“Medical errors exist at the far end of a continuum of unexpected events in clinical practice and they are devastating for all involved. Even when care is attentive and patient compliance perfect, unexpected outcomes occur in medicine. Unanticipated diagnoses, delays in diagnosis, premature death — these are all included in the realm of “unexpected events” even if nothing has gone “wrong” in medical care.

These events cause physicians to suffer self-doubt, worry, shame and guilt, sometimes exacerbated by the magnitude of the event, the temperament of the clinician and the institutional climate in which these events occur.”

Eliza Humphreys is a pediatrician and certified life coach.

She shares her story and discusses her KevinMD article, “Who will heal the physician?”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Rate and review the show at KevinMD.com/rate. Subscribe at KevinMD.com/follow. Today on the show, we have Eliza Humphreys. She is a pediatrician and a life coach. She wrote the KevinMD article “Who will heal the physician?” Eliza, welcome to the show.

Eliza Humphreys: Thanks, Kevin. Thanks for having me. I’m happy to be here.

Kevin Pho: We’ll get into the article in a little bit, but first off, can you share your story and journey to where you are today?

Eliza Humphreys: Sure. As you said, I’m a general pediatrician. I trained in California, at UCSF, for medical school and my general pediatrics residency. Following that, I went and did a preventive medicine fellowship, which involved getting an MPH, also in California. About 15 years ago, I moved to Massachusetts from California, and I’ve been practicing in a private practice north of Boston since then. During the pandemic, I became certified as a life coach.

Kevin Pho: So tell me about that journey. What made you decide to become certified as a life coach in the midst of your busy pediatric practice?

Eliza Humphreys: That’s a good question. While my office never shuttered its doors during the pandemic, our volume was really greatly reduced. I’m part of a midsized, very busy private practice, so when our volume went way down, we kind of cycled who was in the office, and I found myself with a lot more time. When I wasn’t trying to contribute to my children’s remote learning, which I found I wasn’t necessarily very proficient at, I was delving into other things that were available.

I found myself, almost accidentally, attending a summit called the Leverage and Growth Summit. It was a free online series of webinars. Actually, I think, Kevin, you were one of the speakers. At the original one that I attended, I encountered quite a few coaches and got curious about what that was like, and I ended up being the beneficiary of some physician coaching myself. That led to my own path of becoming certified, because I found it so transformational and helpful in terms of both my professional practice with patients and my own personal pursuits.

Kevin Pho: So tell me, you said that it has helped you professionally. How has your life coaching practice helped you professionally?

Eliza Humphreys: Well, initially, when I say it helped me professionally, some of the coaching is really an examination of the thought processes that contribute to behaviors and results. A lot of what we do in clinical practice is teaching and encouraging behavior change, whether it’s nutritional and lifestyle modifications for our patients and their families, or adolescents who you’re encouraging not to vape, or any number of clinical scenarios in which you’re really trying to motivate behavior change. I found having some of the coaching tools and modalities really helpful. It was much easier to connect with patients and hear their priorities in a way that allowed more space for change, and actual, real change.

I think prior to coaching, I had my own agenda, and I was very intent on pushing my agenda through during our time in the exam room, and unfortunately, that doesn’t necessarily get results. I also took it very personally, I think, when clinical outcomes wouldn’t necessarily reflect what I had intended. Through the coaching process, you’re examining your own thoughts, but you’re also able to work with someone else’s thoughts and where they are, and see that from a different perspective, which ends up enhancing the connection between patient and provider. In clinical practice, that connection is everything. Our whole professional work is basically based on the connection we have with our patients and the continuity over time. So that’s why I say it really enhanced my professional tool set.

Kevin Pho: All right, let’s talk about your KevinMD article titled “Who will heal the physician?” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Eliza Humphreys: Yeah, sure. Thanks for asking. Again, on this theme of there being a hidden upside to the pandemic, I know it was a really stressful time for many, and certainly for those on the front lines, in the ERs and ICU. But as I say, I had a little bit more time on my hands, and that time provided more time for reflection and investigation of where I was in my own clinical practice and mindset. I became very interested in the role of uncertainty and risk in clinical practice, specifically how unexpected outcomes and medical errors impact the individual clinician.

The article is sort of my own personal essay, or reflections on that journey. I ended up doing a deep dive into some of the work that had previously been done, and then my own digestion of that, and I ended up in the article with four main points on ways to combat some of the discomfort that arises from unexpected events in practice or medical error.

Kevin Pho: Before getting into how to combat that, go into more detail about a medical error, or a liability lawsuit that arises from that error. How does that specifically affect clinicians?

Eliza Humphreys: That’s such an important question. Obviously, there are individual variations, but overwhelmingly, unexpected events and errors are devastating to all involved. First and foremost, it is tragic for the patient. But as I explore in the article, there is this entity of the clinician involved, the physician involved in the medical error, who is also very wounded by a bad outcome. Albert Wu, in his 2000 BMJ editorial, coined the term “second victim,” which may be familiar to your audience, but may not be. I really wasn’t familiar with it before a few years ago. That second victim would be the physician who is involved in an unexpected or bad outcome, who then endures a series of really negative consequences.

That might first be rumination and second-guessing. It then ends up going into self-doubt and questioning clinical competency, and it could ultimately end up leading to anxiety and depression. Some of this work on the pathway that a clinician would take after a medical error or unexpected event is really delineated by Sue Scott out of Missouri. There is a predictable pathway that a clinician will go through, ultimately leading to either moving on or, in more severe instances, removing oneself from clinical practice. That is part of the specific journey that can happen.

The liability you mentioned is, unfortunately, a very real aspect for anyone in clinical practice. I think the numbers are quite astounding. In fact, one of the articles referenced in the article on KevinMD says that over a career span, upwards of two-thirds, and possibly even more depending on your specialty, whether surgical or not, may confront a medical malpractice lawsuit, which, as we all know, can be incredibly distressing for those involved.

Kevin Pho: Now, what are some of your suggestions in terms of how clinicians can combat some of the effects of this proverbial second victim syndrome?

Eliza Humphreys: I think the first is just to recognize it. No matter what language you use, recognize that for an unexpected outcome or a medical error, certainly it’s very tragic, but the patient is one side of that. We need to also recognize the care providers who are involved, and that may be all members of the medical team. So just awareness of that fact, I think, is very powerful.

I think the literature on self-compassion, and how useful self-compassion tools are to individuals in the health care profession, is also really important. By self-compassion, I’m referring specifically to Kristin Neff, who’s one of the founders of this topic in the literature. She defines self-compassion as basically treating yourself as you would treat a friend, and there are three pillars to self-compassion. One is kindness, as in kindness to yourself. Two is mindfulness, so that’s awareness and acceptance of the circumstance. The third would be common humanity, so acknowledging that as humans, whatever we’re experiencing has been experienced by someone else before, and there is some potential for healing in recognizing that.

Another aspect, one of the combatants to second victim syndrome, is on the institutional level. In the article, I mentioned briefly one such program at Mass General that was founded by Dr. Jo Shapiro. It’s a peer support program, and its aim is to change the culture of medicine after an unexpected event. There’s a group of trained peer providers who are available for more of a therapeutic interaction with the clinician involved in such an event.

Finally, there’s physician coaching, which we talked a little bit about. I think that can be very useful to just acknowledge how our thoughts about ourselves directly affect how we feel about ourselves, which in turn drives our behaviors and actions, which lead to our results. That’s a very powerful tool in terms of managing how we’re dealing with such challenging events.

Kevin Pho: Let’s say I’m a clinician listening to you on this podcast, and I’m unfortunately going through an adverse event that may have arisen from a potential medical error. What are some immediate next steps you would recommend that this clinician take?

Eliza Humphreys: That is a really great question. I think there are many things to do. One is to find immediate support. There are definitely people to talk to. There are usually institutional people available, there’s your risk management team, and there are coaches like myself dedicating their time to people experiencing such events as well.

There’s the immediate “What do I do next?” situation, and I think that is very clear. You can deal with your malpractice carrier, and you can talk to risk management. But after that “Immediately, who do I call first?” situation, it’s more of “How do I take care of myself?” I think that’s really crucial, and some of these self-compassion tools can be really instrumental. A lot of clinicians may experience that fight-or-flight response and be feeling very distracted, not able to sleep, not really able to focus on their other clinical duties, and so it’s really important to take a step back and do some self-care in that situation.

I think also, unfortunately, there is a code of silence, and certainly if there is impending litigation, there are some sensitivities around disclosing events of a specific clinical situation. But as much as we can connect through other colleagues, it’s really important in terms of providing a safe space for healing after this type of situation.

Kevin Pho: When you refer to self-compassion and self-care, what exactly do you mean by that? Can you give an example of what that would look like?

Eliza Humphreys: Yeah, absolutely. Again, the work I am referencing is mostly that of Kristin Neff, widely available tools accessible to all, so that’s a name to remember if people are looking for more information. But it’s literally things like: How are you talking to yourself? Are you saying very harsh words of criticism, “Why did I do that? How could I do that?” and ruminating on the error, or the potential error you’re perceiving? Research has shown that we will often distort reality, and so you’re not necessarily in your right mind if you’re in this sort of negative filter.

It’s really important, for self-compassion, to acknowledge that this is just a difficult situation, and so literally to take a step back and tell yourself, “This is really hard. This has been really distracting for me.” Removing yourself in a distanced way to acknowledge how difficult or how stressful something might be, even that can provide some relief. Again, recognize that there’s a common humanity element, so other people have faced challenges like this as well. How you talk to yourself may in turn allow you to better see opportunities for other potential interventions and healing. So that’s one practice.

There’s everything from calming your fight-or-flight reaction as well. There are deep breathing techniques, meditations, and body scans, trying to process the feelings that you may be having in your body to recognize what they are. There’s some work around those types of things and many others, in fact, if you’re interested in pursuing this further.

Kevin Pho: We’re talking to Eliza Humphreys. She is a pediatrician and life coach. She wrote the KevinMD article “Who will heal the physician?” Eliza, what are some of your take-home messages that you want to leave with the KevinMD audience?

Eliza Humphreys: I think a take-home message is that this is a near-universal experience for anyone in clinical practice, to have an unexpected outcome or some form of error at some point in their career, and many may even face a medical malpractice case over the course of a career. There are two tools and practices to get through this and to relieve some of the distress, and I feel like we should be learning these alongside anatomy and pathology in order to remain happy in practice.

Kevin Pho: Eliza, thank you so much for sharing your time and insight, and thanks again for being on the show.

Eliza Humphreys: Thank you, Kevin.