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characterized by a visceral response of tachycardia, anxiety, and self-deprecation.
In this phase, surgeons described a physiological response upon hearing of the
adverse event. Whether it was at the bedside, at the operating table, over the phone,
or elsewhere, surgeons described a similar response that included a physiological
component. This phase was also associated with a sense of inadequacy and shame.
Surgeons described wanting to hide and run away. One surgeon described almost
running into four parked cars in the parking lot after he heard the news. Others
described a preoccupation after hearing about the adverse event such that they could
not focus on any other activity. Following this initial phase, surgeons progressed to
the next, categorized as the fall. Here, surgeons sought to figure out, “how much of
this was my fault?” This phase centered on the surgeon seeking information—
answers to questions about their role in the error, looking up journal articles around
similar complications, talking to colleagues, and, when relevant, rehearsing the
event over and over in their heads. Participants described the presence of a “black
cloud” or “pall” that affected their emotional well-being as well as their personal
and professional lives. Surgeons acknowledged that the impact was typically greater
if a direct link between their actions and the adverse event could be established. The
third phase, the recovery, focused around communication of the event to colleagues.
For many, it was easier to discuss the details of the case rather than the emotional
impact it had on them personally. The recovery phase appeared to be marked by a
commitment to improve in their practice. Surgeons did not want the patient’s suffer-
ing to be for nothing. By reframing the adverse event into a learning experience,
participants appeared to begin the process of granting themselves permission to
“move on.” The final phase, the long-term impact, left a positive or negative impres-
sion on the physician depending on how they viewed the adverse event and in some
instances resulted in a change to their scope of practice. While most surgeons saw
the long-term impact of each adverse event in a negative light, a few described posi-
tive impacts, such as increased humanity or emotional maturity within themselves
that came from a connection to the patient and/or the patient’s family after these
events occurred.
It noteworthy that the authors of this study could not find a surgeon that did not
describe experiencing these reactions in their practice. Without exception, partici-
pants admitted to being affected by adverse events in similar ways, and many wanted
to talk further about their reactions with the researchers after the study was com-
pleted. Following publication of the study, numerous surgeons—ranging from local
to international—have contacted the senior author to share stories of their own
experience. It is critical to highlight this point, as many surgeons continue to feel
they are unique or “odd” as they are left to deal with their emotions around adverse
events. These feelings can contribute to surgeons feeling isolated at an extremely
vulnerable time in their practice and ultimately surgeon burnout. We will return to
these vitally important issues later in this chapter.
Awareness, then, is the first step toward a healthier experience around adverse
events for surgeons. Naming the phases as individuals experience them is an impor-
tant step toward understanding and is likely quite helpful for surgeons to see that
their experience is shared by so many. Understanding the ubiquitous nature of these
M.H. Mobilio and C.-a. Moulton