“We plan to have a group of disclosure coaches, primarily physicians, as resources for the faculty,” Dr. Nussenbaum said. “They will be trained dually in helping the physician get through the disclosure process with the patient and family and, at the same time, helping the doctor get through the event.”
Explore This IssueJuly 2010
Many experts in disclosure and adverse events agree that one of the most progressive programs for helping not only patients and institutions, but also individual clinicians, deal with the aftermath of such incidents is the one founded by Jo Shapiro, MD, chief of the division of otolaryngology at Brigham and Women’s Hospital in Boston. Launched in the fall of 2008, the Center for Professionalism and Peer Support comprises several different components, such as disclosure coaching and a defendant support program for clinicians named in a lawsuit. But perhaps its most innovative element is a cadre of trained peer supporters who actively reach out to any physician involved in an adverse event.
“The peer counselors provide support, ask how the person is feeling, and get them referred to more professional help if needed,” Dr. Shapiro said. “Physicians tend to feel that they should handle things themselves, so we don’t wait for them to call us—because they won’t. We call them. People have told us that they find it really helpful—even if they don’t necessarily want to sit down and talk, just knowing that the institution cares enough to reach out to them is important.”
The peer-to-peer outreach aspect of Dr. Shapiro’s program is particularly helpful, according to Dr. Gallagher. “A more common approach is for organizations to use pre-existing support resources for helping employees with other problems, like employee assistance programs,” he said. “That sounds good in theory, but in practice, it doesn’t work out so well, in part because many of those efforts rely on the clinician to be the one to initiate the contact.”
But even most academic medical centers—to say nothing of smaller local hospitals and practices—don’t have the resources to establish a peer support program. According to Dr. Nussenbaum, of the 108 or so academic otolaryngology programs in the country, probably fewer than half have a specific staff person dedicated to dealing with patient safety activities and disclosure. “Overall, our specialty is probably behind in terms of dealing with disclosure and adverse events,” he said. “It’s very little discussed at our meetings, and most of the exposure I’ve had to this subject is not through our department [but] through other avenues at our hospital.”