Difficult Conversations Podcast
Lessons I Learned as an ICU Physician
Episode 130 | February 9, 2021
Second Victim Syndrome
Dr. Susan Wilson
Emergency Medicine Physician, Coach
Welcome to Difficult Conversations with Dr. Anthony Orsini. My special guest today is Dr. Susan Wilson. After 15 years of practicing Emergency Medicine, she retired from clinical practice, completed her coursework in coaching and formed SJW Professional Coaching Services, LLC with the goal of providing guidance and support to healthcare professionals. Over the past 25 years, Dr. Wilson has seen the evolution of medical practice, witnessing first-hand how the changes in healthcare have impacted her colleagues. She sees professional coaching as an important tool to addressing issues of burnout among healthcare providers. Dr. Wilson is particularly passionate about Second Victim Syndrome, an extremely important topic that most healthcare providers are not aware of but should know about.
Dr. Wilson talks about physician burnout and suicide rates, and discusses a JAMA article about the relationship between resiliency and burnout in physicians. Dr. Orsini and Dr. Wilson discuss Second Victim Syndrome (SVS), why it’s such a problem, and how it affects both providers and patients. We learn about the stages of grief that occur with SVS and the final stage which is moving on, in which people will either thrive, survive, or drop out. If someone needs help, Susan lets us know the best resources on how to get it. She talks about the staggering statistics of physician burnout and Second Victim Syndrome and how many healthcare professionals are actually seeking help. We find out how Susan coaches people through EAP on their journey of feeling better. Since Dr. Orsini and Susan both do a lot of coaching, they share why it is so important to them to help others. We end with Susan telling us the one conversation that is the most difficult and how she approaches it. Also, she gives advice on how to approach that person you care about that may need help, from either physician burnout or SVS If you enjoyed this podcast, please hit the subscribe button to find out more about what we do and how we teach communication. Go ahead and download this episode now!
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Dr. Susan Wilson (2s):
So the classic definition of second victim syndrome is the impact of an unanticipated adverse medical event on a clinician. So the concept is the patient is the first victim of the bad event, but the clinician and this really applies to anyone, so any member of the healthcare team, whether it’s the physician, mid-level provider, nurse, pharmacist, tech, anyone involved in a case. So they become the second victim. And there are some very well described symptoms that come along with these episodes. So they’re both physical symptoms and psychological symptoms.
Welcome to Difficult Conversations: lessons I learned as an ICU physician with Dr. Anthony Orsini. Dr. Orsini is a practicing physician and president and CEO of the Orsini Way. As a frequent keynote speaker and author, Dr. Orsini has been training healthcare professionals and business leaders, how to navigate through the most difficult dialogues. Each week you will hear inspiring interviews with experts in their field who tell their story and provide practical advice on how to effectively communicate. Whether you are a doctor faced with giving a patient bad news, a business leader who wants to get the most out of his or her team members or someone who just wants to learn to communicate better this is the podcast for you..
Dr. Anthony Orsini (1m 29s):
I am honored today that the Orsini way has partnered with the Finley Project to bring you this episode of Difficult Conversations: Lessons I learned as an ICU physician, the Finley Project is a nonprofit organization committed to providing care for mothers who have experienced the unimaginable, the loss of an infant. That was created by their founder, Noelle Moore who’s sweet daughter, Finley died in 2013. It was at that time that Noelle realized that there was a large gap between leaving the hospital without your baby. And the time when you get home, that led her to start the Finley Project. The Finley Project is the nation’s only seven part holistic program that helps mothers after infant loss, by supporting them physically and emotionally, they provide such things as mental health counseling, funeral arrangements, support, grocery gift cards, professional house cleaning, professional massage therapy, and support group placement.
Dr. Anthony Orsini (2m 24s):
The Finley Project has helped hundreds of women across the country and I can tell you that I have seen personally how the Finley Project has literally saved the lives of mothers who lost their infant. If you are interested in learning more or referring a family or donating to this amazing cause please go to the Finley Project.org. Finley Project believes that no family should walk out of a hospital without support. Well, welcome to another episode of difficult conversations lessons I learned as an ICU physician. This is Dr. Anthony Orsini, and I will be your host again this week. Well since our first episode on August 4th of 2020, we’ve had a variety of guests from both healthcare and the business sector.
Dr. Anthony Orsini (3m 8s):
And if you’ve been listening on a regular basis, you’ll probably recognize that there’s many parallels and overlap between the two. Now a frequent topic during the healthcare episodes has been physician burnout and the high suicide rate among physicians and healthcare workers. In fact, one of our earliest episodes, I interviewed Dr. Dike Drummond, who literally wrote the book on burnout. And if you haven’t heard that yet, I highly suggest that you go back and listen after this interview because it’s really very inspiring and you can learn a lot. Well today I have another physician and coach who’s here to talk about physician and nurse wellbeing and a topic that I must admit I knew very little about before I spoke to her.
Dr. Anthony Orsini (3m 51s):
And that’s the topic of second victim syndrome. My guest today is Dr. Susan Wilson. Dr. Wilson has been practicing emergency medicine since 1994. After attending Loyola school of medicine in Chicago and completing her residency at the medical college of Wisconsin in Milwaukee she retired from clinical practice in June of 2019. Wanting to maintain involvement in medicine, Dr. Wilson completed coursework in coaching, forming SJW professional coaching services, LLC, with the goal of providing guidance and support the healthcare professionals, her 25 years as a hospital-based board certified physician has afforded great insight into the challenges of medicine into this arena.
Dr. Anthony Orsini (4m 37s):
Having seen the evolution of medical practice and witnessing firsthand how these changes have impacted her colleagues, Dr. Wilson sees professional coaching as an important tool to addressing issues of burnout among health care providers. She is currently affiliated with vital worklife, EAP and surgeon masters as a physician peer coach. She is a member of physician coaching Alliance and also serves as a volunteer physician coach for California medical association. Susan is particularly passionate about second victim syndrome, which I find fascinating. So please keep listening. You’ll learn a lot. It’s an extremely important topic.
Dr. Anthony Orsini (5m 17s):
And one that every healthcare provider should know about and every patient should care about. Susan has been a Midwesterner her whole life, and I’m happy to get an opportunity to learn from her today and to truly be inspired, Susan, welcome. And thank you for taking the time out to be a guest today.
Dr. Susan Wilson (5m 34s):
Thanks so much. It’s great to be here. Great. To be able to talk about something that’s very near and dear to my heart.
Dr. Anthony Orsini (5m 41s):
I just said, told everyone you’re at Midwestern your whole life, but you just told me right before you’re in California, at least for a few months now, is that correct?
Dr. Susan Wilson (5m 47s):
It is. Yes. I’ve been in actually did my entire career in the Milwaukee area. And I’m originally from Northern Illinois and yeah, now just spending a few months of the winter in California, but otherwise in Northern Wisconsin during the summer.
Dr. Anthony Orsini (6m 4s):
Fantastic. So last time we spoke, you told me about your journey and it’s fascinating and how you got here. And I really want to talk about second victim syndrome about coaching. And of course this is always about difficult conversations, but I also love to start out with having my audience, get to know you. So if you just tell us about who is Susan Wilson, how did she become a physician and how did she kind of evolve into now doing what you’re doing now?
Dr. Susan Wilson (6m 29s):
So I actually am from a medical family. My mother was a practicing internist. And so that subsequently spurned me on to go into medicine. And so I have done all my training, as I said in the Midwest. I started practicing emergency medicine back in 1994 and actually had to retire last year in June, 2019 because I have developed this progressive retinopathy. And so my vision has become an issue really to the point where I couldn’t practice effectively anymore. So I had to retire. And then I was thinking a lot about what I wanted to do, what the next chapter would be.
Dr. Susan Wilson (7m 10s):
And I really still wanted to be involved in medicine and I really wanted to still be interacting with my colleagues. So I thought, well, coaching would be a great way to do that. Especially, you know, given the fact that people seem to be having a lot of struggles now with job satisfaction and burnout. And so I really wanted to try to help my colleagues with that piece. And then also I’ve along the way, become super interested in the concept of second victim syndrome. And so also really wanted a way that I could continue educating my colleagues about the syndrome and the fact that there is actually help out there and their support.
Dr. Anthony Orsini (7m 53s):
Fantastic. And before we get into the second victim syndrome, if anyone has not heard the interview with Dike Drummond, but if you’re in healthcare, you really know that physician burnout is a problem and suicide rates of physicians higher than any other profession, which most people that I meet do not know. I just like your point of view now that you’re coaching, and this is an issue that you deal with all the time, how bad of a problem is it, and what do we really need to do to kind of bring these suicide rates down? Just tell us your feelings about how we can stop this terrible thing from happening.
Dr. Susan Wilson (8m 26s):
Well, you know, it is the more and more I learn and I hear about burnout, particularly in medicine. It’s just become very clear that, I mean, it’s a multifactorial issue. And really, I think traditionally, you know, you think about somebody getting burnt out, you think there’s something actually wrong with them and that they can’t handle the job. And there’s an inadequacy there, but more and more, I think we’re seeing that it’s not the physician. It’s really the environment that they’re in, that’s causing them to become burnt out. And you know, it’s interesting, there’s actually an article. You may be familiar with this that came out just this year.
Dr. Susan Wilson (9m 9s):
I think in July in JAMA talking about the kind of correlation between resiliency, particularly in physicians and burnout and what the article pointed out was number one, that physicians have higher resiliency rates than it, than the general population, but then also there’s still a significant amount of burnout even in the most resilient physicians. So I think what they quoted in this article was like, even the physicians that scored highest and resiliency still had up to a 30% rate of burnout. And I think what that speaks to is, you know, the idea that really, it’s not the physician they’re already super resilient and they’re already coping with challenges, but what are speaks to, I think is the fact that we really need to change the environment that we’re practicing in.
Dr. Susan Wilson (10m 2s):
And so then you’re starting to talk about trying to reach out to the healthcare organizations, the administrators, and really get the culture to change. And I think that’s the big challenge right now. I think getting that message out there to the big organizations is the strategy that really needs to happen.
Dr. Anthony Orsini (10m 23s):
It seems to me and from my own personal views, and I’m getting ready to interview Quint Studer, who you may be familiar with. The founder of the Studer group and Quint is a very successful entrepreneur, but also very successful person in healthcare does a lot of really successful stuff with patient experience, but also is a really world-known speaker on leadership. I just finished reading his last book. They talked about the importance of employee engagement and the success of a company. My personal view about physician burnout is very similar to employee engagement. I think in the 26, 27 years that I’ve been practicing I personally feel that the patients appreciate us just as much.
Dr. Anthony Orsini (11m 9s):
I don’t believe that administration and, and the leaders in healthcare appreciate us. Do you think that’s a major role? Am I dead on with that? That it’s really not feeling like you’re not appreciated at the end of the day.
Dr. Susan Wilson (11m 21s):
Yeah, I really think there’s a lot to that. You know, it’s kind of interesting when I think about, I mean, I’ve been observing the changes in medicine really for 40 years. I mean, when I think about what I remember my mother’s practice was as an internist and that I think about my own career, I think about how I have observed the shift from, you know, physicians practicing independently or being members of independent groups to now the vast majority I think are employed and the whole transition, you know, from handwritten clinical notes to an EMR, but the pressure that’s put on the physician, you know, to see more patients more quickly.
Dr. Susan Wilson (12m 5s):
And I don’t think, I mean, just from what I’ve observed, I don’t think necessarily that those challenges have been really appreciated by administration, but how difficult they are. So I definitely think that there has become a progressive disconnect between the physician and the practice and what they’ve been asked to do and the administrators.
Dr. Anthony Orsini (12m 29s):
And if you’re a physician out there, I think you’re going to relate to this. If you’re not a physician, you’re probably going to learn something, but on a journey of a physician, you’re a medical student and then you say, if only I can get past this, I’ll do better because I’ll be a resident I’ll have more control than you realize you’re the low resident on the totem pole. If only it could be the chief resident that I’ll have more control. If only I could be the attending physician, I’ll have more control and you work your whole life towards this autonomy. And then you find out that you never get it. And I think that’s what, in my opinion is, what’s leading to this and that’s why we need coaches like you. And we’re going to talk about your coaching style and your theories about that in a second. I think I want to tie that in what second victim syndrome be honest with you.
Dr. Anthony Orsini (13m 12s):
I had never heard a second victim syndrome until we spoke and I know my audience out there is going, I need to know what this is. So tell us about second victim syndrome and why it’s such a problem.
Dr. Susan Wilson (13m 23s):
So I have to say, interestingly, I had never heard this term myself either until 2017 when I went to a lecture. And so, you know, I’ve been practicing well, I had practiced up to 25 years until, until I retired. And I realized after hearing about it, I have been living this my entire career. So yeah, it’s something that just, I observed that the majority of physicians really don’t know. I mean, I think they know what it is because they’ve experienced it, but they don’t know that there’s a name for it. And so the classic definition of second victim syndrome is the impact of an unanticipated adverse medical event on a clinician.
Dr. Susan Wilson (14m 6s):
And so the concept is the patient is the first victim of the bad event, but the clinician and this really applies to anyone. So any member of the healthcare team, whether it’s the physician, a mid-level provider, nurse, pharmacist, tech, anyone involved in a case. So they become the second victim. And there are some very well described symptoms that come along with these episodes. So they’re both physical symptoms and psychological symptoms. And for example, the physical symptoms are things like elevated heart rate, high blood pressure, GI symptoms are pretty common like nausea, even vomiting and diarrhea, sleep disturbances.
Dr. Susan Wilson (14m 52s):
And then there are a whole host of psychological symptoms that come along with this, including things like feeling, shame, grief, feeling irritable, feeling inability to concentrate, certainly lack of self-confidence is a big one. People oftentimes will describe stress and anxiety. That’s increased depression and even suicidal ideations really fall into this category.
Dr. Anthony Orsini (15m 20s):
So it’s, so something happens at the hospital, which is inevitable because we’re human beings. There could be a medical error. There could be no medical error, right? Just the death of a patient that you’ve bonded with. And I’m a big proponent of not blocking our emotions because I think that makes things worse. And, you know, with my patient experience teaching and my teaching with breaking bad news, I tell doctors all the time it is okay to show emotion. In fact, it helps, but basically second victim syndrome is something happens that doesn’t go perfectly well. And we often think that maybe as lay people or physicians, you know, the patient dies. There’s a medical error. We feel bad, but we carry that with us a long time.
Dr. Anthony Orsini (16m 2s):
Dr. Susan Wilson (16m 3s):
Oh, absolutely. Absolutely. And as you alluded to, I mean, I think medical error is probably the number one cause of this syndrome, but there are so many other scenarios that fit this and, you know, complication of a procedure. If you miss a diagnosis or you’ve had delay in diagnosis, obviously a patient death, all of these things really can then contribute to this feeling. And I actually even would put the whole concept of medical malpractice lawsuits in here because I really think that, you know, a physician or any healthcare professional that’s named in a lawsuit, really, it brings up a lot of these, both physical and psychological symptoms.
Dr. Anthony Orsini (16m 47s):
Most people don’t really understand that this is how this really affects us. I had a colleague that I really looked up to. He had practiced neonatology for many years in New Jersey. He was phenomenal with patients and with families. And he had gone his whole life really with no malpractice lawsuits. And then something happened with a baby who needed to have their eyes checked after they went home for retinopathy of prematurity, which is a common blood vessel disease of premature babies. He had documented multiple times that the mother had to follow up and it was in writing and the mother for some reason did not.
Dr. Anthony Orsini (17m 29s):
And the child sadly went blind because of no follow up. And really, I don’t know what else he could have done just on a personal note to explain, but whatever. So he got sued and although the documentation was there and they settled and you know, he watched the lawsuit, but I got to tell you, Susan, he was probably 30 years into his practice. Every day he came into the office. He was thankful for being a physician. And on that day that he lost the lawsuit. I can tell you, it was never quite the same. So you don’t have to do something wrong or cause a medical error, just the act of being sued.
Dr. Anthony Orsini (18m 10s):
He just felt he took it personally, which she probably shouldn’t have, but we’re human beings. Right? You counter that a lot too, just with the malpractice that these people just can’t get over it.
Dr. Susan Wilson (18m 19s):
And you know, I even think to my own career and to my own personal second victim experiences and yeah, I mean, even if you know, you did everything possible and you did everything correctly. Yeah. You just, you know, there is just, there’s an emotional scar there. And I think the challenge in these situations is how to get through that, how to deal with it. And interestingly, one of the things that we learn about second victim syndrome is there’s a very well-defined recovery trajectory and there’s all these different stages that people go through. It’s kind of like the Kubler-Ross stages of grief.
Dr. Susan Wilson (18m 60s):
And after you’ve gone through all these different stages, the very final stage is moving on. And so people will either thrive, survive, or they’ll drop out. And so I think what happens to a lot of us and I think it’s, I think it depends on the scenario. I think you can certainly thrive through one scenario and maybe you’re just surviving through another. But basically what happens is if you’re thriving, you’ve learned something from the event, it makes you a better clinician. You kind of get in the long run, it’s sort of a positive experience that kind of spurs you on in your career. Then the whole idea of surviving is that you have gotten through it, you are figuring out how to cope, but you still have, you’re having a really difficult time forgiving yourself.
Dr. Susan Wilson (19m 51s):
And so you sort of have this permanent emotional scar. And so while you’re still practicing, you’re still going through the motions. Yeah. It’s just there and it changes you. And then as I said, there’s even some people that just after an episode like this, they completely drop out. So whether they quit where they’re working and find another group to join and to have a fresh start, whether they leave the specialty of medicine that they’re in and go into something else or whether they leave medicine altogether is certainly a possibility.
Dr. Anthony Orsini (20m 22s):
That’s where you come in. We need physicians to stay on the job. We need nurses to continue. Especially during this crisis, I come from a family. I’ve mentioned this before in previous episodes, you came from a medical family. I come from a family of police officers. They’re all police officers, except for me, I went into medicine obviously, but my father who was a police officer for 30 years, said to me, when I entered medical school, he said, there’s only two people in this that have to be perfect every time. And that’s police officers and doctors. And that kind of stuck with me, especially pertinent right now, right with what’s going on in the news. But what people forget is that police officers and doctors are human beings also. And human beings by definition are not perfect.
Dr. Anthony Orsini (21m 5s):
And I think we need to recognize that for ourselves and for other people that we make mistakes. It doesn’t mean that we’re a bad person and it doesn’t mean that we’re mean, but we often make mistakes. So how does this work now? So let’s assume there’s a physician there. If he or she is feeling very depressed or feeling a little burnout, there was possibly an event that occurred and now they need some help. How does it generally happen? Did they reach out to you? How do you get that referral? Is it mostly from someone else or that he says, find you and say, Susan, I need some help.
Dr. Susan Wilson (21m 43s):
Well, I think, you know, there’s multiple ways to get the help. And I think the one thing that I would like to kind of point out is that the second victim scenario, I really kind of feel like that is an acute event. Whereas somebody seeking coaching for issues of job satisfaction or burnout, that’s kind of more of a chronic ongoing process. And so it’s almost like, I think an analogy to make would be, you know, you go to your primary care doctor once a year for your, like your annual checkup and you have your ongoing medical care, you’re checking your cholesterol, blah, blah, blah. And these second victim events are really more like unscheduled care.
Dr. Susan Wilson (22m 25s):
So it’s like, you know, you cut your finger and you have to go to the urgent care to get it sewn up, or you’re having a heart attack and you need to go to the emergency department. So the coaching strategies for both those with burnout and job satisfaction, and then those with second victim scenarios, the principles are kind of the same, but it’s just getting the help in a timely fashion specific with second victim. So in terms of how to get it. So in terms of the second victim scenarios, there are actually several large hospital organizations that have established what’s called peer support processes.
Dr. Susan Wilson (23m 6s):
And that is peer support is what we describe as the treatment, if you will, for second victim syndrome. And so like for example, John Hopkins has this, their program is called RISE resilience in stressful events. And then university of Missouri has the four U team. And that actually is basically a team within the hospital that responds like within, I don’t know, 30 minutes to someone that has experienced an adverse event. So those are ways to get help quickly through hospitals if they have these programs in place. But challenges that I think the vast majority of institutions across the country don’t have these kinds of things.
Dr. Susan Wilson (23m 51s):
So oftentimes what happens is that if someone, if a clinician is identified as being a struggling after an event, they’re oftentimes referred to maybe HR or maybe their EAP and then the EAP would in turn, refer them. I work at, I’m actually a consultant with an employee assistance program, which is EAP who specialize in providing services for healthcare organizations. And I’ve actually set up a protocol or process with them that if a client is referred to them specifically for a critical event, like a second victim scenario that they connect with me immediately, and then we get the ball rolling to provide the support because it is really important for these people to get the support in a timely fashion.
Dr. Anthony Orsini (24m 43s):
What percentage of people that come to you after a second victim event come reluctantly? And what portion do you think are really seeking help?
Dr. Susan Wilson (24m 51s):
Well, it’s interesting. So the people that I’ve been helping so far with the peer support piece have come to me through the EAP and one of the gals, she didn’t even know that this was even a benefit that she could access. So she didn’t know anything about, you know, the service that the EAP offered. It was only when she was in crisis that she had a supervisor say, Hey, you know, let’s get you some assistance. So I think it’s kind of, it’s kind of all over the board. I think some people are aware of it, but the vast majority, and again, I’ve worked with mainly physicians, but the vast majority of the physicians that I’ve worked with don’t necessarily know that this is even available for them.
Dr. Susan Wilson (25m 36s):
And so that’s the piece. I think it’s really important to get the word out that yes, coaching is out there. It’s both for you for ongoing support to help you realize your ultimate goals in terms of your work, but that also it’s there for you for these acute events as well.
Dr. Anthony Orsini (25m 56s):
We think we’re Superman and Superwoman and I can handle it. And until you can’t and I think it would be really nice if we can convince physicians that you don’t have to be as Superman or Superwoman and that it’s okay to go to a coach or a psychologist. And so I think my guess is, and tell me if this is true, that there’s a whole bunch of people out there that need your help and need coaching. That just don’t even know they need it or know they need it and won’t come.
Dr. Susan Wilson (26m 29s):
Absolutely well. So interestingly, I think some of the data about second victim syndrome mirrors some of the data regarding burnout. So I’ve heard like burnout up to maybe 50% of physicians feel burnt out. So the data with second victim syndrome is that it’s estimated that 50% of all healthcare professionals will experience this at some point in their careers. And I really do think that number is probably closer to a hundred percent because I feel like if you are in a profession where you have any significant interaction with a patient, this is going to happen at some point.
Dr. Susan Wilson (27m 10s):
I mean, you know, you may not have somebody die, but you know, some, something will happen that you will, that will trigger this feeling. And then of the people that even admit that they have suffered this right now only 30% of those are even seeking help. So the vast majority obviously are just suffering in silence. And again, I think part of that is because of, as you talked about, you know, the stigma notoriously, you know, physicians feel like they just can handle anything themselves and they don’t want to seek out help. But then also just not knowing that this kind of support is available.
Dr. Susan Wilson (27m 50s):
Dr. Anthony Orsini (27m 52s):
So I interviewed Helen Riess, Dr. Helen Riess psychologist, and one of my earlier interviews and Dr. Riess wrote a great book. And Alan Alda was the writer of the foreword for her book. And I often joke that I became a physician because I was a big mash fan. And I know mash probably every episode, every word is just my thing. But when you really think of Hawkeye Pierce, as you were speaking about second victim syndrome, you were speaking about physician burnout. And I know there’s a lot of people that are listening right now that are so young, they’re going, what’s mash. But if you’re old enough to know what my peers had, classic physician burnout, he was someone who, and in the end, I think it’s the last episode.
Dr. Anthony Orsini (28m 37s):
He actually has a breakdown, a mental breakdown. And I think this happened a lot during the war, from what I read, you know, just seeing people die over and over again. So I just went off on a tangent, but just classically Hawkeye Pierce just came into my mind. So now they come to you and how do you help? You know, I come to you, Susan something’s happened, I’ve been referred EAP. How do you take me on that journey of feeling better?
Dr. Susan Wilson (29m 4s):
First of all, I will say that as I’ve mentioned earlier, the quote unquote treatment for second victim syndrome is this whole concept of peer support. And so I will say that physician coaches, I think are uniquely qualified to provide this kind of support because not only are they a peer, but they also have these specific training of coaching skills. So these kinds of conversations really require strategies that we’ve all been taught as coaches. So for example, so when I have someone that I’m talking to specifically about a critical event, it needs to be obviously a very confidential conversation.
Dr. Susan Wilson (29m 48s):
They need to be reassured that it’s just the two of us. It’s non-judgemental I think the important thing for any healthcare professional experiencing this is to know that they have a safe space when they’re talking to you. And so by ensuring that they have the safe space, then they feel comfortable. They can vent, they can say whatever they want and it’s okay because, you know, this is where they are certainly the types of questions that we have been trained to ask as coaches they’re called open-ended questions. And they are very important because that’s kind of then allows the clinician to really elaborate on how they’re feeling and maybe getting some new perspective and new insight into the event for themselves.
Dr. Susan Wilson (30m 39s):
And so the initial conversation really is kind of establishing a relationship with the individual. And then the other piece of it, it’s really important to have several conversations, you know, to have follow-ups. So for example, when I’ve had peer support interactions with people, I’ve had at least four different conversations with them, so that, you know, we’re kind of, you know, making sure that they’re kind of heading in the right direction in terms of their thoughts and their emotions. The other piece of it is that if you’re having these peer support conversations with someone, certainly as a physician coach, we know what it looks like for somebody to have a significant mental health problems.
Dr. Susan Wilson (31m 22s):
So if you identify that somebody now looks like they are clinically depressed, they’re having debilitating anxiety recognizing that, and then being able to refer them for a higher level of mental health care, whether that’s a therapist or a psychiatrist is important.
Dr. Anthony Orsini (31m 39s):
Yeah. And so this is not a short journey back. This is something that takes a long time with you. And then even afterwards, I would think that, especially in a medical error, I weep for the ones out there, God willing, it won’t happen to me. But as you said, it’s something happens to all of us that is feeling that they need help and don’t seek that out. And I think that’s what happens with the physician suicides. We had, I know somebody from a colleague that did do that sadly, and we don’t really understand what that is. And I think part of that is our ego. We really got to get over that ego and ask for help and people like you and other people now, I think physician coaching is getting exponentially more popular.
Dr. Anthony Orsini (32m 25s):
Dr. Susan Wilson (32m 26s):
Yeah. You know, interestingly, I just was a part of a physician coaching summit this past weekend and yeah. You just realize there’s so many people out there that are practicing coaching. Interesting a lot of the physician coaches that I’ve encountered so far have come to coaching because of their own burnout story. And the thing I kind of feel is a little unique about me is that I left medicine, not because I was burnt out, but because I had to physically. And so I kind of feel like, you know, what, I still, I mean, I love medicine.
Dr. Susan Wilson (33m 6s):
I always have, it’s always been a part of my life. And I loved like, you know, you hear a lot of people talking about how they just absolutely, you know, they couldn’t stand medical school or residency or anything. And I actually have really fond memories of both medical school and residency. And I kind of feel like I, through my career was able to find the formula to make it really satisfying for me. And so now as a coach, I want to help others find their own formula because I do feel that as we’ve talked about earlier, with all the new challenges that have kind of developed in the last 25 years, that people do need a little bit more guidance and a little bit more support in terms of finding where do they fit in and how can they feel really good and really satisfied and fulfilled with their career in medicine.
Dr. Anthony Orsini (33m 57s):
And I do a fair amount of coaching as well, but on a totally different end, my coaching as you know, is to help that physician and that nurse communicate with their patients, build better practices, enjoy their job more. So it’s a different end, but an event it’s also physician coaching. And I don’t think we’ve all had coaches in our lives. There’s no reason why we shouldn’t keep having coaches and mentors, especially when there’s areas that we need help for. And there’s not a lot of people that turn to, so that’s why people like you are just so important to our profession, especially at this time during COVID, it’s been much harder on healthcare professionals.
Dr. Anthony Orsini (34m 37s):
As I mentioned in one of my previous podcasts where the general public is looking out and seeing things like healthcare heroes, and we’re seeing pictures on TV of these doctors and nurses who are working 24 seven during the COVID crisis. But those of us working in the hospital and also seeing the other end with the burnout, the nurses who are getting furloughed doctors who are losing their practices. And so we only see the one end, it looks like to the public that every doctors and every nurse is working 24 seven, but because of all the elective procedures and everything going down, actually many nurses have lost their job. And so that makes it even harder. Susan, before we break, I always ask everyone the same question last and most people say it’s the hardest one.
Dr. Anthony Orsini (35m 23s):
So get ready. You have a lot of difficult conversations. And is there one conversation that particularly stands out or it could be a type of conversation that you can point out that is the most difficult and then teach the audience something about how you approach that?
Dr. Susan Wilson (35m 40s):
So I, in terms of coaching, I would definitely say that the peer support conversations are the most difficult. And the reason I say that is because I am entering into this relationship with these clinicians when they are truly in crisis. And so, you know, that is the challenge. I will say, even though it’s the most difficult conversation, I have definitely found it the most rewarding because I really feel like in a relatively short period of time, I mean, when I have my follow-up conversations, I mean, these are occurring over like two weeks. So I may have four conversations with somebody over the course of 14 days, because I want to make sure that they are getting through that they are coping, that they are finding ways to, you know, wrap their head around what’s happened.
Dr. Susan Wilson (36m 31s):
And so it is really rewarding to me when I go from the first conversation where somebody may be actually crying and in tears for 20 minutes to maybe the fourth conversation where I can just tell, I can just hear it in their voice, they’re much stronger and they’re kind of regaining their old self back. So that is the most challenging for me, the way I approach those is as kind of, we talked about earlier, really reassuring the clinician that, you know, this is confidential. I’m not writing anything down. This is just me being here for you. I’m just providing you emotional support. And so this time is for you to vent and say what you want to say.
Dr. Susan Wilson (37m 11s):
And then I do probe a little bit in terms of asking them, how are they doing, who is supporting them? I think one of the other things that’s super important, both in peer support and in regular coaching is ensuring that the client has some kind of self care that they’re following. Because I think we all tend to sacrifice our own personal self care for that of our patients or our career.
Dr. Anthony Orsini (37m 41s):
So for the person who, Oh, I’m going to ask two follow up questions. One is the person who’s in the hospital, doctor, nurse, who recognizes someone that they care for care about and kind of starts to see this physician burnout or an event has happened. Can you give me or someone else some advice on how to approach that person? I mean, that’s gotta be a really difficult conversation.
Dr. Susan Wilson (38m 9s):
So if it was me and I identified, one of my physician colleagues in the emergency department seemed to be struggling or just wasn’t doing well. I think the first thing I would do is I would just ask them, you know, how are you doing? And you just kind of allowing them and, you know, and probably they’re going to say, Oh, I’m fine. Everything’s cool. And then trying to gently probe, I mean, obviously you don’t want to push somebody and you can’t force something on someone that, you know, they don’t want, but I think then my follow up would be, well, you know, I just want to make sure everything’s okay. It just seems like maybe some of the situations that we’ve been in recently seem like they’ve been really difficult and I want to make sure that you’re feeling okay with that.
Dr. Susan Wilson (38m 57s):
And I just want you to know that I’m here and I’m happy to talk through some issues with you. And I think, you know, just being gentle and just kind of letting people know that you care. And certainly we as physicians that we empathize with our colleagues, I think that’s super important, you know, not being condescending and not trying to be in a superior role. I think letting them know that you want to collaborate with them to help them find a better solution or you want, you know, you’re a colleague and you’re an equal, I think that’s really important.
Dr. Anthony Orsini (39m 30s):
And having someone that you can recommend I think would help. So before you have that conversation and say, listen, I know this great person, and she’s done some great things and you know, why don’t you just call her it’s can’t hurt, you know, let’s refer her to, so that’s where you come in and other physician coaches. So having said that as we finish up, what is the best way for people to get in touch with you, whether they want you to speak more about second victim syndrome, or they need some help or they want to refer somebody what’s the best way to get in touch with you.
Dr. Susan Wilson (40m 4s):
So I actually have a website it’s S J W professional coaching.com. And that kind of gives a little bit more detail about my coaching services talks about the methodology that I’ve used. And then my email is Susan WilsonMD@gmail.com. And certainly anyone is welcome to connect with me either on that email or going to my website. I do want to emphasize that there is so much overlap between the whole concept of burnout and second victim syndrome.
Dr. Susan Wilson (40m 44s):
And I really think it’s important also for clinicians to understand that if you do seek out coaching, that doesn’t mean that there’s anything wrong with you. It’s kind of like having a personal, yeah, it’s kind of like having a personal trainer. Like when you go to the gym, you have your personal trainer, that’s helping you optimize your fitness. So I kind of feel like the coaches just really helping you optimize. There’s so many different aspects in people’s lives that they can get coaching for. It’s not all about just your job, there’s personal issues, but whatever it is that you really want to improve, or you want to optimize coaching can really help that.
Dr. Susan Wilson (41m 25s):
And that does not mean there’s anything wrong with you. It just means that you are trying to be the best you can be.
Dr. Anthony Orsini (41m 31s):
Oh, that was a great analogy. How ironic is that? You know, if you tell somebody, Hey, I’m going to LA fitness and I have a personal trainer, everybody goes, wow, that’s really cool. But for some reason you don’t say, Hey, I’m going through this coach to work on my mind. So that’s just a society thing that we have to get over with. But, and for those people listening, Susan, there’ll be, all of your links will be on the show notes. So we just go to the show notes, the links will be there to contact Susan. So you don’t have to worry about writing it down. It’ll be all there. Susan. This has been really very inspiring and enlightening. And I think my audience really got a lot out of this and most of the healthcare people out there now know what second victim syndrome is.
Dr. Anthony Orsini (42m 10s):
And we just have to keep pushing to tell physicians and nurses that it is okay to say, I just need to speak to somebody and we’re a long way there, but I think we’re getting there. So thank you so much. This was great.
Dr. Susan Wilson (42m 25s):
Well, thank you, Tony. I really appreciate the opportunity to talk about this because as I said, I’m really passionate about the subject and you’re right. I think just continuing to try to get the message out there and educate our fellow healthcare professionals is so important.
Dr. Anthony Orsini (42m 41s):
Well, we’re going to push this episode on social media. I’m going to take a screenshot of you as soon as we’re done with this interview. So we can post that. If you liked this episode, please go ahead and hit subscribe. This is available on Amazon, Apple, Google play, Android and Spotify. So please go ahead and hit subscribe this way you’ll get automatic downloads every week. This episode drops every Tuesday. If you want to hear more about the Orsini way and what we do for coaching and also for patient experience in breaking bad news, please go to the Orsini way.com and you can contact me through that, Susan. Thanks so much. And thank you again for being on this and I can’t wait for this to drop so everybody can hear it.
Dr. Susan Wilson (43m 19s):
Thanks again, Tony. I really appreciate it.
Dr. Anthony Orsini (43m 22s):
Well, before we leave, I want to thank you for listening to this episode of difficult conversations lessons I learned as an ICU physician. And I want to thank the Finley Project for being such an amazing organization, please, everyone who’s listening to this episode, go ahead, visit the Finley Project.org. See the amazing things they’re doing. I’ve seen this organization literally saved the lives of mothers who lost infants. So to find out more, go to the Finley Project.org. Thank you. And I will see you again on Tuesday.
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Dr. Anthony Orsini
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