by MELINDA AQUINO, M.D., & SERGEY V. PISKLAKOV, M.D.
What is wellness? While many anesthesiology departments across the country have “wellness programs,” the term “wellness” has been applied in different ways. The National Wellness Institute shares the following interpretation of wellness:
explains the ability of each individual to contribute to his or her environment and community. It allows for the building of better social networks. Using this model we become able to learn the benefits of regular physical activity, healthy eating habits, strength and vitality, as well as personal responsibility, self-care and when to seek medical attention. The model encourages self-esteem, self-control, and determination as a sense of direction and helps to encourage creative and stimulating mental activities, and sharing your gifts and abilities with others.2
For years, employers have realized that on-the-job factors significantly affect workers’ ability to perform their duties appropriately and to be productive. Burnout is a known concern in terms of staff rotation and retention. Burnout is a state of emotional, mental, and physical exhaustion caused by excessive stress. It occurs when one feels unable to meet constant demands. The epidemic of burnout has spread around the world. This epidemic did not leave healthcare untouched. Significantly higher burnout rates have been found among anesthesia providers. The high incidence of burnout was reported among anesthesiology residents and academic chairpersons. Individual factors, stress, family issues and lack of a supportive community can lead to exhaustion, inefficacy, and poor clinical performance.3
Burnout can be easily mistaken for substance abuse, depression, or a personality disorder. However, in the case of burnout the symptoms are job-site related and more about dissatisfaction rather than hopelessness and withdrawal, as one finds in cases of substance abuse or depression. Those who experience burnout feel empty and devoid of motivation, and are beyond caring. Physicians experiencing burnout often don’t see any hope of positive change in their situations. If excessive stress is like drowning in responsibilities, burnout is like being all dried up. There is one additional difference between stress and burnout: while you are usually aware of being under a lot of stress, you don’t always notice burnout when it happens.4
The term “second victim” refers to the healthcare professional who experiences emotional distress following an adverse event. This distress has been shown to be similar to that of the patient — the “first victim.” It leads to burnout as well. Common reactions can be emotional, cognitive, and behavioral. The coping strategies used by second victims have an impact on their patients, colleagues, and themselves. Because of this broad impact, it is important to offer support for second victims. It is critical that support networks are in place to protect both the patient and the involved healthcare providers. “Second victims” may experience lack of respect. This may be responsible for lack of workplace motivation and employee satisfaction, increased turnover, and a lack of trust and team building among anesthesia providers. It can cause serious damage to self-esteem and the ability to contribute.5
It is the duty of the anesthesiology department’s leadership to listen, to mediate, and to be proactive in such cases. The second victims of errors often suffer in silence. Support must begin the moment an adverse event or outcome occurs. We need to facilitate the second victim’s receptiveness to receiving help and to understand the enormous emotional toll that second victims endure. Second victims have a right to participate in the process of learning from the error. The support of peers and organizational leaders is paramount. Certainly, patients and family members who are harmed come first; however, it is also important to take care of the practitioners involved in the errors, especially when they meant to do good and now find themselves in a situation where a patient has been harmed by their unintended actions. Staff needs to be aware of available resources.
Second victims deserve the presumption that their intentions were good. Nobody should be blamed or shamed for human fallibility. Second victims need compassionate help to grieve and heal, and department leaders must understand the psychological emergency that occurs when a patient is
Some healthcare facilities have established special programs to prevent burnout and second victimization. These types of programs are still missing in the field of anesthesiology, however. Recently we established a Wellness Committee within the Montefiore Medical Center Department of
Anesthesiology. We started by establishing a baseline for assessing staff burnout. We used the Maslach Burnout Inventory, a measurement tool that grades burnout, a three-dimensional syndrome made up of exhaustion and inefficacy.6 We also created the position of ombudsman, an individual who will advocate on behalf of the rotating students, residents, fellows and attending faculty. To ensure confidentiality and independence, the position will be held by an attending physician who is not part of the department leadership.
Simple things like exercise, engaging in a hobby, and interacting with significant others are the best preventers of burnout. The role of an anesthesiology department is to enforce a respectful workplace environment. Burned out physicians can be taught the essentials of stress management and
shown techniques that will enable them to deal with stress, making it manageable and thereby improving their performance and increasing their value to the department.3 The most obvious tangible benefit of supporting a colleague is an enhancement of that individual’s personal efficiency, since he or she can then focus attention on patient care and productivity. ■
Melinda Aquino, M.D., is an assistant professor of anesthesiology, pain medicine and regional anesthesiology in the Department of Anesthesiology at Montefiore Medical Center. She is co-chair of the Department of Anesthesiology’s Wellness Committee.
Sergey V. Pisklakov, M.D., is an associate professor of anesthesiology in the Department of Anesthesiology at Montefiore Medical Center. He is also a member of the Department of Anesthesiology’s Wellness Committee.
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