Dr. J, a seasoned anesthesiologist, was nearing the end of an unrelenting week in the OR when she was tasked with leading a team of resident trainees through a complex open repair of a ruptured abdominal aortic aneurysm on a 56-year-old man. After working 60 hours, fatigue weighed heavily on her, but she pushed through, as always. This was the life of an anesthesiologist.

The OR atmosphere was tense, and blood loss was significant. Despite their best efforts in balanced blood and fluid management, the patient’s condition quickly deteriorated. The patient was hypotensive and tachycardic, and oxygenation became increasingly difficult. The crackles of fluid-filled lungs seemed to echo throughout the room. Pulmonary edema. His heart, already strained from massive blood loss, couldn’t handle the aggressive fluid resuscitation. For a brief moment, she felt the weight of the entire situation bear down on her – how a week of exhaustion may have culminated in this critical complication – but she pushed it aside, focusing entirely on the patient. There was no room for additional error. Dr. J. initiated advanced resuscitative measures – vasopressors, careful diuresis, and fluid adjustments. After what felt like an eternity, the patient’s condition stabilized, and he was transferred to the ICU. As she handed off the patient, she had a few minutes to reflect on the weight of the week – fatigued, overwhelmed, and drained. But there was no time to rest, as there were other patients that needed her. This was the life she had chosen.

Scenarios like Dr. J’s case are far too common in today’s practice landscape. According to the American Medical Association’s most recent survey, 63% of physicians experienced at least one symptom of burnout in 2021 – an alarming 38% increase from the previous year (asamonitor.pub/3YdjaXy). It’s easy to assume that highly trained professionals, such as anesthesiologists, would be fully aware of the link between burnout, well-being, and adverse outcomes in patient care. However, the trends continue to move in a troubling direction.

To fully care for our patients, we must also care for our own physical, emotional, and mental well-being. Moreover, we must recognize when our self-care is in a deficit. In his book “Why We Sleep,” neuroscientist Matthew Walker describes the “sleep-loss crisis” as one glaring example of how we neglect an essential element of self-care (Why We Sleep: Unlocking the Power of Sleep and Dreams. 2018). Walker’s research revealed that 65% of Americans fail to get the recommended seven to nine hours of sleep per night, and the World Health Organization (WHO) has declared sleep deprivation a global epidemic in industrialized nations. Sleep loss, inactivity, and poor nutrition are just a few of the self-care deficits that can contribute to burnout. These neglected aspects of wellness can have tangible consequences in the OR, just as they did for Dr. J. By addressing these gaps in self-care – through proper sleep, physical activity, and healthy eating – we cannot only protect ourselves, but also improve the quality of care we provide to our patients.

Following an adverse event, one area of trepidation is what and how to tell the patient, as there are conflicting viewpoints. The literature supports that patients want a full disclosure of the error, the etiology, and how it will be prevented in the future (JAMA 2003;289:1001-7). This same study found that while physicians agreed that adverse events should be disclosed, they felt like they needed to exercise caution with word choice and the extent of information given (JAMA 2003;289:1001-7). Most incidences of litigation occur when there is a perceived lack of caring, poor communication, or a lack of understanding of the patient’s situation (Arch Intern Med 1994;154:1365-70). Additionally, patients often seek an apology while physicians often worry about the legal implications of offering an apology. One article highlighted the difference between expressing sympathy compared with offering an apology. Per the article, sympathy should always be offered (asamonitor.pub/3YbYRK3). Addressing whether an apology is appropriate is situation-dependent and best decided in conjunction with risk management. So, what should you do? A recent meta-analysis looked at action steps following an adverse event. Four themes regarding patient disclosure were seen on review of the literature: revealing the event, communicating openly, providing support to the patient, and giving a full apology (Int J Environ Res Public Health 2020;17:4717).

When an adverse outcome occurs, the first step is to report it to hospital authorities, such as risk management, patient safety officers, and department leadership. Prompt reporting ensures the hospital can begin an objective review with full transparency and proper assessment under the principles of a “just culture,” which focuses on learning and improving practices rather than assigning blame (Hosp Pharm 2017;52:308-15).

It’s essential to document a detailed, factual, and objective account of what happened from your perspective in the patient’s medical chart. This should avoid opinions or speculation. Avoid texting or emailing colleagues, friends, or family about the event, as these communications can be a liability risk; keep communications confined to official channels. Proper documentation is key for both administrative reviews and legal protection.

Discussions during internal reviews, such as a root cause analysis, are often protected by confidential peer-review laws, meaning they cannot be used in litigation. Anesthesiologists should participate openly with facts and avoid conjecture in peer reviews. These actions ensure a productive and protected learning process that improves patient safety. Just culture encourages learning from adverse events to improve safety for patients and physicians alike. Transparency and objectivity help prevent similar incidents in the future, fostering a safer health care environment.

In an ideal system, adverse events are looked upon as an opportunity for growth, improvement in systems-based practice, and to advocate for ourselves. We can look to our colleagues at the American College of Obstetricians and Gynecologists, who recommend written institutional policies for the management of adverse events be in place to minimize ambiguity and doubt, and to include identification of practitioners who may become second victims (asamonitor.pub/3ZV6BRY). A culture of disclosure without fear of retaliation and that supports open discussion of adverse events is a crucial aspect of high-quality patient care and the maintenance of trust in the patient-physician relationship. A health care system can thrive if there is a commitment to establishing purposeful resources to help patients and their health care team maneuver through the challenges of an adverse event (asamonitor.pub/3ZV6BRY).