“We Don’t Want Surgeons to Need Peer Support, But When They Do, We’ll Be There.”
Initiative Offers Colleagues A New Coping Mechanism
By Alexander Huls | Illustration by Davide Bonazzi | Photos by Jörg Meyer
When Gordon Baltuch, MD, PhD, was a junior faculty member in surgery at the University of Pennsylvania years ago, he experienced a complication during a surgery he performed. It was bad enough that it left him wrestling with what had happened. He internalized it in a way that felt like he was spiraling down a dark hole of guilt, shame, and grief. Looking for support, he reached out to a mentor for advice. What should he do?
“The answer I got was, ‘Whiskey. No ice,’” says Dr. Baltuch, now professor of neurological surgery at VP&S and co-chief of the functional neurosurgery division in Columbia Neurosurgery.
For Dr. Baltuch, that moment is representative of attitudes that have pervaded the field for a long time: Surgeons should have no gaps in their armor. When something goes wrong—an unexpected complication that leads to the need for an emergency response, injury, or, worse, a patient death—you keep calm and carry on. You remain strong for patients, families, and yourselves. You don’t—or can’t—allow for emotions.
Steven Stylianos, MD, the Rudolph N. Schullinger Professor of Surgery and Pediatrics and chief of pediatric surgery at VP&S, rallies against the emotional expectations and attitudes that surgeons have lived with for so long. “It was probably a coping mechanism to help us get through an entire career of doing such high-risk work.”
An initiative at Columbia has grown to instill a healthier coping mechanism for surgeons who experience difficult complications and outcomes during procedures. The initiative better addresses the growing understanding—and science—that sometimes doctors need help too.
Challenges For Surgeons Facing Adverse Events
A surgeon’s work is one with high stakes, especially at Columbia where patients often turn when they can’t find help elsewhere. Despite best efforts by surgeons, complex procedures sometimes do not go as planned. Complications can arise mid-procedure that require stressful and quick-thinking intervention. “A unique part of our job description is to do high-risk invasive procedures that carry a higher chance of bad outcomes, such as injury or death,” says Dr. Baltuch.
When bad outcomes occur, the emotional impact is felt most by patients and loved ones, but surgeons also can be left with a debilitating sense of responsibility. “There’s blame. There’s shame. There’s guilt. There’s anxiety,” says Dr. Stylianos, who has felt those emotions himself. But surgeon culture in the past did not always offer healthy models or opportunities to process those emotions.
For surgeons of the generation Dr. Stylianos and Dr. Baltuch were trained in, peer support usually meant small, platitudinal gestures. A quick consoling arm around the shoulder. A “chin up, it happens to all of us” response. Sometimes nothing at all. “When something happened colleagues would, out of respect, leave you alone and let you process it, thinking that that was a respectful thing to do,” says Dr. Stylianos.
“But those who were suffering needed more,” he says. What they needed was what Dr. Stylianos helped stand up at Columbia a year ago. “The quickest way to recover from an adverse event is to be able to verbalize these thoughts to a colleague.”
Building Columbia’s Peer Support System
The new peer support program at Columbia began after a postop debriefing for a procedure in which an attending had experienced—and worked through—a significant complication. “It was a case that was certainly painful for the surgeon to talk about because it was an unusually bad outcome,” recalls Craig Smith, MD, chair of the Department of Surgery.
While listening to the attending’s experience, Dr. Stylianos found himself reflecting on his own experiences with difficult outcomes, how painful it had been, and how long it stayed with him. He noticed too that the briefing lacked empathy and veered more toward medical recommendations than emotional support. He worried about whether the surgeon might struggle as he once did.
After the conference, Dr. Stylianos reached out to Dr. Smith and started a conversation about peer support. Dr. Smith supported a program with volunteers trained to provide assistance when adverse events occur. “Dr. Stylianos was eager to see this opportunity arise,” says Dr. Smith.
Dr. Stylianos began conducting research, learning more about how peer support had been integrated on national and institutional levels. He invited Jo Shapiro, MD, an ENT surgeon at Harvard who has become a national expert on peer support in medicine, to Columbia to help train 18 people as peer supporters. The 18 doctors were a mix of attendings and residents from five surgical departments. They were trained in core concepts and best practices. Training included role playing so the surgeons could be good listeners and provide reassurance.
“You’re simply there to say, ‘I know that you had a challenging event. Tell me about that.’ Then you just allow the person to vent their feelings,” says Dr. Stylianos. Adds Dr. Baltuch, who underwent training, “We’re not offering professional help, but a bridge to talk to people about things and to normalize for them that ‘This is not who you are.’”
During role playing, Dr. Baltuch found himself thinking back to his past and how he had needed more support. “It made me reflect on things like ‘Whiskey, no ice.’”
A critical component of the peer support initiative is that support is not passive. The initiative doesn’t wait for surgeons who experience adverse events to reach out but finds ways to reach in instead. When a surgical complication is flagged, a peer supporter is notified and contacts the surgeon. “The peer support program reaches out to the individual and says ‘Listen, we heard that you had a challenging situation yesterday. Peer support can be very valuable at times like this, would you consider a phone call?’” says Dr. Stylianos. Reaching out is done as soon as possible. “If you can engage someone early and get them to turn that spiral around, you can provide tremendous benefit for them.”
The benefits also extend to a surgeon’s skills. If a physician is struggling emotionally, it can affect his or her abilities, so ensuring a surgeon’s health and well-being has a ripple effect through the institution and directly to the patient.
Once Columbia’s peer supporters were trained, Dr. Stylianos decided against a formal rollout of the initiative. Instead, surgical departments offered what hadn’t been available before. “We wanted the program to just infiltrate and become part of the culture of our departments,” he says. “What was really necessary is for all of us to bring these skills to our daily workplace and to our departments and to begin incorporating the concepts of caring and kindness.”
As awareness has grown around the initiative, peer support has been increasingly leaned on. Dr. Stylianos says calls are increasing from division chiefs, fellow surgeons, and others who worry about struggling colleagues. “They ask for someone to reach out.”
Dr. Stylianos wants the peer support initiative to grow, but he wants more: “Every day, we should keep an eye out for each other and take care of each other the same way that we fight and care for our patients. We have to take care of each other so that we can all be at our best,” he says. “We don’t want surgeons to need peer support, but when they do, we’ll be there.”