AMA to Promote Use of Peer Support Groups

Voluntary gatherings that meet for the purpose of sharing stories, relieving distress and secondary trauma.

 This article was first published on Thursday, June 13, 2019 in MedPage Today.

By Shannon Firth, Washington Correspondent, MedPage Today.

CHICAGO -- Physician wellness programs will be encouraged to consider developing peer support groups, following a new policy passed during the AMA's House of Delegates meeting that concluded this week.

Such groups should be "voluntary, confidential, and non-discoverable."

The policy also called for the AMA in collaborating with other interested groups to encourage study in any future surveys of the prevalence and potential impact of the "second victim phenomenon."

"We're not asking for major legislation or a lot of money here," said Albert Hsu, MD, an American Society for Reproductive Medicine delegate and the author of the resolution, which he brought forward on behalf of the Young Physicians Section.

"We're asking for local physician wellness programs, whether it's at an institution or state or county-based, to consider having peer support groups ... because we do know it's an important part of [preventing] burnout," he told MedPage Today.

Hsu is a reproductive endocrinologist at the University of Missouri Health Care and a member of the "forYOU" team, which is focused on addressing the second victim phenomenon and more broadly, "caring for caregivers."

Second victimization or secondary traumatization occurs when a healthcare provider experiences an unanticipated patient event, a medical error, or a patient-related injury and becomes traumatized by that event, explained Hsu, in a committee discussion on Sunday, prior to passage of the resolution.

When he was taking a paramedic course, Hsu recalled one of the trainers sharing the story of a first responder, who had to clamp his hand over a patient's neck, which was gushing blood.

Once he was relieved by a colleague, the first responder went over to a corner and vomited, Hsu was told.

"But while he's there he's doing his job," Hsu said, and that kind of compartmentalization is a critical part of the job for anyone on the front lines of patient care.

"They have to put their feelings aside every day and not react," Hsu said.

In addition to keeping their cool in emergencies, being a good clinician also requires a measure of compassion, he noted.

"If all we did was deliver clinical information and medications and treatments, you could replace us all in probably 10 or 20 years with robots and artificial intelligence," Hsu said.

"But what makes us effective as physicians, clinicians, providers in general, is the fact that we do the hand-holding necessary, when we're in the context of helping patients ... that's a positive for us ... but then sometimes we get affected," he said.

The second victim phenomenon doesn't affect only physicians, Hsu added. Nurses, mid-level-staff, anyone involved in patient care can be impacted, he said.

"There was a highly publicized case of a nurse who felt so badly about something that happened while a patient was under her care, she actually committed suicide," Hsu noted, recalling the death of Kimberly Hiatt.

While his own experience was far less public, Hsu still remembers a 30-year-old patient who died from HIV while he was in medical school.

"For a good 2 to 3 years after, I felt that I missed something that contributed to her death," Hsu acknowledged.

In reality he knows that he had no clinical responsibilities at that stage in his career and his fears are "foolish," but for a long time he couldn't shake them.

Another friend of Hsu's was working when her own co-resident and friend was brought to the hospital with a blood clot. The friend died.

"These are things that stay with you and drive people to bad places," Hsu said.

Up to half of all healthcare providers, at some point in their professional lives, experience the second victim phenomenon. And even among clinicians for whom the secondary trauma is unrelated to any type of medical error or litigation, they can harbor feelings of anxiety, stress, shame, and guilt around other adverse events, Hsu said during a reference committee discussion, focused on weighing the pros and cons of new policies.

Robert Tortolani, MD, a geriatrician from Vermont and a Vietnam veteran, speaking on his own behalf, said he has been part of an informal, five-person peer support group for more than 20 years.

The group meets once a month at one member's house. Each meeting begins with a meditation and then members are given a few minutes to share with the group, with extra time reserved for the most serious or pressing problems, he told MedPage Today in a phone call.

"I think everybody should have a peer support group. I don't know what I would do without it," Tortolani told the committee.

Virginia Hall, MD, a delegate for the Pennsylvania Medical Society, said she supported the concept of peer support groups, but worried about "discoverability" in legal situations.

"A peer group is only as good as the silence of that peer group," she said, in explaining her recommendation to refer the resolution back to the AMA committee that oversees this particular set of policies.

"I'd like to have some attention paid to the legal issues that go with the peer support groups," she said.

Tortolani countered that his own group never keeps minutes and in 20 years, "nothing has ever left the room."

Hsu said that he shared Hall's concerns about "discoverability" initially, but after speaking to the General Counsel and Risk Management staff of his health system, those fears have been allayed.

"We've been doing this for 8 years. No one once has come to us and asked to get information from the peer support group," Hsu said he was told.

"You see, the plaintiff's attorneys are not remotely interested in hearing that the defendant is a human, and asking for support."

In addition to passing policy to advocate for the growth of peer support groups, the AMA also passed a report this week calling for the association to make efforts to collect more data on the suicides of medical students, residents, and fellows "to identify patterns that could predict such events," according to an AMA press release.