Background: Psychological reactions of surgeons to their major errors and complications constitute an understudied area within the field of human factors associated with medical and diagnostic error. Understanding surgeons’ reactions is important in our overarching goal of studying error prevention, professional reaction, and response to error. The purpose of this study is to characterize surgeons’ reactions and responses to error and to explore the impact of these reactions on subsequent judgment and decision-making.
Methods: A qualitative study with grounded theory iterative methodology was used to explore surgeons’ reactions to complication and error. The study is currently in Phase I, consisting of one-hour semi-structured interviews of surgeons from different specialties and at varying stages of their careers. These interviews focused on recollections of past reactions. A preliminary framework was created from the emergent themes discussed at the interviews. Psychological frameworks and concepts from our literature review provided a theoretical lens during the data collection and were used to assist with the data analysis. A purposive and theoretical sampling strategy was used until saturation of the major themes and a reflexive approach was adopted throughout.
Results: Preliminary themes have begun to emerge from Phase I coded transcripts. Surgeons have described their reactions to major error and patient complications using similar processes to Kubler-Ross’ stages of grief, including time-dependent phases with different emotions. Not surprisingly, surgeon reactions were related primarily to concerns with patient outcomes, although upon further questioning, personal factors such as self-esteem and reputation seemed to play a role in their reactions. The manner in which a surgeon holds opposing and conflicting thoughts about themselves is representative of that of cognitive dissonance, a well-established psychological term. Counterfactual thinking, a process where the surgeon asks “what if…?” was also encountered frequently. Other variables that have been identified as modifiers of surgeon reactions from Phase I interviews include; familiarity of the surgeon to the patient, surgeon experience, and whether the surgery was elective or emergent.
Conclusion: There is a dearth of literature on psychological factors associated with surgeon reaction and responses to error and complication. We believe that understanding these factors could improve surgeon psychological well-being and job satisfaction. Further, the interaction between these reactions and subsequent judgment and decision-making could be influenced, improving patient outcome. Phase II will include surgeon observation and on-site interviews as events occur. The effect of time on reactions will be further explored and the framework further refined.
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