Conversations in Medicine Symposium
Johns Hopkins University
Dr. Albert Wu
November 19, 2014; 8:00 p.m.
Caring for the caregivers can be just as important as caring for the sick when it comes to running a hospital, Dr. Albert Wu told a packed audience at the second Conversations in Medicine event of the fall term on November 19. In his presentation, Wu outlined strategies for supporting healthcare providers when they face loss, trauma, or stress in their daily work.
"Medicine is a privileged profession, but there are inherent hazards too," Wu said. And all too often, he stresed, doctors, nurses, and other caregivers fail to ask for help.
Wu opened with a compelling anecdote about his first day of subinternship on the wards. In the heat of the moment during a terrifying code (when a patient's heart is failing), he accidentally injected the patient with a dose of morphine that was far too high. He described having an "acute stress reaction," in which he felt like his heart failed - paralyzed with fear, he wasn't calm again until the patient recovered from the stupor he had accidentally induced. He remembers every detail of the conversation he had immediately afterwards with a nurse: "I don't think anyone needs to hear about this," she told him.
Reflecting back on that harrowing experience, Wu now believes the nurse's attitude typifies a common but very counterproductive response. He has since coined the idea of the “second victim," referring to caregivers who are traumatized by stressful patient-related events.
He told another story in vivid detail about a set of physicians who failed to intubate a young patient who couldn't breathe. Everyone had done their job to the best of their abilities, but the outcome was tragic.
Students enjoyed snacks and further discussion after the presentation.
"They hadn't made any mistakes, but they had failed in a very big, public way."
One of the physicians involved in the epiosde ultimately quit medicine altogether - which Wu views as a further tragedy.
"This was a big miss on the part of the instutition - they failed to support them," he said.
Caregivers may experience flashbacks, impairment in functioning, and avoidance symptoms after a traumatic event. There are things that peers and supervisors can say and do, Wu emphasized, to prevent deeper damage. But far too often, other doctors will project the sentiment, "thank goodness it isn't me," and distance themselves. A culture that helps physicians and others learn from mistakes and grapple with their emotions will ultimately produce more effective, capable, and emotionally sound caregivers, he said.
Wu discussed an initiative he is involved in called "Resilience in Stressful Events" (RISE), which focuses on providing "timely support to employees who encounter stressful, patient-related events." One tool is to remember to provide a RAPID response, involving Reflective listening, Assesment of needs, Priotitization, Intervention, and Disposition.
"Changing culture is hard," he noted. "But being cognizant can change the culture a little bit."
Wu is an internist who holds joint appointments at the Johns Hopkins University School of Medicine and School of Public Health, where he works to improve patient outcomes, safety, and quality of care.
By Julie R. Barzilay
Dr. Wu was introduced by friend and colleage Dr. Donald Steinwachs, the Chair of the Dept. of Health Policy and Management at the Bloomberg School of Public Health
Dr. Wu tells the audience about the hazards of alienating caregivers who have been through a traumatic event (middle). Above, CiM Directors Yi Shao and Nina Modanlo thank Wu for his presentation.