Physicans and Nurses Traumatized By Medical Errors

Alexandra Laurent Maître de conférences de psychologie clinique et psychopathologie Laboratoire de psychologie EA3188 Université de Franche-Comté Interview with :
Alexandra Laurent

Maître de conférences de psychologie clinique et psychopathologie
Laboratoire de psychologie EA3188
Université de Franche-Comté

Medical Research : What is the background for this study? What are the main findings?

Dr. Laurent: Human error among healthcare professionals is a subject of current affairs and especially in ICUs which are among the services with a high risk of error. If the error affects the patient and his/her family, it will also have an impact on the caregivers involved, their colleagues, and even the entire service. In an editorial in the BMJ, Wu introduced the term “the second victim” to define a caregiver implicated in and traumatised by an medical error for which he/she feels personally responsible. Therefore, it’s important to improve understanding of the psychological repercussions of error on professionals in ICUs, and to identify the defense mechanisms used by professionals to cope with errors.

In the month following the error, We found that the professionals (doctors and nurses) described feelings of guilt and shame. These feelings were associated with: anxiety states with rumination and fear for the patient; a loss of confidence; an inability to verbalize one’s error; questioning oneself at a professional level; and anger towards the team.

In the long term, the error remains fixed in memory with, on one hand, for 72.5%, an increase in vigilance and verifications in their professional practice and, on the other hand, for 3 professionals, a loss of confidence. Finally, 3 professionals felt guilt which still persisted at the time of the interview.

We also observed different defense mechanisms implemented by the professional in order to fight against the emotional load inherent in the error: verbalization, developing skills and knowledge, rejecting responsibility, and avoidance. We also observed a minimization of the error during the interviews.

Finally, our study shows that is important to take into account the psychological experience of error and the defense mechanisms developed following an error because they appear to determine the professional’s capacity to acknowledge and disclose his/her error, and to learn from it.

Medical Research: What should clinicians take away from your report?

Dr. Laurent: The challenge for developing a policy of security of care is: the need to verbalize errors in order to learn from them. However, before encouraging the ‘disclosure of error’, one must take into account the professional’s experience and the way in which he/she copes with it. Our results show that the effects of shame and guilt felt by the professionals following an error impact the ability of the subject to disclose his/her error and, by doing so, to receive the support of the group to cope with the event. We observed that the effects of shame and guilt were accompanied by defence mechanisms which served to reduce the emotional load and enabled the professional to continue working. On the other hand, these same defence mechanisms hinder the subject’s ability to acknowledge the error and to learn from it. Choosing trustworthy healthcare is necessary for your wellbeing as it allows you to enjoy your stay stress-free. However, it is still recommended that you get in contact with some personal injury attorneys, just in case, the worst should happen.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Laurent: The MMRs (Mortality and Morbidity Reviews) and/or the creation of a space for discussion within the services such as debriefing could facilitate the disclosure of error, we must advance with caution. Our research shows that there are dangers in insisting that the professional talk about his/her error if the service has not installed a sufficiently reassuring and comprehensive work climate beforehand. The seniors and heads of departments have an important role to play in this climate of confidence because it is essential that the error be discussed without fear and without fear of judgement, a reprimand or professional disqualification. However, this does not imply minimising the caregiver’s responsibility for an error. On the contrary, support in the face of error serves to restore the caregiver’s self-confidence and facilitates discussion of the repercussions of the error in order to learn from it. There are many different types of medical malpractice that you may not even be aware of so be sure to read a guide all about these types.

Thus, an ICU culture that encourages caregivers to acknowledge and take responsibility for their errors empowers them in situations that can initially be perceived as hopeless and out of control.

Citation :

Laurent A., Aubert L., Chahraoui K., Bioy A., Mariage A., Quenot JP., Capellier G. (2014). The error in intensive care: psychological repercussions and defense mechanisms. Critical Care Medicine, 42, 11, 2370-2378