Where is our support…

On Wednesday 6/11 we discussed the case of “Sally,” a 9 year old girl who died because of medical errors. Regardless of how you look at it, this is a tragedy. In our discussion, the presenter described why this resident was “set up to fail.” The resident had undergone numerous emotional battles in the prior months on the wards and in the ICU, had struggles outside of the hospital, and unlimately quit the residency program as a result of Sally’s death, but there was not one discussion on Wednesday about how we should care for our residents. Unfortunately, this resident’s story is all too common. Many of our Telluride attendees sympethized with the resident outlining how similar their experiences have been to Sally’s resident. I too can look back and see myself in that position.

It is well documented in the literature that residents, regardless of profession, develop higher rates of depression and suicide than the general population as a result of our profession (1, 2, 3). Up to 20% of residents and medical students will face depression, and up to 74% of residents will face burnout. Those residents who battle with depression are six times more likely to cause medical errors than those residents who do not suffer with depression. While it is easy to point the finger at the resident or the system for causing medical errors, and, at the same time, provide support for the family and the patient, there are few programs in place that support our residents and medical students. These are individuals who choose the medical field to cure pain and suffering, not cause them. When residents discover that, despite their best knowledge, skill, and intention they harm someone, it is absolutely devistating!

Do not get me wrong. I completely agree that we should first tend to the patient and family that has been effected. However, we cannot forget about the second patient that was harmed: the resident. We need systems that automatically fire to debrief residents when harm occurs so they can learn from the event. We need systems that automatically fire to find systematic solutions to the problem so no other patient is harmed. We need systems that automatically fire to provide support for patients and families who suffer harm. However, we also need systems that automatically fire to provide emotional support for our residents when they are involved in a case of patient harm. Finding that you were part of the cause for patient harm can have a devastating and lasting effect on a resident. Residents are already a set up for depression which, as mentioned, is then a set up for further medical errors. These two perpetuate each other in a never ending cycle. We need to break the cycle. We need support!