medical staff involved with the event. In an essay published in the British Medical Journal, Dr. Wu de- scribed how "the doctor who makes mistakes needs help too." 1 Dr. Wu's article, almost pro- phetic, was published a year before a high-profile case involving Johns Hopkins and an 18-month-old tod- dler who died as a result of a series of preventable medical errors. After this tragedy, Dr. Wu said many of Coping with medical mistakes and the concept of "second victim"

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