Wellness: Second Victim Syndrome

Medicine is a stressful career, and health care provider wellness is sometimes neglected within the culture of medicine

Throughout our medical training we have had the opportunity to treat and learn from the patients every day. We are exposed to an extremely difficult working environment and are constantly witnessing terrifying traumatic events that most people never see in their lifetime. 

During the past few months in our emergency department, we have recently seen multiple level 1 traumas, pediatric, and adult cardiac arrests. In this stressful environment it is very easy for medical errors or patient safety issues to occur. It is important that we take care of ourselves, support each other, and to utilize extra help if/when needed.

Today, I wanted to speak about second victim syndrome.  

What is second victim syndrome?

·      The second victim syndrome (SVS) is defined as the Health Care Providers (HCP) who commit an error and are traumatized by the event manifesting psychological (shame, guilt, anxiety, grief, and depression), cognitive (compassion dissatisfaction, burnout, secondary traumatic stress), and/or physical reactions that have a personal negative impact (similar to symptoms of acute stress disorder)

·      Examples: incorrect medication dosages, missed diagnosis, incorrect medical management, accidental harm during a procedure, among several others.

·      These types of cases are unforgettable and can leave lasting emotional scars on providers.

·      After an adverse event, the prevalence of SVS varied from 10.4% up to 43.3%.

·      Almost half of HCPs experience the impact as an SVS at least one time in their career

What are the impacts of second victim syndrome on providers?

·      Anxiety, depression, guilt, sleep disturbances, loss of confidence in their practice, and decreased job satisfaction.

·      Isolation, depression, and suicidality

·      Numerous reports in the literature discuss providers (nurses, residents, attending physicians) who died by suicide following a significant event that led to patient harm.

RESIDENTS ARE AT VERY HIGH RISK!

·      Residents are in the learning phase and are expected to make mistakes during their training given their relative levels of inexperience combined with high levels of clinical accountability.

·      According to one study, the prevalence of fourth-year students involved in a medical error was 78% - compared to 98% of residents.

·      A survey of more than 3100 physicians from the U.S. and Canada found that 81% of those who had been involved in a clinical event (serious error, minor error, or near miss) experienced some degree of emotional distress.

How can we identify this?

·      May display similar emotions and behaviors to those experiencing burn out or acute stress disorder or burn out

What can we do to help each other?

·      Peer supporters, patient safety, and risk management all play a critical role in ensuring the provider has a safe space to recover from the event.

·      While support from friends, significant others and supervisors are important, most providers prefer support from a trusted colleague

·      Receiving support from a colleague from within one’s own specialty offers a sense of shared understanding about the complex nature of patient care. It also normalizes the situation for the affected provider.

·      Projects such as clinical event debriefing and help recognize systems errors, near misses, incidents, etc. They can also be used to help set up peer meetings and services if individuals are suffering.

References

https://omh.ny.gov/omhweb/bootstrap/crisis.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6697646/

Second victims in health care: current perspectives

www.ncbi.nlm.nih.gov

Medical errors are a serious public health problem and the third-leading cause of death after heart disease and cancer. Every day, the health care professionals (HCPs) practice their skill and knowledge within excessively complex situations and meet unexpected ...

https://www.emra.org/books/emra-wellness-guide/ch-8.-second-victim-syndrome/#:~:text=The%20second%20victim%20is%20the,becomes%20traumatized%20by%20the%20event.

Thank you for your time!

Happiness

Today, I’ll be reflecting on happiness. 

There is endless literature, philosophy, and psychology devoted to this one word. I spent a couple of hours this morning reading reading about happiness. A few themes emerged, and I wanted to take a moment to share them with you along with some of my takeaways.

(1) “Experienced” versus “Remembered” happiness

Experienced happiness: the happiness you experience in the moment. Experienced happiness can entail going out to dinner with a friend, enjoying a lovely glass of wine, going to a concert. The moment-to-moment bliss can be nourishing. On the flip side, binge-watching Love is Blind on my couch gives me great joy in the moment, but the next day, I look back and I feel sad like I wasted an opportunity to do more. In general, this term captures the “carpe diem” or “YOLO” mindset. However, being happy in a moment can be different than being happy for a longer timeframe.

Remembered happiness: when you reflect back on a period of time and feel satisfaction. For example: residency. Each moment is challenging and often not “fun.” But you may look back on the breadth of the experience and feel a deeper satisfaction that could not be captured in one single moment. The multitude of experiences culminated into happiness. People often use remembered happiness to measure life satisfaction. 

My takeaway: Framing it in these two categories actually really helped me. Being intentional with each type is important. Moments of experienced happiness will help me withstand the journey of the remembered happiness, so it’s important to prioritize simple pleasures that bring me joy. If I overemphasize experienced happiness, then I might lose sight of my larger ambitions and lack purpose. However, if I only prioritize remembered happiness, I might look back on my life with regret that I didn’t enjoy the process along the way. I think the moments in life when we have jolting reminders of our transience push us to embrace experienced happiness even more. 

(2) The Hedonic Treadmill

This theory is also termed “hedonic adaptation,” and it talks about how people typically live at a “happiness set point.” As positive events occur – like getting a great new job, achieving a longstanding goal – expectations correspondingly rise. Thus, there’s no net gain in happiness. The same theory actually holds true with negative events. Over time, you’ll eventually return to your happiness set point regardless of the stressor. 

My takeaway: I am 100% guilty of this. I remember there were so many times in medical school when I thought, “When I match into residency, I’ll be so much happier.” But with each accomplishment also came a new set of dreams. At times, I’ve forgotten to celebrate my achievements in pursuit of the next goal. I think pushing past the negative life events to maintain the happiness set point shows a level of resilience that is innate to us as humans. But the lack of celebration with the positive seems like a missed opportunity to potentially redefine my set point. However, even more importantly, I think this concept made me realize the emphasis I’ve placed on external sources of happiness rather than internal.

(3) The World Happiness Report

The UN publishes a report each year ranking each country on a scale of national happiness. These results are based on respondents rating their happiness. The survey uses a Cantril ladder – “it asks respondents to think of a ladder, with the best possible life for them being a 10, and the worst possible life being a 0. They are then asked to rate their own current lives on that 0 to 10 scale.”

Finland has been ranked the happiest country in the world four times in a row, followed by Denmark, Switzerland, Iceland, and Norway. USA falls at #19 of 146 countries in 2021, relatively lower than other developed, wealthy nations. One theme noted by analysts is that the top ten countries have “solid social support systems [and] good public services.” These countries also tend to have higher taxes. 

The NY Times article that I’ve linked below tells the story of a Finnish town named Kauniainen, also known as the happiest city in the world. On the surface, is a gloomy weathered town, with stoic residents. However, they cite an Adult Education Center as one of the integral components to the city’s contentment. I remember reading this article when it was published three years ago, and I never forgot it. The simplicity, strong sense of community, and investment in social systems really stuck out to me. 

My takeaway: One of my conclusions is that it helps to have a strong sense of belonging. For my in-laws, they derive a lot of happiness in their church group. For my husband, he finds camaraderie in his cross-fit group. And I realized for me, a lot of my happiness is the strong sense of community that we have at Maimo. I feel happy, grateful, and fuzzy-hearted when I reflect on that. 

References:

https://hbr.org/2018/11/what-kind-of-happiness-do-people-value-most 

https://en.wikipedia.org/wiki/Hedonic_treadmill 

https://www.nytimes.com/2018/03/14/world/europe/worlds-happiest-countries.html 

https://www.nytimes.com/2018/12/24/world/europe/finland-happiness-social-services.html

https://worldhappiness.report/faq/

POTD: Tips for writing your CV

I wanted to share some tips for creating an excellent CV. I thought this might be helpful as PGY-2s start thinking about writing their CVs over the summer for jobs/applications. It’s easier to slowly add a line or two over time rather than to frantically create one over 3 days.

Formatting:

• Keep it organized and professional. Use a simple font and clean headers. Don't try to be original.

• Put the most important stuff at the top.

• Order it in reverse chronology – most recent at the top for each section.

• As a general rule of thumb, try to keep your resume within 1 page. However, your CV can be longer since it is more comprehensive. In medicine, they’ll ask you for your CV, but if you’re applying for something corporate, then they will likely want your resume. (Or both.)

• Be consistent throughout with your formatting.

• Save the doc / send it as a pdf

• Label your pages with your last name & page #.

• Use bullet points, and try to keep things succinct.

The sections:

• Of course, start off with some of your personal information. At the minimum, include your name, phone number, and best email address.

• Organize your CV by having clear headers. As a resident, it’s appropriate to start off your CV with a “Training and Education” header with your residency, medical school, and undergraduate schools listed.

• Presentations & lectures: include your morning reports, M&Ms, grand rounds presentations, etc. If you’ve presented at national conferences, include that too! Consider breaking out your presentations & lectures as “National” (where you presented at conferences) and then “regional/local” (Maimo/med school presentations.)

• Publications: designate if it’s peer reviewed vs non-peer reviewed. Use proper citation style.

• Include your residency & leadership activities. You can group them however you find appropriate, but take some time to brag about your chiefdom, research and QI projects, and extra-clinical stuff (e.g. event medicine, scholarly tracks, med school clubs, etc.) The majority of my interviews were spent on talking about this section. If it's still in progress, just say where you are in the process.

• Awards - Gold Humanism, AOA, etc.

• Professional affiliations - SAEM, ACEP, etc.

• Certifications - don't ask me why, but they want your random certs listed like ACLS, ATLS, etc.

• Include a hobbies section! People want to get to know you, and it’s okay to be honest and quirky. It can be endearing and a great ice breaker.

Other random tips:

• For each project or leadership related bullet point that you have, make sure you include the following:

  • What was the deliverable

  • Who was it for

  • What was the impact

  • Your methods

• Tailor it to the job. For example, I created a little bucket called “International experiences” since I was applying for a Global Health fellowship. Remember, a community job CV will look different from an academic position.

• Unless it’s super notable, I think high school is too far back to include. But the cool stuff you did in college or med school is great.

Final touches:

• Get feedback. I sent my resume to 5-6 friends, and 3-4 attendings before ultimately submitting it. You don’t have to take everyone’s advice, but you’ll find most tips to be generally helpful.

• Be neurotic - people use your CV as a harbinger for your attention to detail and your professionalism. Keep your grammar, spelling, and formatting perfect.