Emotional Impact of Patient Safety Incidents on Family Physicians and Their Office Staff

Abstract

Objective: The objective of this study was to investigate the emotional responses and coping strategies that family physicians and their office staff reported in response to a patient safety incident.Method: Two questions contained in a patient safety incident report developed for a study of patient safety in family practice were analyzed. The questions asked reporters to indicate their emotional response to a patient safety incident and how they coped with it. A total of 264 confidential patient safety incident reports collected from September 2007 to August 2010 were analyzed.Results: An emotional response was reported on 82.4% of reports. Of those reports on which an emotional response was reported, a coping strategy was reported on 62.8%. The top 4 reported emotional responses were frustration (48.3%), embarrassment (31.5%), anger (12.6%), and guilt (10.1%). Physicians reported an emotional response more often than clinic staff. An emotional response was reported more often when there was a possibility of harm. Coping strategies were reported as follows: 52% talked to someone about the incident, 37.2% did nothing in response to the incident, 17.9% told the patient about the incident, and 3.6% did something else. Female physicians reported using coping strategies less often than male physicians. A coping strategy was reported more often when there was a possibility of harm. Conclusions: All members of the health care team report experiencing emotions related to patient safety incidents in their practice. Incidents with minor or no harm still invoked emotional responses from the providers. It is important to understand the impact that patient safety incidents have on the medical clinic as a whole. (J Am Board Fam Med 2012;25:177-183.) Keywords: Coping Skills, Family Medicine Research, Medical Errors, Patient SafetyA patient safety incident is an event or process that could have resulted or did result in unnecessary harm to a patient.1 Patient safety incidents affect both the patient and caregivers.2-4 Much work has been done studying the effect of incidents on patients, 5,6 but examining the effect on caregivers, also referred to as "the second victim," 2-4 is in its infancy. Previous studies have focused on the acute care system and medical residents [7][8][9][10][11][12][13][14][15][16] or a compilation of acute and primary care. [17][18][19][20] Only 2 studies have explored the emotional impact of incidents on primary care providers alone. 21,22 The first explored the emotional impact of the most memorable mistake on the family physician and his or her response to a hypothetical scenario. 21 The second used focus groups of family physicians and residents to develop a reference statement for the appropriate management of mistakes in the training environment. 22Other research, primarily in acute care, found that health professionals have varied emotional responses to incidents.

The need and availability of support systems for physicians involved in a serious adverse event

“…[5][6][7][8][9][10][11][12][13][14][15] In addition, our study brought up a distinction of three different ways in which interviewees (physicians) coped during their recovery process. In a hospital without an appropriate collegial support program, the extent to which support is given depends on the willingness of a close colleague to do so.…”

“…[4] Second victims feel confused and experience emotions of anger, anxiety, guilt, grief, self-criticism, and shame. [5][6][7][8][9][10][11][12][13][14][15] These emotions have an impact on both their professional and personal lives. [14,15] Second victims therefore need time to recover from adverse events.…”

What about doctors? The impact of medical errors

“…O'Beirne et al study in 2012 showed that 82.4% of doctors suffered from negative emotions following incidents related to patient safety. 9 Studies have also shown that even minor incidents and adverse events which resulted in no harm or complications to patients' health were associated with significant emotional response from health care providers. This was demonstrated with near miss events as well; one third of doctors reported negative emotions and increased stress at work as a result of near misses.…”

“…7 General physicians (GPs) reported suffering from frustration (48.3%), embarrassment (31.5%), anger (12.6%), and guilt (10.1%) following an adverse clinical event. 9 The life quality at work and job satisfaction are significantly affected following medical error. Feelings of increased anxiety, loss of confidence, sleeping difficulties, reduced job satisfaction, and fear of harm to their reputation were reported by many GPs following such events.…”

“…This was demonstrated with near miss events as well; one third of doctors reported negative emotions and increased stress at work as a result of near misses. 9,10 The emotional impact associated with medical error can vary widely in nature and severity. Doctors from different specialities who were involved in medical error situations reported persistent fear of errors (82%) and experienced loss of social trust (67%).…”