by David Mayer, MD
Last week was the first of three annual Patient Safety Summer Camps for graduate resident physicians in 2017. Each year, I learn from the resident scholars who attend about the current safety challenges and barriers they face on a daily basis as they both try to deliver safe care to patients, and learn to become good physicians. Over the last few years, however, I have noticed a growing concern among our Telluride Scholars, a theme that centers on the overall well being of resident physicians in the healthcare workplace.
Last week, discussions around resident well being reached an all-time turning point, during an interactive presentation on Care for the Caregiver programs led by Crystal Morales from MedStar Health. During the presentation, Crystal asked the residents to think back, and remember the first patient death that happened while under their care—not from a medical error, necessarily, but just the first patient they cared for who died. She asked them to focus on how they felt versus details of the case, and then inquired if anyone was willing to share their story with the group. A first brave resident willing raised her hand. Before she could finish her story, she broke down in tears yet she continued to talk about how that patient’s death affected her to this day. A second hand was raised and then a third…it was like someone opened an emotional faucet. Each story shared served as both validation and acknowledgment that the pain in serving witness to such loss deserved, and needed, to be honored. The sharing of these stories seemed cathartic; helping to ease the pain this group collectively had been holding on to for far too long. Many in the room described Telluride as a “safe place” where they felt comfortable sharing these feelings in the form of stories. Portions of their reflective posts on our Telluride Summer Camp blog are shared below. I encourage all of you to visit the Telluride blog and read their stories in their entirety.
- “The afternoon of day 3 left many of us in tears as we went through our stories of first deaths and tragic patient outcomes. It was clear, as these stories came out that many of us were still hanging on to these painful memories and will probably do so for the remainder of our careers. Another common thread in these stories was the lack of support after these unforgettable events happened. In healthcare, we are expected to take a deep breath and move on with our days as if nothing ever happened. Take another history, make another diagnosis, and speak to another family, all while making sure we check our emotions at the door”.
- “Yesterday during one of our group discussions, people went around the room discussing the first time they were involved in the death of a patient. The different stories told were poignant and extremely emotional. Some of these stories were quite recent while others happened years ago. The unifying trait in all of the stories was the raw emotion and pain in the voices of the speaker. Every story told ended the same way… “and then I just went back to work.” Years later it is entirely evident that these wonderful caring people are still hurting. As a profession we are failing. We are eating our young with the perverse attitude that it will build a thick skin and make you a better doctor. We are not robots.”
- “Why is this happening? We, the physicians, need to speak up. We need to consider how talking about our own reactions to and reflections of patient care events is indeed a critical piece of patient-centric care. Today, we finally had a chance to let it out, to vent our frustrations, to discuss our feelings of self-blame and near self-collapse. These stories are so important because we have to let each other know, YOU ARE NOT ALONE.”
- “If we are unable to care for ourselves, we won’t be able to provide the best care to our patients and their families. The tremendous support ‘care for the caregiver’ provides is amazing and has inspired me to investigate the options my institution can provide.”
- We discussed how good it felt today to open up about the loss of our patients and the support (or lack of) we get in these moments. So many times we just need to talk it out, feel heard, and feel validated. These conversations are cleansing and necessary.”
- “Today, we talked about care for the caregiver. After all, there is no other workplace like the hospital in terms of sacrifice, acuity, and risk of burnout. With such high stakes, healthcare providers are subject to exorbitant levels of stress that perhaps defy human physical, mental, and emotional capacity.”