Tuesday, March 29, 2016

Risk Tolerance

I recently read a book review for a book titled THE NORM CHRONICLES (yes I read the book review and not the book). It reminded me of one area that has me constantly perplexed - the concept that while it is inevitable that one will encounter a crisis situation in their practice, the common thought process I run across frequently is that these "events are rare and preparation unnecessary" or that "team training is an unnecessary disturbance to our practice".

In some series, crisis events may occur in 100 of every 10,000 cases performed in a busy hospital system, or 1 in 1000 cases (not that uncommon but not frequent enough for most surgeons to bat an eye at). It turns out that risk perception has little to do with numbers and more to do with stories, anecdotes and personal experience. The more horrendous the outcome the more that risk means to us. The odds of dying on a plane are estimated at one in one million people but we worry endlessly about that. We have a 6100 times higher risk of dying immediately after being born than dying on a plane. The more catastrophic events where we have little control seem to torture us more than events that we actually can control. You are more likely to die from complications associated with obesity than most other horrific causes but obesity rates continue to rise.

Previously, I have discussed that physicians (especially surgeons) have been shown to be quite overconfident in their self-assessment capabilities. Perhaps when we think we are always in control, we don't have any fear of a chance occurrence where we have no control. So, now I ask a favor from those out there: I am interested in anecdotal stories whereby an organized response to a totally unexpected event threatening event led to a good outcome. It is not that I am not interested in when massive city wide planning saves multiple lives after a major catastrophe, it is just that those events are planned for specifically and therefore are likely not really considered unexpected threats- that is... you planned an entire city for this. What I am looking for are events that came in out of the blue, in which the team was never prepared for, but because of prior team training or other team work concepts they survived (or if you want where the outcome was not great).

The question remains, how do you train individuals, or teams, to withstand any threatening event and not just specific scenarios. I do not believe you can unless you can get them engaged.

Kenneth A. Lipshy, MD, FACS

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