When Drama Becomes Trauma
By Lynn Welch
A critically ill child, accompanied by her parents, was being transported from the ICU to the operating room on another floor, under emotionally wrenching circumstances. A plant engineer was summoned to operate the elevator to ensure the family a non-stop transition between floors. Later that day, a nursing house manager who had been trained to reach out to staff involved in unsettling events realized he hadn’t checked in with the plant engineer. He sought him out in his basement workspace and discovered him alone there, sobbing. The quiet conversation that ensued provided an opening for the plant engineer to share his distress at witnessing the parents’ extreme pain, and his grief at the acute realization that he could lose his own daughter, the same age as the couple’s child. Before they parted, the engineer expressed deep gratitude to the manager for reaching out, and he confided that he hadn’t planned to return to work the next day.1
“Healthcare settings are inherently places of drama, and when drama becomes trauma, anyone involved can be affected,” says Sue Scott, PhD, manager of patient safety and risk management at University of Missouri Health Care and a leader in the field of patient safety and clinician support research. It’s a point she stresses often, as she did when she shared the story above at a recent patient safety conference.
And it’s a point with which MMIC’s chief medical officer, Laurie Drill-Mellum, MD, MPH, is quick to agree.“It’s important for hospitals and clinics to recognize that everyone suffers, and we need to be proactive in developing and ensuring that systems and services are in place to support care providers and staff and patients when there are unsettling events,” says Drill-Mellum.
She prefers the phrase “unsettling events” to the more familiar “adverse events” because “it more accurately reflects the scope of situations where support may be needed.”
“An unsettling event could be an adverse outcome,” she says. “But it could just as easily be a terrible event that we are witness to: a SIDS death, a horrible car accident, a patient suicide.”
As the importance of clinician and family support becomes more acknowledged, and its impact on everything from clinician well-being to patient satisfaction to malpractice litigation risk is better understood, more organizations are implementing programs to help care providers deal more effectively with the challenges they face.
Schwartz Center Rounds
In hundreds of healthcare settings across the country, clinical caregivers participate in a unique, multidisciplinary forum called the Schwartz Center Rounds where they are able to discuss, in a supportive and nonjudgmental setting, the difficult emotional and social issues that arise in patient care.
According to one facilitator of Schwartz Center Rounds, participants gain “a much greater understanding of the issues their colleagues are dealing with” — an understanding that fosters a greater sense of compassion and empathy for patients.
Patients benefit from other insights gleaned during these sessions, too. A special set of rounds was conducted in Boston following the Boston Marathon bombing in 2013. In a white paper summarizing the rounds (see link at the end of this article), a surgeon who cared for the injured reflected on the benefits of the collaboration he witnessed during the crisis:
“When everyone came out of their silos and came together, the outcomes were much better. That’s something we took from the events and are applying forward to other patients who had nothing to do with the event.”
Another organization dedicated to supporting clinicians and patients is Medically Induced Trauma Support Services (MITSS). MITSS was launched in 2002 by Linda Kenney, who, as she describes it, “found myself at the sharp end of an adverse medical event that nearly took my life.” Her experience made her aware of the lack of emotional support, not only for patients and their families, but also for care providers following traumatic incidents.
MITSS works to build awareness of the crucial need for support services, provides direct support to patients, families and clinicians, and consults with healthcare institutions to develop infrastructures for clinician peer support systems.
The MITSS website brings patients and clinicians into each other’s awareness to enable them to better understand each other.
Loud and clear: “Stay near!”
Listening to almost any patient’s recounting of an adverse medical event, one is struck by how often the physician withdraws in those situations, and how devastating that distancing is for the patient.
“I was undone by her disappearance,” says Peg Metzger of her doctor, in a moving patient video shared on the MITSS website.
Metzger’s story is a measured and poignant account of the many emotions she experienced during the months following an adverse outcome. Her feelings ranged from anger:
“Why should an adverse event feel like a hit-and-run accident? She was treating me like I would treat road kill: feel bad, but keep moving. And whatever you do, don’t look back.”
... to a desire to connect:
“I know that every story has at least two sides. I wanted to hear hers because how else was I going to ever make sense of what happened to me?”
... to speculation about the motives for her doctor’s behavior:
“Did she know I was still in the hospital? Did she care? Was she driven by fear? Or shame? Or was there a cover-up?”
Dr. Drill-Mellum understands the strong urge care providers can feel to turn inward rather than toward their patient in difficult circumstances. “Many physicians are introverts to start with,” she says. “They often don’t have strong social networks. In fact, they may have given up building their networks while their peers were building theirs, because of the demands of the profession. And they may fear they’ll appear weak or vulnerable. This is difficult work.”
It can be different
Sometimes, the courage to resist turning away requires the encouragement of someone able to help you see the bigger picture. Scott recalls one physician in this situation.
“She’d had a bad experience and had really shied away from the family,” Scott says. “A colleague urged her to go to the bedside and talk to the family.”
Reluctantly, the physician agreed. As Scott recounts, “She sat down on the side of the bed and said, ‘I’m terribly sorry this happened to you.’ The patient started to cry. The physician cried. They hugged. Six years later, she’s still treating that patient.”
That’s the difference the right support at the right time can make.
GETTING STARTED WITH CLINICIAN SUPPORT
Survey your organization, advises Sue Scott, PhD. You may be surprised at the results. In 2007, Scott’s team added just two questions to an internal patient safety culture survey. In answering these questions, almost 1 out of 7 staff members reported they had experienced a patient safety event within the past year that had caused personal problems such as anxiety, depression or concerns about their ability to perform their job. And almost 70 percent of these clinicians reported they did not receive institutional support.
Check out the Clinician Support Toolkit on the MITSS website (see Resources). This comprehensive resource includes help for every stage of program development, including assessments, work-plans, how-to guides, communication pointers and inspiring videos.
Ask around to find out who are the natural caregivers in your organization. People will be eager to name them, and they can become champions for your efforts. Scott says she finds that palliative care providers are often very good in critical situations and can be valuable resources.
Connect with others on the journey. Ask for help from those ahead on the trail. And be generous in sharing what you learn with others.
Bombing White Paper — Schwartz Center
Tools for Building a Clinician and Staff Support Program
Lynn Welch is Senior
COmmunications Consultant with MMIC.