Karthik Balakrishnan, MD, MPH, associate professor of otolaryngology at the department of otolaryngology–head and neck surgery at Stanford University in California, explained that burnout increases the risk of “effects of cognitive and implicit biases, and dehumanizing patients and colleagues. In turn, second victim effects can exacerbate burnout if not addressed thoroughly. Additionally, surgeons may tend to attribute errors to individuals rather than systems or processes, which makes this problem worse.”
Explore This IssueApril 2023
Errors in otolaryngology take a variety of forms and can broadly be divided into blunt-end errors that relate to latent weakness in the system, involving problems with electronic health records, administrative processes, and design flaw, or sharp-end errors made by frontline clinicians related to direct patient care, Dr. Brenner explained. “Although both take a major toll on patients, attention tends to focus on the sharp-end errors, because it appears that a problem is attributable to the individual, even though system factors are often in play,” Dr. Brenner said.
According to Dr. Weisskopf, who previously served as a flight surgeon for the U.S. Navy, a possible solution to some of these issues can be found in the military, where mishap investigations are separate from either legal or criminal investigations, allowing witnesses and participants the ability to speak freely without concern that there will be legal consequences.
“The focus is on improving the process. Besides assisting with individual investigations, it develops a culture of process improvement and learning, with pilots discussing their errors and how they corrected them. A similar mindset in medicine might help doctors move away from a sense of personal failure,” Dr. Weisskopf said.
“In some institutions, there are structured approaches to help surgeons and other professionals respond to the trauma of patient harm. The most widely practiced is the Schwartz Rounds [www.theschwartzcenter.org/programs/schwartz-rounds/], which offer a forum to openly discuss the human dimension of care, including the social and emotional challenges. Other programs are tailored to promote resilience in stressful events,” Dr. Brenner said. “Such programs are the exception rather than the rule, however. Therefore, what’s most often needed is emotional first aid from peer supporters who actively listen, offer a compassionate presence, and provide support,” Dr. Brenner said.
“Surgeons instinctively want to persevere—get through the workday or ‘tough it out’—but often the better approach is to identify a colleague who can cover clinical duties in the moment and take the healthful measures of getting adequate diet, sleep, and exercise. It’s also important to avoid excessive alcohol, caffeine, or other substances,” Dr. Brenner said. “Otolaryngologists trying to recover from error can benefit from structuring time to avoid rumination, doing things that bring joy, maintaining as normal a schedule as possible, and realizing that those around them are under stress too and can often empathize with their struggles.” Dr. Brenner added that follow-up and connection with colleagues are important, as silence or avoidance can worsen the pain or burden.