Bad Outcomes and Second Victims

It’s been a while since I’ve posted.  When I started this blog, I had planned to work up to writing weekly.  Shortly after my last post, something happened that shut off my writing for a while. And now that I’m writing this, I realize that I probably was avoiding posting to avoid sitting with these thoughts.  

You see, OBs are in a field that is generally happy.  

Unfortunately, it’s not always happy.  

We really care when patients have something bad happen to them or their babies, and sometimes it really hits us.  There’s even a name for it:  Second Victim.  I don’t know that I love that moniker, because it implies someone did something wrong, when in reality that’s not usually the case.  Patients are quite often the “victim” of just plain bad luck. 

Also, it doesn’t seem right to call the doctors “victims” when generally, they’re physically fine and get to go home and hug their babies.  But we wonder what we could have done differently.  If we don’t, we’re crappy doctors.  We are taught in medicine to evaluate what happened and look for ways we can improve so that the next patient can have a better outcome. It’s the whole crux of morbidity and mortality conferences in training programs.  We get colleagues to evaluate the chart with us and look at whether we could have changed anything.  We do root cause analysis to evaluate for issues in the healthcare system that could have changed the outcome.  It makes us better doctors to do all of this.  But it’s really hard, especially after a bad outcome.

Anyone who cares enough about their patients to be a good doctor will be affected when their patient doesn’t do well.  It takes empathy to be any good at what we do.  Sometimes that empathy comes with a cost.  It’s really difficult to deal in human suffering as part of your daily job and not have it affect you.  We’re taught to compartmentalize so that we can function, and we’re usually good at it, but everyone has a limit.  Occasionally a situation hits us harder than usual.  

At most hospitals, we have a debrief opened up for all the people who were involved in the case to discuss what happened and support each other.  It helps to talk through the evolution of an emergency with the people who were there because often things are happening so fast that we don’t have time to discuss it as it’s happening.  This needs to happen more often in my opinion.  So often this only happens when the outcome is really catastrophic, but it would probably be helpful to debrief after more emergencies so that we can all hear each other’s fears that we didn’t do enough, and be reassured that everyone thinks the other person did their best in a bad situation. 

Speaking of a terrible situation and second victims, I’m writing this in May of 2020, in the midst of the Covid 19 pandemic.  I cannot even imagine how many doctors and nurses are going to need debriefs, in addition to therapy and support, after witnessing all the suffering associated with this outbreak. I am so very relieved that our outbreak here in Jacksonville, FL has not been as bad as was predicted, at least so far.  We were already at a tipping point with physician burnout in this country, and physician suicides had already become all too common prior to this pandemic.  There have been more suicides since the pandemic started, particularly in hard hit areas of the country.  Sadly, I would imagine there will be more still to come as people move out of survival mode and have time to process what they’ve dealt with.  So many doctors and nurses are witnessing so much suffering and death and feel helpless to do anything to change it.  

We will need to focus on mental health for our caregivers as we proceed through this next year or two. I wish I had magical solutions to suggest here, but I don’t.  Let’s all try to be there for each other and help each other through this as much as we can, and look for warning signs that our colleagues are not doing well so that we can encourage them to get help if they need it.  Maybe it would also help if we normalize the feelings of failure that happen to all of us in the face of bad outcomes so that people don’t feel so alone.