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March 17, 2016

Silent suffering: How do doctors and nurses live with their mistakes?

Daily Briefing

Editor's note: This popular story from the Daily Briefing's archives was republished on August 7, 2019.

Many clinicians have made errors that harm patients and leave lasting scars that affect their personal and professional lives—but few feel they receive ample support from their organizations, Sarah Kliff reports for Vox.

Medical errors and beyond: Help your clinicians consistently follow care standards

Medical errors lead to more deaths every year than drug overdoses, terrorist attacks, and plane crashes combined, Kliff writes. One study published in JAMA Surgery found that about 50 percent of clinicians are involved in a "serious adverse event" each year.

"Every practicing physician has either made an error that harmed a patient or [has] certainly been involved in the care of a patient who has been harmed," says Albert Wu, director of the Center for Health Services and Outcome Research at Johns Hopkins.

Emotional toll

Although much attention is paid to the damage done to patients, what's far less discussed is the emotional toll that the errors can take on clinicians—the "second victims" of medical mistakes, as Wu calls them.

A 2009 study found that about 66 percent of clinicians said they experienced "difficulty concentrating" and "extreme sadness" after harming a patient, more than 50 percent experienced depression, and about 33 percent avoided caring for similar patients. Some clinicians also have considered or committed suicide, Kliff reports.

Many clinicians who make errors then must continue seeing patients, Kliff says. "If they don't regain confidence in their skills, other patients could suffer," she writes.

Yet most of the time, clinicians don't talk about mistakes with their coworkers, and they feel isolated after an error.

"I remember there were people who just wouldn't engage. They wouldn't look at me," says Rick Boyte, a Mississippi pediatrician who had a young patient die after a medical error. "I felt so amazingly terrible."

Jarring statistics prompt renewed concerns about doctors' mental health

Most clinicians don't think their colleagues experience emotional distress after an error, which increases their sense of isolation, Kliff reports.

Many clinicians say they do not receive support from their organizations, either. In a 2007 survey conducted by the University of Missouri, 175 providers said a patient safety event in the past year caused them anxiety, depression, or other personal issues—and 68 percent of those respondents said they did not receive any institutional support.

Hospitals take action

The survey prompted Sue Scott, a patient safety expert at the University of Missouri, to launch a hotline that university providers could call 24/7 for peer support after an adverse event.

The hotline does not require callers to provide identifying information and doesn't have a relationship with the hospital's legal department, Kliff reports.

Missouri's hotline was the first of its kind in the United States, and perhaps the world, Kliff says. About a dozen hospitals have launched 24/7 hotlines since.


The hotlines can be controversial. "There is real resistance in places," Wu says. "Some of that comes from patient advocates or injured patients ... where they view themselves as having being victimized by the health care system. So the idea that there should be service provided to the perpetrator gets met with some pushback."

Hospital legal departments also can be concerned that the hotlines could affect clinicians' liability in malpractice lawsuits if information ends up being subpoenaed. Rick van Pelt, who helped set up Brigham and Women's Hospital's hotline, said the organization had "to be really careful making sure [the hotline] was about well-being, and not about getting information that could ultimately be subpoenaed."

In addition, it can be difficult to measure whether the hotlines are working, given their emphasis on anonymity. And encouraging clinicians to speak openly about their mistakes represents a culture shift for some providers, Kliff writes.

Steve Pratt, who helped establish Massachusetts General Hospital's provider support program, says that concern about patients' well-being, more so than the trauma that providers experience, could ultimately lead organizations to provide more support.

"The idea that another patient could be harmed—that the error would hurt someone else receiving care —ultimately will" be what drives change, he says (Kliff, Vox, 3/15).


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