Date: 11/04/2016

Few if any clinicians get through their career without experiencing an adverse event. Loss of confidence, isolation and burnout can follow; relationships with colleagues can become strained; and patient care can suffer.

For some, the shame and isolation can lead to depression, anxiety and even suicide, says Jo Shapiro, director of the Center for Professionalism and Peer Support at Brigham and Women’s Hospital in Boston and an associate professor of otolaryngology at Harvard Medical School.

On the invitation of Diane Colgan, Suburban Hospital’s chief of medical staff, Shapiro spoke to a gathering of physicians, advanced care practitioners and nurses from Suburban about offering peers support when they are struggling after an adverse event, malpractice suit, personal tragedy or other traumatic occurrence. The all-day seminar took place Oct. 11 at the Chevy Chase Club, in Chevy Chase, Maryland. Jacky Schultz, president of Suburban Hospital, delivered opening remarks. The aim of the event was to train clinicians to offer support in a considered, nonintrusive way when they see that a peer is struggling.

The support offered can be adapted for other traumatic events, such as treating mass casualties as occurred after the Boston Marathon bombing. The death of a beloved colleague or a favorite patient can also be emotionally devastating, says Shapiro, and some providers in those circumstances can benefit from the support and understanding of someone who’s gone through the same thing.

Medical culture can exacerbate a clinician's distress, says Shapiro. “Not only is the culture of medicine one of high standards and perfectionism, it is also one in which emotional reactions to adverse events are generally not acknowledged or openly discussed,” she writes in a recent issue of Academic Medicine. What’s more, she and her colleagues have found that the same culture can discourage seeking help.

For those reasons, the peer supporter contacts the provider, acknowledges the painful event and its aftermath, and offers one-to-one support. That peers are the ones offering help is a critical piece of the program’s success, says Shapiro. Her research has found a strong preference among providers to accept help from peers rather than from mental health professionals.

The program has five components:

Outreach

The peer supporter contacts the provider and offers support. About 80 percent of physicians contacted agree to a peer support conversation, Shapiro has found in her research. The peer supporter explains that the call is to offer support at a challenging time, explaining that most providers prefer to talk to a peer after an adverse event, because it can be difficult for people outside the medical profession to fully understand the range of emotional reactions.

Invitation

In the conversation, the peer supporter invites his or her colleague to talk openly about the event.

Listening/Reflecting/Reframing

The objective is to listen without judgment and help the colleague process the event and put it into perspective.

Colgan emphasizes that it is important not to minimize the event or its impact: “Telling a colleague, ‘That’s not so bad’ or saying you’ve made a worse mistake is unhelpful.”

The peer helps the distressed clinician reframe the adverse event in the context of an entire career. In her presentation, Shapiro suggested using language like “You have done so much good for so many people. Think about how many lives you have saved. You are an excellent physician.”

Coping

The peer supporter elicits the colleague’s coping skills and encourages self-care: “How have you managed other troubling events in your life? How did you take care of yourself through that?”

“Humans make errors at predictable rates,” says Shapiro. “Even if your colleague understands that intellectually, it is good to have it emphasized. Encourage the physician to use his or her experience as a way to improve patient care, either by working on systems issues that could prevent human error or by sharing his or her experience with others.”

Resources

The provider in distress is offered a list of resources and an invitation to speak again if needed. The peer supporter typically follows up one time, says Shapiro.

Says Colgan: “What you want to do is help your peers understand that it is appropriate to suffer after a traumatic event because it shows they are caring, committed providers. Remind them how much good they've done for people.”

Suburban's patients as well as its staff will benefit from the program, says Colgan: “The relationships we have with colleagues and patients determine how happy and healthy we are and, in turn, affect how well we care for patients. Close connections matter.”