Addressing clinician health after adverse outcomes

Support for the clinician is crucial in overcoming poor patient outcomes.

Where do clinicians find support after an adverse outcome?
Where do clinicians find support after an adverse outcome?

When you work in the medical field, there are bound to be bad outcomes now and then. In obstetrics, the bad outcomes can be devastating, the worst being the loss of a baby or the death of a mother.

In obstetrics, when bad things happen, people often want to cast blame on the doctor, midwife, or nurses. It is difficult to fathom that pregnancy and childbirth is still risky, even in this age of technology and advanced medical knowledge. There is no way to prevent every bad outcome, despite incredible advances in prenatal testing and high-risk antenatal care.

However, we are all human; medicine is not a perfect science; and mistakes do happen. Details are overlooked. Decisions are not made in time. Sometimes, despite our best efforts, it is possible that our clinical judgment, action, or inaction results in an adverse patient event.

When there is a question of blame, what is a clinician to do? Obviously there are standards and protocols that follow bad outcomes. Charts are reviewed, sometimes lawsuits are filed, and disciplinary actions may be taken. But when poor outcomes occur, is anyone addressing the clinician's emotional health?

Speaking from experience, every adverse patient outcome stays with you, whether you are possibly to blame or not. You go back and examine every decision and every note. You second-guess everything you did and said.

I personally know two providers who left obstetrics after being involved in a poor outcome. I often wonder if they would have continued in obstetrics had they experienced more immediate and appropriate support.

But where do clinicians find that support? Some clinicians want to discuss the case with colleagues. Others want to vent to friends or loved ones. Legal departments often discourage discussing bad outcomes at all. So whom do we turn to in order to cope with the feelings that often accompany adverse patient events?

Many hospitals and large practices offer employee assistance programs that provide a set number of counseling sessions at no cost. But according to a study done at Brigham and Women's Hospital in Boston, these services are underused.

Brigham and Women's Hospital has since established a clinician peer support service to work closely with employee assistance and provide one-on-one peer support and outreach, which they have found to be more helpful to clinicians.

It is imperative that providers have somewhere to turn for appropriate support after an adverse patient event.

The judgment, stigma, and shame that often occur after bad outcomes can be detrimental to future practice and emotional health. Confidential, empathetic, and compassionate peer support seems to be the best tool to assist clinicians through these difficult experiences.

Robyn Carlisle, MSN, CNM, WHNP, works as a full-scope midwife at University Doctors and Kennedy University Hospital in Sewell, N.J.

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