Physician Mentor Helps Colleagues Ease the Trauma of Medical Mistake
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Added: 05/19/2004
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Physician Mentor Helps Colleagues Ease the Trauma of Medical Mistake
“Conscientious physicians are often deeply traumatized upon discovering they have made a medical mistake. Shock, horror, disbelief even a full-blown acute stress reaction, and sometimes posttraumatic stress disorder can result,” explains physician mentor, Barry Bub, M.D., on his way to the 2004 Annual Meeting of the American Psychiatric Association (APA) in New York City, carrying a heavy case of river stones that will be used in his workshop, “The Trauma of Medical Mistakes: An Experiential Workshop.”
“Litigation adds immeasurably to physicians’ trauma. Many physicians then isolate themselves becoming withdrawn or aloof. Others suppress their emotions with work, alcohol, or drugs. They begin to practice defensively, ordering unnecessary tests that cost the healthcare system billions of dollars annually. Ironically, the initial trauma often shuts them down as communicators, increasing their risk of future litigation,” adds Dr. Bub, founder and director of Advanced Physician Awareness Training. The May 5 workshop, designed as a ritual for an intimate group, was similar to one conducted at a conference on physician health cosponsored by the American and Canadian Medical Associations in Vancouver, Canada, in 2002.
“This was an extraordinary experience to help physicians who have made occasional errors, not to carry an overwhelming burden with them throughout their practice and lives,” says workshop cochair Dr. Leah Dickstein, professor of psychiatry at the University of Louisville School of Medicine and an associate dean for faculty and student advocacy. “It was an incredibly unifying experience, as these traumas are not normally verbalized, so physicians may think they are the only one who has experienced such trauma, but in this situation they were among colleagues in their specialty, and it was an opportunity for people with courage to share their experiences. Some shared their stories with the entire audience, while others spoke about their traumas as they were paired with a partner, one on one.” Dickstein concludes, “All participants learned that they were not inferior or incompetent, as this healing process began. While they won’t forget their error, the physicians realize that they are human beings and will not continue to be weighted down by the guilt they were carrying.” Dickstein was recently chosen as one of 20 female psychiatrists (among 339 female physicians from the Civil War to the present) featured in the interactive exhibition, Changing the Face of Medicine, on view at the National Library of Medicine in Bethesda, MD.
“Society offers no sanctuary for safe release, nor community of caring to hold the anguish of physicians,” states Rabbi Goldie Milgram, Dr. Bub’s wife and partner in facilitating the workshop. “The pillorying they experience in the press and legal system diminishes the nobility of the dedication of their lives as healers. We cannot afford to have our finest trained health professionals so damaged.” The workshop was inspired by a Biblical ritual for helping people to forgive the unintentional mistakes of leaders. Rabbi Milgram explains, “When I saw the text of Leviticus 4:22-26, I thought how impressive, this ancient wisdom tradition didn’t seek to overturn or shame a leader for an unintentional mistake. Instead, they creatively applied the sacrificial system to acknowledge the mistake before the community, creating the basis for communal forgiveness. In speaking with my husband, he agreed - medicine needs to reclaim some version of this.”
“So we adapted the ritual by creating a simple ‘altar of awareness.’ After reminding participants that the word doctor means teacher, participants engaged in a ritual honoring their most memorable teachers,” explained Dr. Bub. “Having connected them to the noble lineage of medicine as a learning/teaching profession, participants were then led through guided imagery that transformed the river stones they were holding into the metaphoric burden of their medical mistake upon their spirits. They then wrote their principle emotions on the stone. Words such as shame, guilt, fear, and sadness were most frequently used. After sharing with a partner, the stones were placed on the altar, followed by a flower symbolizing the pain and suffering of their patients.” Rabbi Milgram added, “For many, expressing their emotions in a community of support for the very first time was an intensely moving experience, one that will assist in freeing them to learn from their mistakes rather than suffer from them.”
This workshop represents just one component of offered by Dr. Bub through his Advanced Physician Awareness Training. This program, designed for medical professionals, assists physicians in enhancing their communication and relationship skills with patients, through both private mentoring sessions and workshops offered across North America. Bub is also the author of Communication Skills that Heal (Radcliff Medical Press, Fall 2005). His dynamic, experiential trainings have been offered by NAJC, NICABM, APA, and AAPP. He has taught at medical schools and in hospital systems, such as the University of Minnesota and Kaiser Permanente, as well as at retreat centers, including Esalen and Elat Chayyim. A leader in the AMA Physician Health Initiative, his mentoring articles such as “Listening Myths in Medicine” appear in Medical Economics. His extensive professional background includes graduation from the University of Cape Town Medical School; certification in Gestalt therapy; membership in the New York Gestalt Institute; chaplaincy training at the Hospital for Special Surgery; twenty-five years experience in family practice in Pennsylvania, also serving as a residency preceptor and president of the hospital medical staff; and at AJR-NYC, developing curriculum and teaching on communication and brief counseling skills. |
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