The Impact of Adverse Events on Physicians and Residents

10 March 2020
Joan Anzia, MD

“We’re not supposed to be vulnerable; we’re not supposed to be weak. God forbid our colleagues know this affected us.” Dr. Joan Anzia, vice chair for education, residency director, and professor of psychiatry and medical education at Northwestern University’s Feinberg School of Medicine, sees first-hand how adverse events can negatively affect physicians and how physicians hide those effects because physicians are her patients.

At the January 22 Baldwin Seminar Series presentation, The Impact of Adverse Events on Physicians and Residents: What Do Ethical Principles Say About Self-Care and Care of Colleagues, Dr. Anzia explored the psychological and physiological effects of adverse events on physicians, how the culture of medicine prevents physicians from seeking help after an adverse event, and what residency and fellowship programs can do to help physicians recover faster from the emotional trauma an adverse event can cause.

Adverse events are varied and include patient harm or death; a near miss; patient or family assault of the clinician; exposure to severe or multiple traumas; or even negative peer review. Physicians can have a range of responses to these events including impaired concentration, insomnia or feeling on edge, avoidance of similar procedures, and feelings of grief, guilt, and fear, all of which can compound into larger problems like substance abuse, burnout or depression, thoughts of suicide, or decisions to leave their role, their specialty, or medicine altogether. Because a physician’s professional identity is centered on alleviating, curing, supporting, and healing, events leaving patients worse off are particularly devastating, she said.

“It can turn your whole life around, even if you had training to help prepare you for this,” Dr. Anzia said, noting she has found little training that actually prepares physicians for these inevitable, human errors. There is a false assumption that physicians can never make mistakes and are not affected by workplace trauma, she added, and this culture of perfectionism makes it all the more difficult when an adverse event occurs, leaving physicians feeling isolated, shameful, and without a path to recover.

“Physicians want support, but doctors don’t reach out for help. We need to reach out to them,” Dr. Anzia said.

A positive community within a residency program can be a bedrock for preparing physicians to weather adverse events, she said. Recommended interventions include creating a system for reaching out to affected physicians and providing positive peer support; providing physicians with options for time off or brief planned distance from triggers of the event (e.g., scheduling a surgeon in other operating rooms for a few days after a surgery with poor outcomes, or scheduling a resident at another site following a workplace shooting), and providing simulations to practice responses to adverse events throughout medical school and residency. Physicians can recover from adverse events in five to six weeks typically, though with better intervention systems, Dr. Anzia believes recovery time can be reduced and the risks of compounded trauma lessened. 

She believes the medical field can learn from the airline industry on the best ways to protect physicians from negative fallout. “Airline pilots are not allowed to fly for several days, weeks, or months after an event; docs go right back in,” she said.

Shifting from a culture of perfectionism to a community of support will ultimately build more resilient—and more effective—physicians.

“People will work really hard and tolerate all kinds of difficulty if they feel they are surrounded by people who care about them and share the same values… and that you’re sharing this higher purpose,” she said.

The ACGME’s Baldwin Seminar Series is offered free of charge and continuing professional development (CME) is available. The next Baldwin Seminar on April 15, 2020, from 9:30-11:00 a.m. Central at the ACGME office will feature Holly J. Humphrey, MD, MACP, president of the Josiah Macy Jr. Foundation. Email to join the invitation mailing list.