When health journalist Cheryl Clark wrote about the need for crisis intervention for “second victims” of medical error, defining “second victims” as medical caretakers, she struck a nerve. Recommending crisis intervention for staff, highlights the absence of meaningful help for injured patients and their families.
In Clark’s article, a hospital patient safety officer notes that medical error trauma is worse when hospital staff have a personal relationship with the injured or deceased patient, e.g. if the deceased is a colleague.
But the obvious conclusion is not drawn: Survivors need more assistance than they currently receive. Isolating patients and their families from circumstances surrounding medical errors does not promote healing of patients or their families any more than it helps traumatized medical staff.
Recognition of the needs of caregivers should trigger awareness that patients and their families deserve more effective care as well. Too often, when medical errors occur, patients and families may not even learn that the mistake happened.
Crisis intervention for medically-harmed patients and their families is virtually nonexistent. Yet, bullet-proofing communications between staff and patients fuels both grief and anger.
As the parent of a patient, I have personally encountered crisis responses which appeared to be designed for our benefit as harmed patient and family member. However, my daughter’s medical records suggest that interventions might have been self-serving, business-based efforts designed to minimize the hospital’s liability and to protect its reputation rather than genuine efforts to help.
After a mistake on the telemetry unit resulted in respiratory arrest, rescue, and transfer to the ICU, a telemetry nurse visited my daughter in the ICU and exchanged emails with her. We never questioned whether the nurse’s outreach was genuine.
But when the nurse broke off communication after asking me to let her know about a time to meet, I wondered if her assistance was an effort to deflect a possible complaint to the state health department. Because the error was serious and at least indirectly led to my daughter’s death, I did file a complaint, and the state health department issued a statement of deficiency and ordered a plan of correction.
In the notes of the meeting that followed, I found the following:
“It is well known that this patient was a very difficult patient and frequently refused to comply with the physician prescribed pulmonary treatments.”
My daughter was intubated, but alert. Everything she “said” is preserved in the notebooks she filled and sent home from the hospital. A typical note:
I am very motivated to do as much as possible to get better!
At this point, when I try to inhale sometimes I exhale instead and it is very hard, but I am not giving up.
I want to do as much as I can to get better!
When it doesn’t work, when someone tells me “take a deep breath” and I instead take a shallow breath or even exhale I am TRYING to take a deep breath and the wrong thing happens. Just let me keep trying until I get it right (if possible)
Duplicity is never a good idea in personal or business relationships. It is particularly difficult in the context of a parent watching her only child die in the ICU.
Martha Deed is a retired psychologist and author of The Last Collaboration.
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