Stress and
Comfort zones- with Dan Kuhn
General Surgery News recently published a
piece titled “When a Stressful Event
Sticks Traumatic Stress Disorders Can Plague Surgeons; Psychiatrist
Describes Technique Helpful in Erasing Ill Effects “ (an interview with Daniel Kuhn, psychiatrist) http://www.generalsurgerynews.com/In-the-News/Article/10-16/When-a-Stressful-Event-Sticks/38146/ses=ogst?enl=true.
The topic meshes well with other discussion I have had on physician/surgeon
resiliency (http://crisislead.blogspot.com/2016/08/lessons-on-resilience-and-burnoutdr.html). In this editorial Dr. Kuhn relates that when
the Yom Kippur war erupted in Israel he returned home to serve as a physician
in the Israeli Army. It was in this role that he detected a pattern amongst
those who suffered from PTSD. He realized that the traumatic event takes over
the victims mind and they become obsessed with that event to the point that
they can no longer function. Trauma is associated with anger, fear and
helplessness which tighten the disruptive cycle. As a cellist he discovered
performance inconsistencies so he developed a technique that disrupts that
cycle. When his practice was developing he detected a pattern similar to that,
in Surgeons. Surgeons tend to bury stress and fixation on error.
Surgeons face stressful conditions and
unpredictability on a frequent basis. In his book Forgive and Remember,
Bosk, describes the difficulties in a Surgeon’s professional life in handling
failure. Essentially our patients and peers (and us) expect surgery to be a
quick fix compared to medical therapy of disease. When the outcome is not
perfect doubt begins to creep in. If the surgeon does not elicit help or find a
solution to break the cycle, then inevitably, performance will be negatively
affected.
Several recent studies have highlighted
the risk for PTSD in Trauma Surgeons and Surgical trainees (Journal of Trauma and Acute Care Surgery 2014;77:148-154; Surgeon
2015. pii: S1479-666X[15]00099-2). surgical trainees have been shown to have
higher rates of psychological distress than the general population (10%
reported PTSD symptoms lasting more than one month) In the Journal of Trauma
and Acute Care Surgery Study 40% of
trauma surgeons relayed symptoms of PTSD (15% met the diagnostic criteria for
PTSD). This risk was increased with the following factors:
·
Male trauma surgeons operating on more than 15 cases
per month
·
more than seven call duties per month
·
less than four hours of relaxation per day
Back in Dec 2015 Carol-Ann Moulton and
I discussed a paper their Toronto group published in the Annals of Surgery on
Comfort Zones and Risk Taking in Surgery (Taking a chance or playing it safe: reframing risk assessment
within the surgeon’s comfort zone. Ann Surg. 2015); Details of that conversation are at http://crisislead.blogspot.com/2016/10/interview-with-carol-anne-moulton.html In our discussion of the interviews
which led to their publication it appeared that even the boldest appearing
surgeons probably have a breaking point.
It is likely that every surgeon has a perception of where their boundary
is; the place where they no longer feel comfortable. Self-assessment literature seems to indicate
that we frequently do not openly acknowledge that we have a comfort zone (or
may not accept that personally). It may be that the temperamental and angry
affect we see in some surgeons is actually a reflection of anxiety. It is
unlikely that anyone is immune, but we simply do not discuss it.
I had some questions for Dr. Kuhn:
·
Surgeons are more likely to not acknowledge they are stressed,
burned out or in a PTSD state. What are the key symptoms I should be relating
to my comrades that indicate they have a high likelihood of having entered or
on the cusp of a PTSD state?
·
If they have not quite reached that point, what is your advice to
prevent their potential situation from worsening?
·
How do I approach a colleague who I think is either on the cusp of
or in a PTSD state?
·
If I am diagnosed and then recover from a PTSD state, are their
triggers that I will need to keep away from to avoid a relapse?
·
Without giving your secrets away could you simply describe your
technique that you have perfected in dealing with this?
·
Is there a point of no return where you would look at someone and
simply state that an alternate career should be a high consideration?
·
Are we genetically predisposed to obsession and
PTSD? That is why do some people seem to be teflon coated and let stress run
off of them?
Any familial risk?
Bosk CL. Forgive and
Remember: Managing Medical Failure. 2nd ed. Chicago, IL: University of
Chicago Press; 2003
Zilbert NR, Murnaghan L,
Gallinger S, Regehr G, Moulton C. Taking a chance or playing it safe: reframing
risk assessment within the surgeon’s comfort zone. Ann Surg. 2015;
262(2):253-259.
Kenneth A. Lipshy, MD,
FACS
No comments:
Post a Comment