Seven keys to dealing with adverse events
Someone dies unexpectedly on the ward; a baby is born with a severe abnormality; a surgical patient wakes up with paralysis – so many things can and do go wrong in the daily life of a hospital. Nearly half a million adverse events occur every year in Australian healthcare, so it’s likely that you’ll one day find yourself dealing with a patient who has been harmed under your care.
Although clearly the first priority in such circumstances are the patients themselves, doctors too can find themselves traumatised when something goes badly wrong. Managing doctors’ mental health after serious adverse events is extremely important and often overlooked.
Common responses when things go wrong are shock, disbelief, guilt and shame, along with a loss of confidence in your abilities as a practitioner. Some doctors can even develop PTSD symptoms or suffer survivor guilt. Reactions can be more extreme with patients with whom we feel a closer connection, which is why establishing some separation is important to maintaining your ability to be effective.
The reactions to avoid are denial, obsessively going over the events in your mind, worrying about things you can’t control and isolating yourself from those who can help.
Open disclosure with the patient harmed or the patient’s family is a crucial process. This needs to be honest as well as consistent over time, with a primary point of contact. You need to have all the information at hand before starting this process, and be honest about what is not known. Avoid speculating or elaborating to try and comfort the patient or family, and let them know what more is being done and when.
Express sympathy, and offer to listen if they feel like talking. Ask how you can help in other ways. Saying nothing can be misconstrued as rejection, or reinforce the notion of a “code of silence” around the event.
Here are some keys for coping after an adverse event in your professional life:
- Look after your physical health; make sure you’re getting enough sleep and exercise;
- Don’t obsess about the adverse event, and make sure you debrief after the incident;
- Try stress reduction techniques such as yoga or meditation;
- Take an active role in the open disclosure process
- Learn from the incident and consider what you can proactively do to prevent the same thing happening again;
- Seek advice from your GP if you’re concerned about how the incident is affecting your health;
- Contact a medico-legal advisory service about how to handle the event and notify your insurer.
For more information about health issues for doctors, access a range of online resources from Doctors’ Health Advisory Services Pty Ltd.