Waking up the next morning: surgeons’ emotional reactions to adverse events
Article first published online: 21 NOV 2012
© Blackwell Publishing Ltd 2012
Volume 46, Issue 12, pages 1179–1188, December 2012
How to Cite
Luu, S., Patel, P., St-Martin, L., Leung, A. S., Regehr, G., Murnaghan, M. L., Gallinger, S. and Moulton, C.-a. (2012), Waking up the next morning: surgeons’ emotional reactions to adverse events. Medical Education, 46: 1179–1188. doi: 10.1111/medu.12058
- Issue published online: 21 NOV 2012
- Article first published online: 21 NOV 2012
- Received 17 December 2011; editorial comments to authors 30 March 2012; accepted for publication 23 July 2012
Medical Education 2012: 46: 1179–1188
Context The adverse patient event is an inherent component of surgical practice, but many surgeons are unprepared for the profound emotional responses these events can evoke. This study explored surgeons’ reactions to adverse events and their impact on subsequent judgement and decision making.
Methods Using a constructivist grounded theory approach, we conducted 20 semi-structured, 60-minute interviews with surgeons across subspecialties, experience levels, and sexes to explore surgeons’ recollections of reactions to adverse events. Further interviews were conducted with six general surgeons to explore more immediate reactions after 28 adverse events. Data coding was both inductive, developing a new framework based on emergent themes, and deductive, using an existing framework for care providers’ reactions to adverse events.
Results Surgeons expressed feeling unique and alone in the depths of their reactions to adverse events and consistently described four phases of response, each containing cognitive and emotive components, following such events. The initial phase (the kick) involved feelings of failure (‘Am I good enough?’) experienced with a significant physiological response. This was shortly followed by a second phase (the fall), during which the surgeon experienced a sense of chaos and assessed the extent of his or her contribution to the event (‘Was it my fault?’). During the third phase (the recovery), the surgeon reflected on the adverse event (‘What can I learn?’) and experienced a sense of ‘moving on’. In the fourth phase (the long-term impact), the surgeon experienced the prolonged and cumulative effects of these reactions on his or her own personal and professional identities. Surgeons also described an effect on their clinical judgement, both for the case in question (minimisation) and future cases (overcompensation).
Conclusions Surgeons progress through a series of four phases following adverse events that are potentially caused by or directly linked to surgeon error. The framework provided by this study has implications for teaching, surgeon wellness and surgeon error.