VULNERABILITY AND RESILIENCY- A LESSON ON HUMANITY FROM TIM LEEUWENBURG.

VULNERABILITY AND RESILIENCY- A LESSON ON HUMANITY FROM TIM LEEUWENBURG.

        This may be old to some, but I watched a heartfelt video from a presentation Tim Leeuwenburg gave at a few months back on dealing with our vulnerabilities “ALL ALONE ON KANGAROO ISLAND” Vimeo.com/130819016. Without giving the talk completely away he goes through his journey of anguish and shame during a misdiagnosis, leading to a patient who went septic, and subsequently became paralyzed, only to learn a nurse at the receiving facility told the wife she should sue him. After a two-year ordeal (alcohol, suicidal ideation…) he was able to reconcile with his patient and his wife. Later he describes his ability to look differently at life leading to his ability to maintain empathy and compassion at a different level. Sadly, he received the typical support we all do when we endure a tragic situation resulting from our own mistake.

       I began to recall the ACS papers a few years back on burnout in surgeons and the high association with medical errors, subsequent distraction, more errors, abuse and potentially suicide. About the same time the ASA published a paper in 2012 about how rare it is for an anesthesiologist to take the day off after having just witnessed a tragedy in the OR. I recently conversed with a CRNA who relived a story with me, whereby he watched an unfortunate mother die of hemorrhage after a delivery complication, and simply had to move onto the next case. My point is that, last year I chatted with a local Sherriff Deputy who was a State Trooper and asked him how they handle this in the police service. He relayed to me the story of how he was called at 2am on a 10 degree January day to a scene where an intoxicated driver speeding the wrong way on the interstate, slammed into a car with four college coeds. He said he had seen a lot by that point in his career, but nothing prepared him for the scene he walked into. A decade later he remembers vividly that when he arrived, the steam was pouring off the bodies which were severed in two by the seatbelts. I asked if he had to go back to work (like we do). I was surprised when he said that a Police counselor responded to the scene to assess if they were fit for duty. He was clearly not, so they found a replacement for him.  On that note, I asked Dan Linskey (ex Police Chief in Boston and incident commander during the marathon massacre) and he too said their police force relied heavily on on-the-scene therapist to assure that people were fit to go on or needed time to recover. So it seems that our first responder services do a better job of tending to their professionals than we do.

               So back to this video…Dr. Leeuwenburg explains how we are all vulnerable. We often are afflicted by shame or guilt in our profession. These unfortunately unclothe our vulnerability when we are exposed to medical error, administrative frustration (and our less than admirable responses), own expectations, and work-life imbalance. We quickly find a difference between our expectations and reality and are disappointed. As physicians, we idealize perfection and are less than satisfied by “good enough”.  His lessons in the end were to work towards resilience (and not alone but with others). Accept we are not alone in this battle and have empathy towards others who may be suffering (be kind). Be prepared to expose your own vulnerability to help yourself and others. In the end, he displays his transition in dealing with human suffering as he describes his care of a brave fire-fighter with lethal injuries, providing a humane approach and a lasting conversation with the fire-fighter’s wife.

 I hope this video is motivation to change how we deal with tragedy, mistakes and stress in medicine. I really would like to chat with Dr. Leeuwenburg at some point on this.

KENNETH A. LIPSHY, MD, FACS

www.crisismanagementleadership.com

VULNERABILITY AND RESILIENCY- A LESSON ON HUMANITY FROM TIM LEEUWENBURG.

VULNERABILITY AND RESILIENCY- A LESSON ON HUMANITY FROM TIM LEEUWENBURG.

        This may be old to some, but I watched a heartfelt video from a presentation Tim Leeuwenburg gave at a few months back on dealing with our vulnerabilities “ALL ALONE ON KANGAROO ISLAND” Vimeo.com/130819016. Without giving the talk completely away he goes through his journey of anguish and shame during a misdiagnosis, leading to a patient who went septic, and subsequently became paralyzed, only to learn a nurse at the receiving facility told the wife she should sue him. After a two-year ordeal (alcohol, suicidal ideation…) he was able to reconcile with his patient and his wife. Later he describes his ability to look differently at life leading to his ability to maintain empathy and compassion at a different level. Sadly, he received the typical support we all do when we endure a tragic situation resulting from our own mistake.

       I began to recall the ACS papers a few years back on burnout in surgeons and the high association with medical errors, subsequent distraction, more errors, abuse and potentially suicide. About the same time the ASA published a paper in 2012 about how rare it is for an anesthesiologist to take the day off after having just witnessed a tragedy in the OR. I recently conversed with a CRNA who relived a story with me, whereby he watched an unfortunate mother die of hemorrhage after a delivery complication, and simply had to move onto the next case. My point is that, last year I chatted with a local Sherriff Deputy who was a State Trooper and asked him how they handle this in the police service. He relayed to me the story of how he was called at 2am on a 10 degree January day to a scene where an intoxicated driver speeding the wrong way on the interstate, slammed into a car with four college coeds. He said he had seen a lot by that point in his career, but nothing prepared him for the scene he walked into. A decade later he remembers vividly that when he arrived, the steam was pouring off the bodies which were severed in two by the seatbelts. I asked if he had to go back to work (like we do). I was surprised when he said that a Police counselor responded to the scene to assess if they were fit for duty. He was clearly not, so they found a replacement for him.  On that note, I asked Dan Linskey (ex Police Chief in Boston and incident commander during the marathon massacre) and he too said their police force relied heavily on on-the-scene therapist to assure that people were fit to go on or needed time to recover. So it seems that our first responder services do a better job of tending to their professionals than we do.

               So back to this video…Dr. Leeuwenburg explains how we are all vulnerable. We often are afflicted by shame or guilt in our profession. These unfortunately unclothe our vulnerability when we are exposed to medical error, administrative frustration (and our less than admirable responses), own expectations, and work-life imbalance. We quickly find a difference between our expectations and reality and are disappointed. As physicians, we idealize perfection and are less than satisfied by “good enough”.  His lessons in the end were to work towards resilience (and not alone but with others). Accept we are not alone in this battle and have empathy towards others who may be suffering (be kind). Be prepared to expose your own vulnerability to help yourself and others. In the end, he displays his transition in dealing with human suffering as he describes his care of a brave fire-fighter with lethal injuries, providing a humane approach and a lasting conversation with the fire-fighter’s wife.

 I hope this video is motivation to change how we deal with tragedy, mistakes and stress in medicine. I really would like to chat with Dr. Leeuwenburg at some point on this.

KENNETH A. LIPSHY, MD, FACS

www.crisismanagementleadership.com

ERRORS OF OMMISSION OR COMMISSION- a call with Carla Pugh

      In our discussion about the book Crew Resource Management for the Fire Service, Senator Lubnau mentioned that under duress 60% of FIRE FIGHTER errors are those of COMMISSION -where we carry out a task incorrectly and the rest are errors of OMMISSION - where we neglected to carry out a task element.

    Dr. Carla Pugh was kind enough to discuss The University of Wisconsin groups study assessing how residents either succeeded or failed to recognize that an operative error occurred (typically errors of commission or omission) and then comprehend the steps necessary to adapt to the new uncertain situation- ie reverse/salvage the error.  (D’Angelo AL, Pugh CM et al. Error Management: Do residents identify operative errors as reversible.)

       This brings to light the two problems we face: 1. Do we rehearse the case in advance to identify the most likely critical points where a mistake is going to be made so we can pause and assure that happens. This was one area that Dr. Pat Croskerry advised is an opportunity in critical thinking we often avoid but need to address. It is also an area that  Dr’s Zenati and Tarola in West Roxbury are working on in which they are using the HUB system to  automatically introduce alerts during cardiac bypass and valve procedures whereby critical steps need to be focused on and avoid errors of omission. 2. Do we have the capability to understand when an error occurs what mechanics are needed to salvage / reverse the error?

I am hoping Dr. Pugh and I have more opportunities to discuss this.

Kenneth A. Lipshy, MD, FACS
www.crisismanagementleadership.com

ERRORS OF OMMISSION OR COMMISSION- a call with Carla Pugh

      In our discussion about the book Crew Resource Management for the Fire Service, Senator Lubnau mentioned that under duress 60% of FIRE FIGHTER errors are those of COMMISSION -where we carry out a task incorrectly and the rest are errors of OMMISSION - where we neglected to carry out a task element.

    Dr. Carla Pugh was kind enough to discuss The University of Wisconsin groups study assessing how residents either succeeded or failed to recognize that an operative error occurred (typically errors of commission or omission) and then comprehend the steps necessary to adapt to the new uncertain situation- ie reverse/salvage the error.  (D’Angelo AL, Pugh CM et al. Error Management: Do residents identify operative errors as reversible.)

       This brings to light the two problems we face: 1. Do we rehearse the case in advance to identify the most likely critical points where a mistake is going to be made so we can pause and assure that happens. This was one area that Dr. Pat Croskerry advised is an opportunity in critical thinking we often avoid but need to address. It is also an area that  Dr’s Zenati and Tarola in West Roxbury are working on in which they are using the HUB system to  automatically introduce alerts during cardiac bypass and valve procedures whereby critical steps need to be focused on and avoid errors of omission. 2. Do we have the capability to understand when an error occurs what mechanics are needed to salvage / reverse the error?

I am hoping Dr. Pugh and I have more opportunities to discuss this.

Kenneth A. Lipshy, MD, FACS
www.crisismanagementleadership.com

Mack Brown on getting through a tough period

I am sure many leaders can relate to Mack Brown's past quote from Darryl Royal on how to get thru a tough period. He said Darryl once told him when he asked Him what it takes to recover from a losing skid, he replied "when your tired enough of losing and good enough to fix it". That simple statement likely pertains to a lot of professions who experience problematic periods. More often than not, we seek answers that justify our convictions confirming what we believe to be true rather than accepting we have failed at the current course and that we are simply tired of losing and willing to understand how to fix things.


Kenneth A. Lipshy, MD, FACS
www.crisismanagementleadership.com

Mack Brown on getting through a tough period

I am sure many leaders can relate to Mack Brown's past quote from Darryl Royal on how to get thru a tough period. He said Darryl once told him when he asked Him what it takes to recover from a losing skid, he replied "when your tired enough of losing and good enough to fix it". That simple statement likely pertains to a lot of professions who experience problematic periods. More often than not, we seek answers that justify our convictions confirming what we believe to be true rather than accepting we have failed at the current course and that we are simply tired of losing and willing to understand how to fix things.


Kenneth A. Lipshy, MD, FACS
www.crisismanagementleadership.com