Coping with a Terrible Error by Simon Carley
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Error is almost inevitable in our clinical practice so we should be prepared to help and prepare those individuals involved for the benefit of them, our systems and our patients. Do you remember that patient you saw last night?': A phrase the strikes terror into the hearts of all physicians. The prospect of a patient coming to harm as a result of a mistake is terrifying but it can and does happen. The consequences for the patient and their family are often tragic but what of the clinicians who made the error? For many the result of making a terrible error is life changing. Those permanently harmed by error are often referred to as second victims with the consequences of terrible events being life-long. This talk explores the predictable course for clinicians who are involved in error and asks whether we can prepare and support such individuals through a difficult time.
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Coping with a Terrible Error by Simon Carley
- 1. a terrible error Simon Carley
- 2. short stay
- 5. feel
- 6. panic
- 7. radiology
- 8. path
- 9. experts
- 11. personal
- 12. clinical
- 16. second victims
- 17. Medical Error: the secondVictim A.Wu. BMJ 2000 Second victims are healthcare providers who are involved in an unanticipated adverse patient event, in a medical error and/or a patient related injury and become victimized in the sense that the provider is traumatized by the event. Frequently, these individuals feel personally responsible for the patient outcome. Many feel as though they have failed the patient, second guessing their clinical skills and knowledge base.
- 18. Medical Error: the secondVictim A.Wu. BMJ 2000 Second victims are healthcare providers who are involved in an unanticipated adverse patient event, in a medical error and/or a patient related injury and become victimized in the sense that the provider is traumatized by the event. Frequently, these individuals feel personally responsible for the patient outcome. Many feel as though they have failed the patient, second guessing their clinical skills and knowledge base.
- 19. predictable course for second victims.
- 20. Chaos chaos
- 26. Williams 1999
- 28. are we helpless?
- 29. what works?
- 30. resilience
- 32. It is not the stress… it is the state of mind, that matters when one is stressed Hans Selye
- 36. what happened?
- 38. Be Kind
- 39. thank you
- 42. Why bother?
- 43. Enduring the inquisition The inquisition GMC HIPAA Families Coroner
- 44. ED days
- 45. In no relationship is the physician more often derelict than in his duty to himself (herself).
- 46. monitor incidents contact supervisors Mentors Parallel support for second victims Other things - develop emotional understanding Schwartz rounds - build emotional and psychological understanding of how people feel not just what happens. Organisations
- 47. Understanding of self and self mastery Interactions with others and wider world Meaning beyond self- values-goals-focus Positive approach-perspective Personal growth Care of health Learning from overcoming challenges understanding self social interactions meaning beyond self health learning from error
- 48. Organisations Contact clinical staff Reaffirm your confidence Give time and space Keep informed Let them know you care Be visible to all staff members. Teach resilience Guide don’t dictate
- 49. Clinicians get harmed too You may become a second victim You will certainly meet second victims There is a predictable course to recovery You can personally prepare You can organisationally prepare You can personally support You can organisationally support
- 50. FOR SUFFERERS Be honest Don’t rationalise Ask for help Prepare
- 51. Personal impact Professional impact
- 52. Serious event Chaos Intrusive reflections Restoring personal integrity Enduring the inquisition Obtaining emotional first aid Moving on Dropping out Surviving Thriving
- 53. “a health care provider involved in an unanticipated adverse patient event, medical error and/or a patient related-injury who become victimised in the sense that the provider is traumatised by the event.
- 54. “a health care provider involved in an unanticipated adverse patient event, medical error and/or a patient related-injury who become victimised in the sense that the provider is traumatised by the event. Frequently, second victims feel personally responsible for the unexpected patient outcomes and feel as though they have failed their patient, and feel doubts about their clinical skills and knowledge base.”