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EA20 Newsletter: Session ESAPD1: Second victim, burnout and more...how to prevent, how to cope?

Sunday 29 November, 1130-1230H – Channel 10

Never have stress and burn-out been more relevant topics than during 2020 with the COVID-19 pandemic sweeping the world.

The first presentation in this four-part session, on burnout, will be given by Professor Francis Bonnet – Tenon/St Antoine University Hospitals, Assistance Publique Hôpitaux de Paris, France and former President of the French Anaesthesia Society (SFAR).

“Burnout is a serious problem with an increased incidence among health care providers over recent years. The development of burnout is related to the overload of work tasks compared to the limitation of environmental and personal resources,” he explains. “Burnout syndrome needs to be prevented before the occurrence of serious consequences such as conflicts with other staff members or patients, medical errors and/or psychological distress leading to depression or even suicide.”

He will say that prevention begins with an analysis of subjects’ behaviours, identifying emotional exhaustion, depersonalisation, and lack of personal accomplishment. The management of medical staff plays a critical role in the prevention of burnout syndrome. “Goodwill management means recognition of the work of everyone in the team, favouring communication between healthcare providers and organising work tasks in order to avoid overload,” says Prof Bonnet. “Each member of staff must have the feeling that he or she is supported by others in daily practice as well as in professional objectives. Subjects demonstrating an overt syndrome have to be withdrawn from the workplace to allow recovery, that may take time. The most serious cases who experience depression or addiction require a special psychological or psychiatric support.”

To explain the concept of the ‘Second Victim’ in more detail, Assistant Professor Zeev Goldik, Lady Davis Carmel Medical Centre, Haifa, Israel, and Past-President of ESAIC, takes us back in time into British royal history. “Those of us who are old enough will remember the tragic death of Diana, Princess of Wales and the intense demonstrations and tributes of love she received,” he says.

However, the tragedy Prof Goldik will examine relates to another Princess of Wales, Charlotte of Wales, the only child of King George IV who died in childbirth in November 1817. Married to Prince Leopold, she tried several times to get pregnant and give birth without success until the year 1817 when she was only 21 years old.

Due to the importance of the pregnancy that the sole heir to the throne would bring, Sir Richard Croft (who was not a physician but what would be more considered today a male midwife) was entrusted to accompany the pregnancy from a medical point of view and conduct the delivery. When her medical team began prenatal care in August 1817, they put her on a strict diet, hoping to reduce the size of the child at birth. The diet, and occasional bleeding, seemed to weaken Charlotte.

The story of Princess Charlotte became the so-called “triple obstetric tragedy”. At nine o’clock in the evening of 5 November, Charlotte finally gave birth to a large stillborn boy. Efforts to resuscitate him were in vain. Then, soon after midnight, Charlotte began vomiting violently and complaining of pains in her abdomen and she finally died from bleeding.

“Although the post-mortem was inconclusive, many blamed Croft for his care of the Princess,” explains Prof Goldik. “Three months after Charlotte’s death and while attending another young woman, Croft picked up a gun and fatally shot himself.”

Croft was found dead with an open book on the page of a Shakespeare play (Love’s Labour’s Lost) in a paragraph that says: “Fair Sir, God save you! Where is the Princess?”

“When an adverse event occurs in health care, the first victim is the patient, and the second victim is the healthcare provider related to the unexpected adverse event, traumatised by that event,” says Prof Goldik, who will discuss studies demonstrating that 3% to 17% of patients in acute care hospitals experience adverse events.

He will explain that, due to changes in traumatised health personnel, the safety and trust environment of the health service is altered. Intrusive reflections follow the event and can include feelings of anxiety, confusion, depersonalisation, difficulty concentrating on tasks, frustration, feelings of guilt, sadness, insomnia, constant repetitive analysis of the event, doubts about one’s professional capacity; and fear of legal consequences and loss of reputation.

Prof Goldik will explain how in recent years, social networks have made this problem worse, with ‘virtual violence’ carried out with impunity. Many times, the person involved is left alone, even though psychological assistance is frequently needed. He concludes: “Every institution should have a contingency plan and a written policy on how to assist the second victim.”

Stress responses and coping strategies are the subjects of the final presentation, to be given by Dr Wolfgang Lederer, Medical University of Innsbruck, Austria. He will discuss that anaesthesiology is a stressful speciality and effective stress management is essential to avoid harm to health and well-being. An unhealthy job environment and inadequate working conditions contribute to work stress and impair patients’ safety. Certain risk groups have a greater susceptibility to stress-related illness including anaesthesiology trainees, young female anaesthesiologists and senior anaesthesiologists.

He says: “Consequences of prolonged, excessive stress may be experienced as impaired physical health, as emotional deterioration and behavioural problems and as cognitive dysfunction. Complaints may be as severe as complete intellectual decline with an inability to work. Anaesthesiologists have a considerable risk for burnout, depression and suicidal ideation. Professional treatment is needed in advanced stages before helplessness proceeds to self-abandonment. Completed suicide has been reported to be high in anaesthesiologists.”

However, what can be done to cope with occupational stress? Dr Lederer will say: “Rather than waiting for assistance from superiors you should take the initiative. Maintain a healthy lifestyle. Most important: get moving and do not neglect your social contacts!”

He adds: “Advanced training is important! Learn stress management. Insist on commensurate pay and regular working hours. Call for timeout and allocate enough time for leisure activities. Learn to accept your limits, know your rights and learn to how to say ‘No’!”.

 

Read More of our special newsletter covering our virtual congress

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