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Physicians may turn to a colleague for solace or advice after a medical error, because a
colleague is uniquely positioned to provide personal validation, reassurance, and pro-
fessional affirmation. Such discussions with colleagues may be beneficial unless the
individual attempts to minimize the mistake in an effort to avoid emotional concern
[ 21 ]. In the study by Luu et al. [ 13 ], it took some time for the participant surgeons to
speak clearly and deeply about their role in the mishap during the acute phase. In the
initial time following an acute event (i.e., first 24–48 h), surgeons spoke quite clinically
about the facts of the case, but once into recovery, deeper reflections about the surgeons
role in the mishap surfaced. Meeting with the patient who was harmed seems to also
combat some of the negative feelings associated with the event [ 63 , 65 ], although it
may not be as effective a coping mechanism as discussing the event with medical col-
leagues [ 64 ]. Physicians may also benefit from seeking professional help to deal with a
complication [ 64 ], although only a minority of physicians report doing so [ 19 ].
In a study by Scott et al., a defining moment is described in which the physician
can either drop out, survive, or thrive following adverse events [ 18 ]. Similarly, Luu
et al.’s study suggests that cumulative reactions over time either had a long-term
personal growth effect, where surgeons were able to face errors head on and learn
from them, or a long-time negative effect, where surgeons were left feeling depleted
and wanting [ 13 ]. It is interesting to consider the difference between those that
thrive and those that drop out or simply survive in surgery. Will arming providers
with effective coping tools, including an awareness of the phases and emotional
effects described in this chapter, increase the likelihood of surgeons being able to
thrive following error? We suspect this will help, but ultimately a change in culture
is needed for providers to feel truly supported and accepted following these events.
Conclusion
Echoing Mutabdzic et al., it might be considered ironic that a surgeon’s cultur-
ally embedded value of performing strength and shunning vulnerability may be
the very thing that leads to surgeon burnout and ultimate weakness [ 60 ].
Returning to the Hippocratic Oath, it is well past time to move beyond the
unachievable myth of the ideal surgeon as one who will “do no harm” and,
instead, embrace the surgeon as a highly educated, talented, fallible human being
with the potential to improve her practice each day. A culture that strives for and
values perfection, and fosters invulnerability, leaves surgeons unable to discuss
their mistakes openly and transparently, let alone their own emotions surround-
ing these events. The modern version of the Hippocratic Oath includes a call to
embrace vulnerability, to call for help when needed, and to put the patient before
all else [ 1 ]. When faced with the implications of our current culture on surgeon
improvement, surgeon learning, and surgeon wellness, it is clear that it is time for
surgical culture to shift toward these ideals. It is time for a change.References
- Tyson, Peter. “The Hippocratic Oath Today” PBS.org. http://www.pbs.org/wgbh/nova/body/
hippocratic-oathtoday.html 03/27/01. Accessed February 10, 2017.
M.H. Mobilio and C.-a. Moulton