One-Third of Surgeons Suffer Traumatic Stress After Serious Patient Complications By James E. Barone August 25, 2014 ................................................................. NEW YORK (Reuters Health) - According to a new study, more than a third of surgeons experienced clinically concerning traumatic stress after having a patient with a serious complication. Respondents who were general surgeons and who used self-distraction more often as a coping mechanism were more likely to meet the criteria for acute traumatic stress on the Impact of Events scale. Surgeons perception of the controllability of the cause of the complication, the severity or timing of the incident, and surgeon characteristics were not related to the incidence of acute traumatic stress. In an email to Reuters Health, senior author Dr. Anna Pinto said, We expected the perceived locus or controllability of the complications to be associated with higher levels of stress, as this is supported by our interview findings and wider literature on causal attributions and stress. She felt the lack of significant associations could be due to the small sample size of the study or the use of single-item scales to assess this point. Dr. Carol-Anne E. Moulton, an associate professor of surgery at the University of Toronto, has done research on stress and surgeons. She said, Like the authors, I was surprised that surgeons who thought they were more to blame for the complication did not experience stress more often as many other studies would contradict this finding. She added that in one of her studies, surgeons described a sense of relief if they could identify a link that was not directly related to what they did. The investigators, from the Imperial College in London and the University of Oxford, gave questionnaires to 73 surgeons, 54 of whom completed the survey. Seven were excluded for not having had a patient with a major complication, leaving 47 responses (64.4%) for analysis. The surgeons worked at three different National Health Service hospitals in London; 60% were general surgeons. Although almost two-thirds were trainees, they had an average of 6.2 years of experience. As described in the paper, published online in the American Journal of Surgery, they were asked to recall events surrounding their most recent major surgical complication. In addition to the Impact of Events scale, the use of surgeons coping strategies was measured with the Brief-COPE tool, and the Hospital Survey on Patient Safety Culture was used to determine the degree of punitive response to mistakes by hospitals. The authors found that 36.2% of surgeons experienced clinically concerning traumatic stress after having a patient with a serious complication. Self-distraction was the only significant coping mechanism associated with acute traumatic stress (p = 0.002), and surgeons with clinically concerning acute traumatic stress more frequently used self-distraction than those who were not acutely stressed (p = 0.006). Dr. Moulton agreed that self-distraction and the incidence of acute traumatic stress are associated. She said, The more you are traumatized, the more you try to put it out of your head. But she questioned the authors suggestion that surgeons who use self-distraction are at higher risk of experiencing stress. Acute traumatic stress occurred more often in hospitals with a punitive response to complications (p = 0.047). A lot of surgeons feel that blame is still prevalent in the NHS and it is one of the key factors that exacerbate their reactions of stress in the aftermath of serious adverse events, said Dr. Pinto. Responses from general surgeons indicated that 53.6% scored above the cut point for acute traumatic stress of clinical concern compared to 15.4% of vascular surgeons (p = 0.021). On hierarchical multiple logistic regression analysis, the only two factors that were significantly associated with the occurrence of traumatic stress were being a general surgeon and more frequent use of self-distraction to cope. Dr. Pinto suggested some ways to help surgeons cope with complications more effectively, such as a formal mentoring system that is introduced early on during surgeons training, M&M meetings that function as learning forums rather than opportunities for personal rivalries, and improved teamwork practices within surgical teams. Dr. Moulton, who was not an author of the paper, feels that surgeons have a culture of perfection with little acceptance of mistakes. She said it is important to let trainees know how prevalent the traumatic stress response to complications is, and how it might affect them. SOURCE: bit.ly/1ADZ8Cs medscape/viewarticle/830349
Posted on: Fri, 26 Sep 2014 01:38:06 +0000
Trending Topics
Recently Viewed Topics
© 2015