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Dr. Luiz Santos Guides Us Through Second Victim Syndrome
553 Plays1 year ago
Here at NAVAS we spend a lot of time educating veterinary professionals on safe anesthetic practices, but what about the safety of the anesthetist? In today’s episode, we are going to explore a mental health phenomenon known as second victim syndrome. Second victims are health care providers who are involved in an unanticipated adverse patient event, in a medical error, or in a patient-related injury and begin to feel personally responsible for the patient outcome, causing the provider to become traumatized by the event. As a result, veterinary professionals experience a tremendous amount of professional and personal suffering following these unanticipated clinical events. Anesthesia is a high-stakes field driven almost entirely by human decision making, and it is not surprising that errors, complications, or unexpected outcomes, although unintended, will occur and the patient may suffer. This makes anesthetists vulnerable to the second victim syndrome when medical errors occur. How can we help support ourselves and our peers following an adverse patient event and how can we learn to thrive after experiencing such a traumatic event? To help guide us through this important, but difficult topic, is Dr. Luiz Santos. He is a Senior Clinician of Veterinary Anesthesia at the University of Glasgow and he is currently obtaining his PhD in topics related to patient safety culture, burnout, and second victim syndrome as they relate to veterinary anesthetic practice.
Dr. Santos will be one of the featured speakers at our NAVAS Virtual Spring Symposium on April 27th and 28th, 2024. Registration is free!
As a warning, there will be mention of mass casualty events and suicide in this episode. Timestamps for these discuss are as follows:
Discussion on gun violence/mass casualty event: 16:30-17:30
Mention of suicide: 46:15-47:26
Resources mentioned in today’s episode:
Dr. Hoffmeister’s and Dr. Love’s JAVMA article on patient safety culture in veterinary medicine
Dr. Ludder’s book on medical errors in veterinary anesthetic practice
The Second Victim Experience: Caring for our Own a presentation by Dr. Susan Scott
If you or someone you know is experiencing trauma related to second victim syndrome, please reach out to the US National Suicide Hotline (or dial or text 988).
If you like what you hear, we have a couple of favors to ask of you:
Become a member of NAVAS for access to more anesthesia and analgesia educational and RACE-approved CE content.
Spread the word. Share our podcast on your socials or a discussion forum. That would really help us achieve our mission: Reduce mortality and morbidity in veterinary patients undergoing sedation, anesthesia, and analgesia through high-quality, peer-reviewed education.
Thank you to our sponsor, Dechra - learn more about the pharmaceutical products Dechra has to offer veterinary professionals, such as Zenalpha.
If you have questions about this episode or want to suggest topics for future episodes, reach out to the producers at education@mynavas.org.
All opinions stated by the host and their guests are theirs alone and do not represent the thoughts or opinions of any corporation, university, or other business or governmental entity.
The NAVAS Podcast is published monthly on or near the 15th of the month.
Special thanks to Chris Webster for editing, producer Maria Bridges, and Saul Jimenez for IT support in making this podcast a reality.
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Transcript
Introduction to the podcast and its focus
00:00:06
Speaker
Hello, gas passers, and welcome to another episode of the North American Veterinary Anesthesia Society podcast, sponsored by DECRA. I'm your host, Dr. Bonnie Gatson. Our mission with this podcast is to explore the latest advancements and hot topics in veterinary anesthesia to help veterinary professionals and caregivers advance and improve the safe administration of anesthesia and analgesia to all animals.
Patient and anesthetist safety: A dual concern
00:00:31
Speaker
As part of this educational mission, we spend a lot of time talking about how we, as anesthetists, can improve the safety of our patients under anesthesia. But what about the safety of the anesthetist? And I'm not talking about physical safety, although I have heard some great stories about oxygen tanks turning into projectile missiles. No, today's episode, we are going to talk about the emotional and psychological health and safety of veterinary professionals providing anesthesia services.
Acknowledgement of sponsor and event promotion
00:01:00
Speaker
But first, a huge shout out to our sponsor, DECRA, without whom this podcast would not be possible. We are very grateful to them as they allow us here at the NAVAS podcast to have creative control over the content of this podcast, while also aligning with the overall mission of NAVAS regarding anesthesia education. If you have not done so already, please check out their line of veterinary anesthesia related products at www.decra-us.com.
00:01:29
Speaker
Second, just a reminder to register for the Navas Virtual Spring Symposium going down on April 27th and 28th of this year. You can register at www.mynavas.org slash 2024-spring-symposium. Registration opened on February 1st, so make sure that you pause this episode and go register right now before you forget.
00:01:55
Speaker
At the website, you will also find the full speaker lineup with a line of speakers for a technician track, a general anesthesia track, and an advanced specialty track. So you can pick and choose which topics are the most relevant for you.
00:02:11
Speaker
It's going to be an amazing weekend full of anesthesia education and you won't want to miss it.
Introduction to Dr. Luis Santos and second victim syndrome
00:02:16
Speaker
In fact, our guest today on the podcast is going to be one of the featured speakers at the symposium. So if you like what you're hearing today and you want to learn more, remember to register for the Navas virtual spring symposium.
00:02:31
Speaker
Lastly, if you haven't done so already, please consider becoming a member of the North American Veterinary Anesthesia Society. That is just one way that you can support this podcast, but if you've been listening to the show over the past year and you find yourself enjoying the content, please spread the word by liking and subscribing to this podcast. Consider telling your friends and coworkers about us. We really appreciate any and all listener support.
00:02:57
Speaker
In this episode, we are going to be discussing a phenomenon called second victim syndrome. It's a term I first heard only a few years ago at a veterinary anesthesia specialty conference. I was sitting in the audience listening to the lecturer describe the psychological impact and the symptoms of second victim syndrome, and I couldn't help but think to myself, wow, I have totally experienced this.
00:03:23
Speaker
Something unique about anesthesia is that it is a high-stakes field driven almost entirely by human decision-making. An animal does not become anesthetized unless we make it so, and this makes anesthetists particularly vulnerable to human error and clinical mistakes.
00:03:41
Speaker
A portion of the practice of anesthesiology remains an art, and it is not unexpected that errors, complications, or unexpected outcomes, although unintended, will occur, and the patient may suffer as a result. We, as veterinary professionals, are taught above all to do no harm, and this makes veterinarians and technicians vulnerable to the second victim syndrome when a medical error does occur.
00:04:09
Speaker
The second victim experiences negative and potentially debilitating effects on their physical, mental, and overall well-being, which can culminate in burnout or other severe mental health conditions. In an era where more and more veterinary professionals are experiencing too much pressure from mounting daily challenges and an ever-increasing expectation for delivery of clinical care,
00:04:34
Speaker
What can we do to protect ourselves from the mental health challenges of working in this profession? And what can be done to help the second victim, the anesthesia provider, when a medical error or an adverse outcome does occur? To help guide us through this important but difficult topic is Dr. Luis Santos.
00:04:52
Speaker
He is a senior clinician of veterinary anesthesia at the University of Glasgow, and he is currently obtaining his PhD in topics related to patient safety culture, burnout, and second victim syndrome as they relate to veterinary anesthetic practice.
Dr. Santos's background and personal motivations
00:05:07
Speaker
As a warning, there will be mention of mass casualty events and suicide in this episode, and we will timestamp those points in the episode in the show notes in case that is something you do not want to listen to. As a reminder, please consider subscribing to the North American Veterinary Anesthesia podcast on your favorite podcast platform to stay updated on the latest in veterinary anesthesia. Let's begin.
00:05:37
Speaker
Thank you so much for coming on the podcast today. Why don't you start by introducing yourself and just letting us know where you're at right now and what your past training was. Hi, Bonnie. Thank you for having me. It's great to be here. So my name is Luis Santos. I'm a board certifying anesthesiologist. I'm a senior clinician in venous physiology at the University of Glasgow.
00:06:00
Speaker
And I'm also doing a part-time PhD, believe it or not, on the aspects related to patient safety and staff's well-being at the University of Queensland. I'm originally from Brazil. I've done my anesthesia training, including my internship in anesthesia and LSU and my residency at Cornell University. So I like to ask all of my guests this, but what drew you to having an interest in anesthesia?
00:06:27
Speaker
Oh, that's a good question. I guess it's exactly this non-technical skills that anesthesia brings you, these challenges, the self-awareness, the difficult decision-making process that we have to do with a patient that is under care. I started my journey as an anesthesiologist working with analgesia, especially in horses. So I was fascinated since early ages, since I had my
00:06:54
Speaker
my surgeries and no and with local anesthetics and how fascinating that was. So all these things I guess contribute a little bit to my desire to start anesthesia. That's I like how you said something about your childhood. I actually recently was thinking about this personally. I always kind of told the story and I'm sure my listeners have heard the story before that there was actually a veterinary technician that I worked with
00:07:23
Speaker
in vet school that pushed me into anesthesia. But recently, I just came to me in a memory that when I was a child, I tripped and fell and I split my knee open and I had to go to the hospital to get stitches. I was also away at summer camp, so I didn't have my parents with me or anything like that. It was just me and
00:07:45
Speaker
this poor probably 19 year old camp counselor. They did the stitches and they numbed me with lidocaine. And I think like that might have been a very early memory of mine that really sparked my interest in anesthesia. Like I remember there was suturing my knee closed and I was like staring at it along with the doctor. Like I just got to watch it happen. I didn't feel anything.
00:08:10
Speaker
And that might've been like one of my first introductions to the power of anesthesia. It's fascinating. Yeah. Yeah. So I'm glad you brought like your child into that as well. Mine was an epidural. I had a fracture femur when I was a young and I had an epidural. I was like, Oh my God, this is actually, I'm not feeling any pain anymore. This is great.
00:08:38
Speaker
Yeah, I've had two kids now, so I've gotten to have two epidurals and they are like amazing. Yes.
00:08:46
Speaker
So for our listeners today, the goal for us is to talk a little bit about burnout. And we're going to talk about something called second victim syndrome in veterinary medicine. And we're going to specifically relate this down to anesthetic practice. And we're going to define those terms kind of momentarily. But you mentioned that you were doing a PhD in patient safety. So what drew you to patient safety concerns in general?
00:09:15
Speaker
What led you to wanting to become a strong advocate for conditions like second victim syndrome in veterinary medicine? I guess it's a little bit about personal experience as a vet.
00:09:30
Speaker
Before becoming an anesthesiologist, I used to be an equine clinician, an ambulatory clinician for delving into anesthesia. And the whole thing about incivility culture has always been there for me, but we always thought early age, when we graduate, things like that are normal, you know, misbehaving incivility.
00:09:56
Speaker
toxic culture that we see sometimes and we don't stop to think. So at early age during my career as a vet, I always thought something wrong here that we could, but when we are young, we're always trying to prove ourselves, isn't it? I want to be the best and as a geologist, I want to be the best ones that put catheters, arterial catheters. I want to put a central line. I want to
00:10:22
Speaker
always intubating, you know, doing the best anesthesia possible. And we often forget to focus on the other things that needs to happen. Like I said before, in all this decision making processes, the culture within the space you work, how that affects having the animal on the table, and having the animal coming out to the client alive,
00:10:49
Speaker
and without any comorbidities from anesthesia so all these steps I think it's fundamental as well and we often don't emphasize that during vet school and I learned through my PhD basically I always wanted to do something research related with these aspects of patient safety
00:11:11
Speaker
And also not only the patient itself, but also with the individual like us anesthesiologists or anesthetists. I'm not talking just to anesthesiologists, I'm talking also to technicians, you know, vet nurses, that technicians out there that deal with animal, any individual dealing with animal. And that's how I came to doing research with that type of subject. So what it sounds like you're saying, and if I'm wrong, please correct me.
00:11:41
Speaker
is that as veterinarians or technicians, we feel like the
Impact of workplace culture on patient outcomes
00:11:47
Speaker
patient's outcome is directly related to our skill set, how much we know, and we want to be like the best possible
00:11:56
Speaker
practitioners that like we can be because that way we can control the situation. It sounds like what you are saying is you're trying to study how the culture of the entire hospital or how systems are set up that can affect patient outcome that are outside the individual's controls. That kind of. That's exactly it. I want to use spot on, especially teamwork as part of the culture, like how you work as a team. So I communicate, you know, how leaders lead.
00:12:26
Speaker
We're not taught how to lead until we become seniors, and that can be for a vet tech or for a veterinarian. So we're not taught how to lead. So we sometimes have to kind of learn this on the go, and it's not ideal. And so all these aspects that surrounds patient safety culture, I think it's super important for what we do. And the outcome of the patient, yes, it's directly related.
00:12:56
Speaker
to all these factors, not just, yes, I know how to put a catheter, I know how to intubate, but if you don't know how to make a proper decision in a stressful environment, in a stressful situation, then you might be putting your patient at risk. For our listeners, if you're interested in learning a little bit more about patient safety issues and steps you can take to increase
00:13:18
Speaker
your level of patient safety awareness at your hospital. We have a previous episode on that with Dr. Lydia Love, so I'm going to redirect you towards that episode. But really our focus today for this episode is to talk about a syndrome that has been defined fairly well in the human side but is less well described on the veterinary side of practice
00:13:41
Speaker
which is second victim syndrome. So I'm going to start by asking you to just define what second victim syndrome is. So the second victim is basically, like you said, it's a terminology that has been coined by human anesthesiologists back in 2000. In healthcare, they have been studying second victim phenomenon for 20 now, four years.
00:14:07
Speaker
So it's a phenomenon, it's a syndrome where we're talking about professionals here and not necessarily veterinarian that attacks. It can be any individual that deals with animal under their animal care who suffers an emotional trauma as a result of a medical error or a diverse patient event. So if, for example, you
00:14:30
Speaker
I myself consider myself a second victim because I was traumatized in the past by having a horse once fracture its leg in the recovery. And I was deeply, deeply affected psychologically, doubting my skills, doubting if that's what the right thing I'm doing. So those are the characteristics of second victim syndrome. It's that psychological impact on the individual after an adverse outcome.
00:14:58
Speaker
Thank you for sharing that personal story. Does it have to be related to a medical error that can trigger some of this emotional trauma or are there any types of triggering events that can occur that can cause second victim syndrome? Usually by definition, when we compare to burnout, because burnout can have similar symptoms, we might probably can talk about that later, but that's work related in terms of stress of chronic
00:15:28
Speaker
Workload second victim is directly related to a medical error or an outcome adverse outcome but it can increase intensity this psychological. Trauma if a patient has had burnout for example already the patient is burned out and had had an error mistake.
00:15:54
Speaker
is not supported, is not acknowledged, then their second victim phenomena can be increased. Yeah, I wanted to point something out. We'll talk about burnout in a little bit, but I think it's well documented, at least on the human side, and I'm not sure about the veterinary side that clinicians or technicians that are burnt out are more likely to cause medical error. So I think the two can kind of like burnout
Trauma exposure and its effects on veterinarians
00:16:19
Speaker
can lend itself to second victim syndrome. Correct.
00:16:23
Speaker
And the other thing I want to just mention is that I was reading up a little bit about psychic victim syndrome before we spoke because it's something that I'm personally interested in, but don't know very much about. So I was reading about an ER clinician who was working in Las Vegas during the mass murder that happened there. And that person described that they had felt
00:16:51
Speaker
second victim syndrome related to the amount of trauma that they had seen that evening. And so I don't know if that is something that at least maybe not on the anesthesia side, but maybe on the emergency and critical care side, if you have a lot of animals coming at once for some kind of mass event that's happened, I wonder if that can lend itself also potentially to second victim syndrome.
00:17:16
Speaker
Yeah and there's a little bit of compassion fatigue as well there when you care about someone like in your example or an animal that you care a lot and you feel the sensation of I could do much more you know of senseless or hopeless and a little bit of guilt
00:17:35
Speaker
So are there certain subsets of the veterinary profession, for example, like anesthesia practitioners, that are more likely to experience second victim syndrome or can really like anybody in any aspect of the field experience the syndrome? Anyone really funny, it's
00:17:57
Speaker
It can be from the receptionist, it can be a med tech, it can be the anesthesiologist, the emergency clinician, the medicine clinician, the oncology that deals with grievance and patients with cancer. So the prevalence and the impact might vary among different groups or specialties.
00:18:18
Speaker
And especially based on factors like the nature of their work, the frequency of high-stakes decisions, and the proximity to the adverse patient events. So anesthesia, for example, and emergency medicine are probably some of the areas that the individual will probably be more affected by. I'm not saying it's exclusively, but
00:18:44
Speaker
because you're dealing with high-stakes situations, stressful environment, the patient lies as a stake in those situations. So those individuals are probably more prone to the second victim phenomenon.
00:18:56
Speaker
So if some of these stuff you're listening to it and it's sounding a little bit familiar to you, can you just describe maybe what some of the symptoms of second victim syndrome are and maybe also talk about what we know about kind of the physical and emotional consequences of second victim syndrome?
00:19:18
Speaker
Yeah, of course. So, those are individuals, when they are affected by secondary victim syndrome, those are individuals that they felt personally responsible for the outcome of their patient. Those are the individuals that they feel that as they have failed a patient, they start second-gassing their clinical skills and their knowledge. They feel like they should have done more for that patient. So, that sensation of guilt is there.
00:19:47
Speaker
So the emotions are diverse and people will feel one or two emotions and they can feel a range of emotions that can range from guilt, fear, anxiety, even depression. And all these events can be the events, the outcomes that whatever happened to the patient, you amputate the wrong leg or you gave the wrong drug, you know, all these things can be replaying, reviving the event is another thing that happens during the second victim syndrome as well.
00:20:17
Speaker
Questioning their decisions, you know, feelings of incompetence, loss of confidence, fear of future errors. People avoid doing similar procedures. Like on my case, for example, I can testify when I had that horse breaking, it's like, I second guess myself, am I really good at what I'm doing? You know, should I be doing something else? Should I be just teaching students? I don't know if I should be a clinician.
00:20:44
Speaker
So those emotions, they start to come into your head and there's a defined pathway when you're a second victim. We can talk about that later if you want. There's a recovery period that I can talk to you about that's pretty defined for second victims.
00:21:00
Speaker
We're gonna talk a little bit later about what it looks like when you're recovering and maybe factors that can help you if you feel like you have suffered from second victim syndrome, things that we know that help people get through that. So we are gonna address that in a little bit.
00:21:16
Speaker
Do you think there are certain personality traits that are instilled in us as veterinarians and veterinary technicians just being in the veterinary field? Do you think there are certain personality traits that are instilled in us to make us be more at risk of experiencing second victim syndrome?
00:21:37
Speaker
Yes, absolutely. So individuals that are more empathized, so they are more empathetic towards patients are more prone to second victim syndrome. So you can relate, for example, or individuals that are, for example, anesthetizing your sister's dog. You feel that pressure, you know? So there are circumstances and feelings or characteristics on the individual's integrity.
00:22:06
Speaker
That can make you a little bit more prone to second victim syndrome. I'm also thinking of the fact that in the veterinary profession, we're oftentimes told to like stuff our feelings down and keep going and get through the grind.
00:22:24
Speaker
And a lot of times people are not given the space to process a tragedy or a medical error if it happens because we just have to keep going. And there's like a level of stoicism that's required or at least is told to us that it's required in order for us to be the most productive individuals that we can be and help the most number of patients that we can help
00:22:53
Speaker
And I mean, I can't even tell you how many times I've been with a team and we've gone through a code and it was awful. We lost a dog or a cat and then we have another case we have to do. So you kind of have to just
00:23:10
Speaker
do the next case and there's not enough people to maybe tag out and maybe the technicians who were there in the code, there's not enough people for those to allow those technicians who are involved in the code to step away and process whatever happened to them.
00:23:27
Speaker
So that level of stoicism and that level of like, get through as many cases as you can and just jump to the next case. I just feel like that might worsen or make it more likely for a person to experience second victim syndrome. I don't know if you feel that way or you agree or if you have... No, no, no. I absolutely agree with you.
00:23:48
Speaker
And that's up to the leadership. The leaders need to be more empathetic towards their staff. Leaders are there to support their staff, not just to make money. Yeah, money is important. We are a provider of a service. People keep telling me, yes, we are a provider of service. I agree. But we need to come to our work a little bit more humane about each other.
00:24:13
Speaker
I'm checking in, are you okay? If you see a person that is struggling already on the first consult, offer help, offer an advice saying, do you want me to do this next concert for you? Or do you want to just have five minute coffee break just in between these concerts to actually talk about this, to kind of diffuse? I think we're losing the humanity of going from case to case. Or if you have to do case to case, if we're not allowed to have a break,
00:24:41
Speaker
At least at the end of the day try to diffuse those emotions before going home in the end you're going home to your kids to your family you don't want to be coming home angry and frustrated talk to your kids to your family and that's often what we have and that's why second victim can lead to burnout and vice versa burnout person can.
00:25:00
Speaker
when mistake happens can aggravate so i think the emotions and we often say don't go home straight away right and we sometimes i used to do that mistake i used to say just go home you know you made a mistake something happened to this patient just go home and there's actually no you should actually just go upstairs or to the office of x y and z and let's let's have a coffee or just use a little bit.
00:25:26
Speaker
Talk to a friend we're gonna talk about the support the support structures for second victims but it's important that the day-to-day of an air vet technician is acknowledge that it's a hard we're here for patients first and most important and for to keep the best care for patients we need to be in a good mental health.
00:25:46
Speaker
Yeah, I think that's such an important point is that if you want to be the best possible clinician, you can be, you have to be at a good mental state. It's absolutely. But it's up to leaders to be there and see, as Louise, I see you're struggling, but do you want me to do this concert for you, you know, and we can talk about later and give that support because otherwise burnout will happen.
00:26:13
Speaker
Yeah, and I think just to add to that, if you are somebody who has decided to reach out to somebody who you think is struggling, I think the first thing is I feel like the person who needs the most amount of help is the person who's the least likely to ask for help. And so I do think it is important that you check in on your colleagues, but just be aware and be okay with the fact that you might get resistance.
00:26:41
Speaker
and try to just keep in the back of your brain that just asking, hey, are you okay? And that person might be like, I don't want to talk about it, leave me alone, but probably just the act of you asking, it might just be helpful enough.
00:26:59
Speaker
What second victim desires the person that is affected? What do they want? They want to be appreciated. They want it to be respected. They want it to be valued. They want to be part of the team. Whenever you make a mistake or you give the wrong dose, you know, made the wrong decision. You don't want people gossiping on the hallways talking about you and that guy is incompetent.
Support and acknowledgement for second victims
00:27:23
Speaker
He made the decision, the wrong leg.
00:27:25
Speaker
You never know what people are going on on their private lives when they come to work. So the individual wants to feel valued. They want to be part of a team. They want to be trusted. And when you come to a person with second victim, obviously everyone, you don't need to be a second victim. Everyone wants to be valued and part of a team. But second victims, they are on steroids, wanting for help, wanting to be acknowledged, wanting to say,
00:27:55
Speaker
Look i know you you're frustrated and stay can happen but i'm here you're a good technician i've seen you done wonderful jobs anesthesia is i've seen how you're nice ties.
00:28:10
Speaker
It happened. Make mistakes is human. You know, acknowledge, send a message that you're here if you need, even if the person doesn't want to talk to you. Just send a message. Yeah, that was really well said. So let's talk a little bit about medical errors. And again, I do have another episode on patient safety, so I don't want to spend too much time on this. But we do know that second victim syndrome is often linked to medical errors. So maybe we should learn a little bit about
00:28:40
Speaker
What are the most common types of medical errors that we can see in anesthetic practice? Because maybe that will heighten our awareness to avoid making these types of mistakes if we can. So do we know how often anesthetists are involved in medical errors compared to other types of specialists? It's really hard to answer that question. Yeah. Only because
00:29:03
Speaker
The problem with veterinary medicine, we don't publish our mistakes, medical errors as often as healthcare does. And we're very embryonic to talk about mistakes in our field. We're scared of saying we're feeling incompetent. And thank God Dr. Eric Hofmeister came and published an article on veterinary medicine talking about what happened in his
00:29:28
Speaker
I can't talk about how many to be shins of the distributions how many of levels left closed and then the interventions that they made to actually decrease those so i take my hand for him to talk about those mistakes in his place and we should be doing this more.
00:29:46
Speaker
We should be talking more about errors and mistakes. There's a person here in the UK called Catherine Oxtoby. She published a while back now, but talking about we need to talk about errors. We need to embed this in our culture. We need to report, we need to disclose, we need to talk about it. And hopefully that message
00:30:08
Speaker
starts to spread in the veterinary community and we know more about these numbers. We know that in healthcare, for example, just to give you some perspective of what happens in the healthcare, we know that anesthesiologist and intensive care providers, by dealing with drugs, we often make more mistakes, calculation mistakes, giving wrong route, wrong drug, etc.
00:30:32
Speaker
There was actually a study done in 2012 by a health provider called Fenaz Gazzoni. He's from the University of Virginia Department of Anesthesiologists, and he published that at around 90% of anesthesiologists experience at least one serious period of injury or death of a patient over their entire career. So we can assume that very anesthesiologists, very technicians, they are very the same.
00:31:00
Speaker
We will all be at least have one patient that had some sort of comorbidity or died an anesthesia. And it's good that they're reporting these numbers, but we don't know anything in their medicine as far as I know to date.
00:31:15
Speaker
Yeah, we're going to link the study that was done by Dr. Eric Hofmeister and his team when he was working at Georgia. We will link that in the show notes. And I remember reading that paper and finding a lot of inspiration as far as things that I can do in my practice that allowed me to reduce errors.
00:31:34
Speaker
I think, like you mentioned, the most common errors that were reported in that paper, and also in my personal experience, I agree with this, is really drug errors, mostly in drug calculations and route errors. Somebody gave a drug intravenously when they should have given it intramuscularly, for example.
00:31:53
Speaker
And so one of the strategies I was suggesting in that paper and that I actually have adopted in my clinical practice, and I think probably most of the technicians that work with me know that I do this, which is that before I ever inject a medication, I always read the drug label and either I'm doing it in my head or I'm doing it out loud. The paper suggests that you should do it out loud because it's an extra mental step.
00:32:22
Speaker
but read the drug label and state the route that you're giving it. It sounds funny, isn't it? Funny. And people, when I do my classes with closed loop communication and CPR people, why do you have to repeat? Obviously, I'm going to get the right drug. I'm going to give the right drug. And if we underestimate our cognitive abilities and when we're stressed, when we're hungry, all those human factors,
00:32:47
Speaker
that leads to a mistake, it becomes so easy by talking to yourself out loud, sends a message to your brain, doesn't it? Yeah, it does. I also think there's a book that was published and I haven't read it, but I'm curious about it. I think there is a book about medical errors in veterinary anesthetic practice. Do you know about this book? Yeah, I think there's a book by Dr. Ludders. Actually, he was my supervisor.
00:33:12
Speaker
Cornell University actually read the draft before he published. It's interesting you talked about this. It's Macmillan and the letters, I think. He told me, Louise, I don't know if this book will be published because there's no appetite. And that was 15 years ago, more or less when I was still on my residency.
00:33:36
Speaker
And I say, I'm sure we will get published, Dr. Leather. You know, this is super important, but I'll tell that to the editorial people because I've been trying to get, you know, people to publish this type of stuff. And thank God it came out, you know, it's like something to have.
00:33:53
Speaker
Yeah, so there's a lot of terms when it comes to mental health conditions that veterinary professionals can succumb to in practice. We talked about burnout, but I want to take a minute to talk about some of these other types of conditions and how they relate to second victim syndrome. So the first one is compassion fatigue, which you mentioned earlier. So can you just define what that is?
00:34:17
Speaker
Yeah, compassion fatigue is this condition where often is experienced by professionals, not only healthcare professionals, but very professionals as well, who are frequently exposed to this emotional distress of others or of their patients. So for example, a nurse working on ICU might constantly encounter patients and clients going through tense suffering and grief. So over time, for example, this nurse may start feeling
00:34:45
Speaker
quite emotionally drained, physically exhausted, and find it harder to feel empathy, you know, and could become even more irritable or anxious. So this is what compassion fatigue is, is this drainage of emotion. I cannot bear this anymore. You know, it's difficult to empathize difficult situations and stressful situations. And compassion fatigue can also lead to burnout if not addressed. That's what's important as well.
00:35:14
Speaker
Yeah, let's define burnout for our listeners then. So burnout is this state of physical, emotional and mental exhaustion that is caused by prolonged and excessive stress. It's a chronic stress that happens at work and drains you physically, emotionally, mentally, unlike compassion fatigue, which is specifically related to exposure to other suffering.
00:35:37
Speaker
Or the animal suffering burnout can happen in any occupation and soften related to work environment workload so that's basically the big difference.
00:35:46
Speaker
So I guess an example would be a veterinarian who works long hours in a busy animal clinic. And he deals with sick animals, emotional pet owners, and sometimes has to make tough decisions like euthanasia. And despite their law for animals, the vet starts feeling overwhelmed by the workload, emotional stress, and possibly even financial pressures of running the clinic. Exactly those cases that you mentioned earlier about having one consult after the other.
00:36:13
Speaker
and not having the pause to kind of diffuse those emotions from the first concept, for example, leads to, in the end, burnout. How are compassion fatigue and burnout and second victim syndrome, are these just all kind of similar ways of saying the same thing or are they related to each other in some way? No, they're not the same thing, but the emotions can be the psychological impact
00:36:41
Speaker
grief, stress, trauma, guilt, you know, I cannot sleep well, all, you know, the sensation of, I don't know if I'm doing this, the right thing. So those are things that are quite similar, but I think the reasons behind are different.
00:36:59
Speaker
Okay so second victim again is something that we're dressing as a phenomena where people when they make mistakes and adverse patient outcomes like for example anesthetized a dog for a spay and castration this animal died under anesthesia and there's that burden the sensation the psychological impact from that event.
00:37:23
Speaker
burnout again related to work related stress and then compassion fatigue is that the empathy related to animals and clients that is exhausted.
Burnout in veterinary professionals and recovery
00:37:37
Speaker
Do we have any data on how often burnout or second victim syndrome are occurring in the veterinary profession?
00:37:44
Speaker
Yeah, burnout is something that is actually studied a lot more than second victim phenomena. And it has been pre-COVID and exacerbated with post-COVID. So approximately, I would say 50% or more of it is reported and moderate to high levels of burnout. There are studies saying students, depending on the level, there's a nice paper from Dr. Michelle Staffy from the University of California, Davis.
00:38:10
Speaker
She's an on-call surgeon, published also student burnout, technician burnout, and veterinarian. So yes, burnout is present is a thing we need to acknowledge exists. The rate of burnout will depend on age, gender with women,
00:38:32
Speaker
twice more likely having burnout than men. And we probably know why I have my wife and she, I posed that question to my wife the other day. Why do you think we even ask twice more? And she's like, Luis, do you really want to know? One is because I have to pick up the kids and deliver to school. I have to solve the issues with
00:38:57
Speaker
not only the kids but with my horse and my dogs and I always have to deal with being a woman in an academic environment where you know all those issues with salary differences and so
00:39:12
Speaker
And I say that's exactly what this paper that I'm quoting actually says it is. There's differences between gender. And I don't know what I think. No, I totally agree. I think that women from, I mean, even girls from very young age are basically, it's ingrained almost in young girls that to carry the emotional burden of running a household is
00:39:42
Speaker
It's just incredibly ingrained.
00:39:44
Speaker
ever since you're very young and that carries with you through adulthood. And so I agree. I mean, personally, I do feel like I am constantly juggling my career and my family life and having to do that without feeling guilt about neglecting either one. It's a huge challenge for sure. A huge personal challenge. So see the emotions are already there and then you come to
00:40:14
Speaker
a very high stress environment like variant medicine and you endure a place sometimes where the culture is not there for you, there's no support. So yes, those are the factors. So young veterinarians or less experienced veterinarians, there's also evidence that suggests exhibit higher burnout rates compared to those with more experience. So that's an interesting thing as well. And probably we understand why.
00:40:44
Speaker
So let's talk a little bit now about strategies that
00:40:50
Speaker
mitigate these emotional symptoms that occur as a result of second victim syndrome. So if you have second victim syndrome, or you think you have it, or there's somebody that you work with that you're concerned about might have this, what do we know about the recovery period? And what do we know about strategies that we can do to help somebody or ourselves if we feel like we are experiencing second victim syndrome?
00:41:20
Speaker
So basically, second victims have a very defined recovery period. And it's quite interesting because there's six stages, basically. And this was a study done by Dr. Scott, a research nurse. In preparation for our discussion today, I actually did find on YouTube a lecture that she gave about second victim syndrome. Yes. So I would totally direct people, if you're interested in learning more about this, you should totally watch her talk. She's wonderful. And she's like,
00:41:50
Speaker
has so much information to give. She published in 2009 the recovery trajectory of second victim. So basically, there is this chaos and accident response at this first stage where people go through where, you know, they realize the mistakes and the errors they made. They tell somebody trying to get help.
00:42:11
Speaker
So it's this moment where you're most distracted by the event. So it is the chaos right after the event.
00:42:21
Speaker
And we have the stage two, which is intrusive reflections, where you start, you know, reevaluating the scenario and self isolating yourself. You recognize that you made something bad to the patient, this feelings of inadequacy. And then you go through stage three, where is it restoring this personal integrity? It's always feeling like people are pointing fingers at you, trying to manage this gossip,
00:42:50
Speaker
that it goes around and trying to accept accepted them again in that circle of safety and then the fourth stage is the enduring the inquisition as she mentions where you feel like now you're in the police station where somebody is in the other side of the table and trying to get information from you and then you realize how serious it was the mistake that happened.
00:43:18
Speaker
So trying to understand what happened, you know, and the whys about the event. So all these four stages can happen one after the other or it can happen simultaneously. Now,
00:43:34
Speaker
The fifth stage is attaining emotional first aid. And that's when second victims, they're trying to identify, the individuals are trying to identify who is safe to confide, who is safe to talk to, that someone hopefully will reach out. This is the stage where I'm dying to receive some comment or somebody comes talk to me, are you okay? You know, you want to talk to.
00:43:59
Speaker
And then the final stage is the moving on stage, which can have three subsets of outcomes. So second victims can either thrive. So that depends on if you're especially on pre factors like if you don't have any burnout related, if you're a person that
00:44:19
Speaker
tribes on mistakes for example okay and i actually learned with giving the wrong drug on the wrong routes or the wrong dose and i learned that and i'm not gonna do that again and you feel clean and you feel emotionally okay about it you're triving yes you kind of don't have emotions about it anymore then we have the survivors
00:44:46
Speaker
As she mentions, or her text is where the survivors are the people that are there, but they're still emotionally quite loaded with negative emotions, guilt, fear, and they're just doing the bare minimum work. We call that presentation. There's absenteeism where people suddenly don't show up to work because of mental health, but then we have people that come to work.
00:45:13
Speaker
they are doing the bare minimum necessary, but still affected by. So we call presentism different from quiet quitting, which has a terminology where it's not related to mental health or sickness. Presentism is related to sickness. Yeah. It's like showing up physically, but not showing up mentally. Exactly. Exactly. And then what worries me most is the dropping outs is the people that are so affected by it so deeply.
00:45:43
Speaker
typically psychologically affected by it, that they either change careers, they go to do anesthesia or or another type of work in a different service, like for example, a technician that was doing anesthesia now is doing consults or reception, they're moved to a different section of the hospital.
00:46:04
Speaker
And, worryingly, the ones that we have to be careful is the ones that we have to that level as well about those individuals. And I don't know if you know about the case of the nurse in the US, the medical nurse that she gave the wrong drug to a child.
00:46:24
Speaker
And she was convicted of manslaughter. Yeah, that was a very popular case in the US. Yeah. So that individual, her license, she never could work again, you know, and you could understand the emotional impact of that. And she eventually took her life, you know, it is tricky.
00:46:47
Speaker
That's why people are so afraid of reporting and talking about it. I think, though, by giving a platform to talk about second victim syndrome and normalizing some of the emotional feelings you're going to have when you make a medical error
00:47:06
Speaker
I think that is very powerful and very important to get out there so that we can try to allow people to understand that it's normal and maybe take away some of the stigma of the consequences of making a medical error. So it's really important. I'm so glad you're here talking about that today. Thank you. And now answering the other question about what strategies work to mitigate the onset of second victim
00:47:35
Speaker
My answer is support the individual. Yeah. I'm not talking only about leadership here. I'm talking about the individual next to you, your colleague. Extend your hand to your colleague and say, you know, tap in the back, say, hey, I'm here with you. We're in this together. I trust you. So support, support, support. It's normalizing, like you said, mistakes. Mistakes are humans happen.
00:48:03
Speaker
to a lot of us, and we need to create this culture of learning and support for one another. And you briefly talked to Lydia on the previous podcast about a little bit about blame culture, and this is something that we need to shift eventually.
Peer support programs and recovery effectiveness
00:48:21
Speaker
So when I'm talking about support, people ask, okay, Luis, so what leaders and organizations can do?
00:48:29
Speaker
to support these individuals. It's published and it's proven all throughout this 24 years of research in healthcare about second victims that the best thing to do is having a peer support program.
00:48:42
Speaker
So what is a peer support program? Not even all healthcare providers have peer support program. It's something that you get individuals from the same expertise. So for example, veterinarians, vet nurses, vet technicians, receptionists, interns, residents, train these individuals in mental health first aid. And then form this group of people to collaborate and be there for
00:49:09
Speaker
if this individual wants to talk about a mistake. So if if I make a mistake, maybe I'm more comfortable talking to another anesthesiologist rather than my supervisor, because I don't go along with myself. You know what I mean? So you have that in your practice doesn't need to be a great amount of individuals can be one or two people that are keen to listen. But needs to be trained. So a peer support program is is well established and is proven to be effective for second victim.
00:49:37
Speaker
Then we have the whole counseling that practices can send their staff, psychologists, and educating staff about second victim syndrome is one step that practices can do. Engaging staff to do self-care activities, you know, and maintain work-life balance. But
00:50:00
Speaker
I don't like when leaders and organizations bring a psychologist to talk about all these, you know, create awareness, but they don't do anything about actually, let's do it. Instead of just saying, Oh, I care, I know about this, but let's do it then, you know, let's bring the resources because this will impact an individual. And for those leaders listening to this podcast, it will save you money.
00:50:29
Speaker
on staff turnover, because I can guarantee if you don't take care of that stuff, that stuff will drop out. Right. And by taking care of that stuff, you avoid turnover, which sometimes can take months nowadays to get a new vet tech or a new vet. And that saves you money.
00:50:47
Speaker
Yeah, there's a few things I wanted to add to that. So when I was learning a little bit more about second victim syndrome, something that I read about or I heard about on the human medical side is that when they talk about the person who you want to confide in, if you feel like you've had a medical error or something like that, most physicians felt the most comfortable talking to a peer of the same level.
00:51:13
Speaker
So if you're a technician, you should talk to another technician. If you are a veterinarian, either talking to a technician or a veterinarian, depending on the relationships you have is really important. Something else I think that is totally missing in most of my practices that I go to, but something that's super important
00:51:32
Speaker
is you should have somewhere in your hospital where you post, at least in the US we have this national suicide hotline prevention phone number, just be somewhere up in the hospital and just making people aware that it exists and just having it somewhere so that if that's a resource you feel like you need that you have that. Have you heard of something called code lavender?
00:51:56
Speaker
No, I don't, I didn't. This is something that I heard about very recently and I thought it was really interesting. It's something that it's not in every hospital, but it's something that was developed. I think in a human hospital in the NICU department, because again, this is an area where you have very high stakes patients that are, you know, potentially having
00:52:21
Speaker
very complicated disease processes. And so they develop something called a co lavender whereby if some kind of catastrophic event happens.
00:52:31
Speaker
either you lose a patient or you made a medical error, something like that, that individual has the freedom to call a co-lavender. And essentially what that means is that there's a team of nurses or doctors on standby that you can call and will fill that person's role so that person can leave the floor.
00:52:54
Speaker
Oh my God, that's amazing. I haven't heard of that. That's great. I mean, I don't think it's something that we can necessarily do in veterinary medicine to mean most places are so understaffed in the first place. But wouldn't that be amazing if we could implement something similar to a code lavender?
00:53:11
Speaker
Yes. No, that's amazing. Yeah, obviously you would have, but you can do what you know what you can do. You can call that person that was on after a shift. Can you come a little bit earlier to start this shift, you know, or even if you have to pay a little bit more, you know, to, to kind of offset the stuff that needs to be living early because of an issue. So we should allow this flexibility as well on, on out. Obviously the staff can come earlier to support.
00:53:40
Speaker
And as leadership, just making sure you financially support everybody who's doing that. Yeah. So if you feel that you have experienced second victim syndrome or somebody you know is experiencing this right now, Louise, do you mind pointing out some resources that people can turn to in order to get the help that they need?
00:54:01
Speaker
Yeah it seems to shoot institutional practice and each country i think they will have some sort of mental health support system in place is so variable here in the uk we have hotlines twenty four seven in scotland and there is one just for scotland for for venetians and that nurses.
00:54:22
Speaker
24-7 hotlines are very nice because they are confidential. You don't need to disclose who you are, but it's all answered by vets on the other side of the phone. Obviously, people can seek if their organization provides support programs for counseling services and peer support networks. That's great. And I think that's what we have now here in Glasgow University. We formed a group of
00:54:50
Speaker
multidisciplinary group of people invested in and trained in mental health first aid and we're starting this not only with the students but also for the for the staff i think it's up to the organization to provide those services or at least say okay you need some time off and i have here like you said a phone of counseling service and guide the individual not just assume
00:55:21
Speaker
fend for themselves and go home. Some individuals don't want to talk to their family members about their issues at work. Like you said, they want to talk to individuals from the same area where they will understand their mistakes. It's important to have that level of support at work as well. Do you have anything else you want to add? I think leaders need to be encouraging a non-punitive learning focus approach to errors.
00:55:50
Speaker
I think should be their jobs and into institutionalizing that in the practice. So this helps reduce fear and shame associated with reporting mistakes, allow people to report. Like we said, establish peer support programs with colleagues. That will help a lot. And the conduct of hot debriefs or debriefing process
00:56:18
Speaker
This allows staff to have five minutes just to quickly get together and check in with each other during those debriefs. Talk about emotions as well, not just about the facts of the cases. It's very easy to run into what happened, what happened, why did it happen? But check in, say, we often say, are you okay? Notice that this, you made a mistake, but this has impact on you.
00:56:44
Speaker
Instead of just jumping, what happened again, encourage open discussions about errors. We need to start talking about mistakes and errors and learn from them. Right. And, and healthcare, they are already starting to learn about safety one, which is when things go right and learn from when things go right, not when things go wrong. So we should also embark on that. So that's all my, my message to the leaders out there.
00:57:12
Speaker
Yeah, there are peer-to-peer support groups that you can find even on Facebook. I know there is not one more vet and I know that that has been in a space where people can feel safe. They can post anonymously and maybe just talk about their feelings a little bit. So if you feel like you're not getting support from your leadership, there are outlets. You just have to go find them a little bit. Yeah.
00:57:37
Speaker
Well, I appreciate you coming on today and talking to me about this very important phenomenon that occurs in veterinary medicine, but is underreported and not talked about enough. So thank you so much for your time. Thank you for having me. Appreciate it.
00:57:58
Speaker
If you like what you heard today, I encourage you to check out NavAss and consider becoming a member. As a member of the North American Veterinary Anesthesia Society, you get tons of benefits, including access to sea events, focusing on anesthesia and pain management, blog posts, fireside chats with boarded anesthesiologists, as well as specialty technicians, and just so much more. Visit www.mynavass.org to advance your anesthesia journey today.
00:58:28
Speaker
As a reminder, the NAVAS virtual spring symposium will be taking place on April 27th and 28th of this year. If you enjoyed this conversation, Dr. Santos will be a featured speaker at the NAVAS symposium where he will be discussing second victim trauma.
00:58:45
Speaker
For more information, including other speakers and topics that will be presented, visit the website www.mynavas.org slash 2024-spring-symposium. Registration for the symposium opened on February 1st.
00:59:03
Speaker
If you've been enjoying the content of this podcast, I would sincerely appreciate it if you would give us a like or subscribe to our podcast, write a review, or simply spread the word about this podcast to your friends and coworkers. We appreciate any and all listener support. If you have any questions about this week's episode or the Navas podcast in general,
00:59:26
Speaker
Or if you want to suggest topics you would like for us to discuss in future episodes, please reach out to us at education at mynavass.org. We would love to hear from all of you. Also a huge thank you to our sponsor, Decra, without whom this podcast would not be possible. Visit their website, www.decra-us.com to learn more about their line of veterinary anesthesia products.
00:59:54
Speaker
This podcast was produced by Maria Bridges, edited by Chris Webster of Chris Webster Productions, and technical support was provided by Salheminis. I want to thank our guest, Dr. Luis Santos, for this incredibly insightful discussion on this important topic.
01:00:11
Speaker
And lastly, a huge thank you to all the gas pastors out there who choose to spend their time with me today on the North American Veterinary Anesthesia Society podcast. Becoming a skilled anesthetist is a lifelong journey of learning and self-discovery, so I hope you consider listening in the future. I'm your host, Dr. Bonnie Gatson, and please take care of yourself and stay safe.