Peer Support for Physicians
A critically ill patient codes unexpectedly and dies in the OR. A medical error changes a patient’s outcome. These are just two examples of events that can leave physicians feeling upset and isolated, and the tradition of medicine calls for physicians to move on and suppress their emotions.
BWH is working to change that culture with peer support teams to help physicians handle the emotional stress of their enormous day-to-day responsibilities. The departments of Surgery, Anesthesia and Nursing in July launched a peer support team pilot, although the team has been informally in place for about two years.
“The fact is, we are affected by events, and not dealing with the emotional side can affect our work, health and home life,” said Jo Shapiro, MD, a member of the pilot peer support team and the associate director of Graduate Medical Education for Partners. “We have to care for each other because we’ve all been through it. It’s healthier to deal with it than ignore it.”
The support team concept came from Rick van Pelt, MD, an anesthesiologist who experienced an adverse event in 1999. The emotional impact of the event weighed on van Pelt, who found that little support was available to physicians. With patient Linda Kenney, he formed a support group for patients affected by medical errors.
From there, he joined forces with Janet Barnes, RN, JD, executive director of Clinical Compliance and Risk Management, to build a peer support program modeled on support networks used by first responders, including the Boston police and fire departments and EMS.
“This is voluntary participation for anyone affected by an event, and it’s strictly confidential,” van Pelt, chair of the Peer Support Team Initiative, said.
The team includes physicians, nurses, residents and staff from the Employee Assistance Program, Chaplaincy, Ethics and Psychiatry who have been trained in active listening to recognize warning signs of colleagues in trouble. The team provides one-on-one peer support for any physician requesting it, regardless of whether there has been a definable event. There are also group sessions with several support team members to discuss a case with members of the patient care team when a major event occurred. A member of the support team is on call 24 hours a day, seven days a week to respond to an adverse event.
“The formal response with a group session is mainly for significant events,” van Pelt said. “For smaller events, we encourage those who want to talk to seek out a member of the team they are comfortable with. If we hear about someone feeling bad over a smaller event, we’ll have a team member give them a call.”
Shapiro, Stan Ashley, MD, and Roger Christian, MD, make up the Surgery physician peer support team, and they reach out to fellow physicians who may be having difficulty facing an unexpected patient outcome. “We let these physicians know we’re here for them and they can call us anytime,” Shapiro said. “It might be easier for them to talk to us initially and then seek more formal support if they feel they need it.”
She added, “We try to make them realize these are normal reactions to abnormal events.”
Team member Shailaja Koppolu, MD, a third-year Anesthesia resident, provides peer support for residents and reaches out to residents who are struggling. “It’s comforting and reassuring for residents just starting out,” she said. “Early on in our careers, even the littlest thing can be a big deal. Being able to talk to someone else who’s been through it really helps.”
This summer, Koppolu found herself on the other side of an event and participated in the group as a member of the patient care team. “I felt so much better after we discussed the case in the group,” she recalled.
The Peer Support Team has been called upon several times after events, generating positive feedback from those who have attended the group discussion sessions. “The support team is well received just by virtue of the fact that it’s there,” van Pelt said. “People know the institution cares because the team is there.”
When the pilot ends, van Pelt would like to extend the peer support team model to other departments such as the Emergency Department, OB/GYN and intensive care units. In addition to physicians, residents and nurses, van Pelt is considering others who might benefit from the training and support, such as patient care assistants and hospital administrators.