"In medicine, every one of us has faced a major challenge, one that had the potential to take a huge emotional toll."
The practice of medicine is filled with immense rewards and challenges. Our training and culture have explicitly stated and implicitly implied that the challenges are just part of our job and that we should be strong and not let the challenges affect us emotionally. Somehow, we are meant to not feel, acknowledge that we are feeling, or process whatever feelings we have after sometimes devastating clinical traumatic events. While this denial is reasonable in the moment – where we must focus on our patients and their families – it is not a sustainable long-term practice. It is not sustainable for our own wellbeing or careers, and it is not sustainable for our capacity to give compassionate and wise care to our patients.
MAKING THE CASE FOR PEER SUPPORT
At no time are the emotions so intense as after we have made a medical error. The literature is replete with the negative emotional impact on clinicians who are involved in inadvertently causing harm to their patients. These effects can lead to burnout, depression and even suicide. We have not yet moved entirely from a culture of shame and blame to a culture of psychological safety. This failure to fully change the culture ultimately limits the learning in the organization and therefore also limits the improvement in safety and quality of our patient care. In addition, the involved clinician’s emotions can have an unintended negative impact on the communications with their patients and patients’ families: it is nearly impossible to be transparent and compassionate when feeling ashamed and fearful. A truly accountable organization will need to support the clinicians after involvement in patient harm.
BUILDING BLOCKS FOR PEER SUPPORT PROGRAM
Due to the barriers for clinicians seeking out support for themselves, it is important to have peer support be a reach-out program rather than requiring that the clinician self-identify as needing support. In addition, peer support should be a preventative intervention, rather than waiting for a colleague to experience prolonged suffering. As such, the peer support intervention needs to be proactively offered after an event. Events such as errors, being reported to the Board of Registration, being sued, etc. should all be automatic triggers for offering peer support. The program therefore should be woven into the fabric of the organization.
Leadership support – making the case for why this program is crucial and why it needs resources
Choosing a clinician or group of clinicians to lead the program – frequently these are the wellbeing committee or champions, supported by clinical leadership.
Collaborating, engaging and informing various groups about the program (e.g., risk management, patient safety, legal and other clinical leaders) – these groups will need to both approve of the program as well as often being the sources of referrals for peer support.
Deciding to which groups you will offer peer support (e.g., everyone on the clinical team; physicians and APPs or only physicians) - this depends upon resources and structure of the organization.
Selecting peer supporters based on nomination by peers and/or chosen by clinical leaders – this is preferable to self-nomination as not everyone who thinks they would be an effective peer supporter would in fact be.
Training peer supporters – because formal peer support differs from informal peer support and mental health support, being a peer supporter requires different skills that should be taught rather than assumed. They need specific training in how to reach out to peers; how to be present for their peers; how to balance listening with eliciting coping strategies and sharing when appropriate.
Deciding how to assign peer supporters – this will depend upon who is trained and available at the time of the event. Considerations include, for example, the seniority of the colleague to whom the peer support will be offered and the colleague’s discipline and specialty.
Supporting the supporters – quarterly meetings for the peer supporters to reconnect as a community, debrief, and practice peer support interventions.
Keeping a de-identified database for program utilization
Assessing the impact on the peer who were supported – this can be done with an anonymous on-line survey, for example
Peer Support Resources
PUBLICATIONS & RESEARCH
Physicians’ needs in coping with emotional stressors: The case for peer support. Hu Y, Fix M, Hevelone N, Lipsitz S, Greenberg C, Weissman J, and Shapiro J. JAMA Surg 2012; 147(3):212-217.
Emotion and coping in the aftermath of medical error: A cross country exploration. Harrison R, Lawton R, Perlo J, Gardner P, Armitage G, Shapiro J. Online Jrl Patient Safety 2013.
Wisdom in medicine: What helps physicians after a medical error. Plews-Ogan M, May N, Owens J, Ardelt M, Shapiro J, Bell SK. Acad Med. 2015 Sep 4. [Epub ahead of print].
The impact of adverse events on clinicians: what's in a name? Wu AW, Shapiro J (co-corresponding author), Harrison R, Scott SD, Connors C, Kenney L, Vanhaecht K. J Patient Saf 2016 (in press).
Peer support for clinicians: a programmatic approach. Shapiro J, Galowitz P. Acad Med. 2016 Sep;91(9):1200-4.
Well-being in medical education: A call for action. Ripp JA, Privitera M, West C, Leiter R, Logio L, Shapiro J, Bazari H. Acad Med. 2017 Jul;92(7):914-917.
We Have Enough Information to Act. Shapiro J. Otolaryngol Head Neck Surg. 2018;158(6):985-986.
PEER SUPPORT IN THE MEDIA
Narrating Medicine: Offering a Shoulder When a Doctor Might Need It National Public Radio/WBUR CommonHealth blog, October 2016.
As patients turn violent, doctors and nurses try to protect themselves STAT (a national publication from Boston Globe Media Partners), November 2015.
Many Brigham workers sought help from peer counseling Boston Globe, March 2015.
Forgiving ourselves for being human: Normalizing the isolating experience of adverse events Arnold P. Gold Foundation's Humanism in Medicine blog, October 2014.
The Crisis of Burnout Among U.S. Physicians Academic Medicine AM Rounds blog, February 2014.
PODCASTS, WEBINARS & VIDEOS
Caregiver Wellness Through Peer Support and Community In A Time of COVID-19
Beth Israel Lahey Health Primary Care Team this Thursday at noon. Dr. Jo Shapiro participates in an organizational-wide virtual forum with the Beth Israel Lahey Health Primary Care Team hosted by Dr. Matt Germak.
AAO-HNS Coronavirus Disease (COVID-19) Podcast Series Episode 6: ENTs Personal COVID-19 Experiences [April 3]
William R. Blythe, MD, AAO-HNS Board of Directors, and Partner at East Alabama ENT is joined by Jo A. Shapiro, MD, Associate Professor of Otolaryngology-Head and Neck Surgery at Harvard Medical School, and founder of the Center for Professionalism and Peer Support at Brigham and Women’s Hospital (and who is currently recovering from COVID-19), and Julie L. Wei, MD, Division Chief of ENT and Audiology at Nemours Children’s Health System and Director of Resident and Faculty Wellbeing, discuss the importance of physician wellness during the COVID-19 pandemic.
AAO-HNS Coronavirus Disease (COVID-19) Podcast Series Episode 10: Physician Wellness (Peer Support) [April 27]
Jo A. Shapiro, MD, Associate Professor of Otolaryngology-Head and Neck Surgery at Harvard Medical School, and founder of the Center for Professionalism and Peer Support at Brigham and Women’s Hospital, is joined by William R. Blythe, MD, AAO-HNS Board of Directors, and Partner at East Alabama ENT; Sonya Malekzadeh, MD, AAO-HNS Board of Directors, Professor of Otolaryngology, and Director of the Residency Program at Georgetown University School of Medicine, and Assistant Chief of Surgery at the Washington, DC VA Medical Center; and Julie L. Wei, MD, Division Chief of ENT and Audiology at Nemours Children’s Health System and Director of Resident and Faculty Wellbeing, in a peer support session during the COVID-19 pandemic. The podcast is also offered in a Video Version.