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Words above written by physicians as a recognition and
release of emotions
during a ritual within our workshop
on medical mistakes
Physician Mentor Helps Colleagues Ease the Trauma of Medical
Mistakes
Dr. Barry
Bub, founder and director of Advanced Physician Awareness
Training, aids physicians with the traumas of medical mistakes.
New York,
NY, May 20, 2004 -- “Conscientious physicians are often deeply
traumatized upon discovering they have made a medical mistake.
Shock, horror, disbelief even a full-blown acute stress
reaction, and sometimes posttraumatic stress disorder can
result,” explains physician mentor, Barry Bub, M.D., on his way
to the 2004 Annual Meeting of the American Psychiatric
Association (APA) in New York City, carrying a heavy case of
river stones that will be used in his workshop, “The Trauma of
Medical Mistakes: An Experiential Workshop.”
“Litigation adds immeasurably to physicians’ trauma. Many
physicians then isolate themselves becoming withdrawn or aloof.
Others suppress their emotions with work, alcohol, or drugs.
They begin to practice defensively, ordering unnecessary tests
that cost the healthcare system billions of dollars annually.
Ironically, the initial trauma often shuts them down as
communicators, increasing their risk of future litigation,” adds
Dr. Bub, founder and director of Advanced Physician Awareness
Training. The May 5 workshop, designed as a ritual for an
intimate group, was similar to one conducted at a conference on
physician health cosponsored by the American and Canadian
Medical Associations in Vancouver, Canada, in 2002.
“This was an extraordinary experience to help physicians who
have made occasional errors, not to carry an overwhelming burden
with them throughout their practice and lives,” says workshop
cochair Dr. Leah Dickstein, professor of psychiatry at the
University of Louisville School of Medicine and an associate
dean for faculty and student advocacy. “It was an incredibly
unifying experience, as these traumas are not normally
verbalized, so physicians may think they are the only one who
has experienced such trauma, but in this situation they were
among colleagues in their specialty, and it was an opportunity
for people with courage to share their experiences. Some shared
their stories with the entire audience, while others spoke about
their traumas as they were paired with a partner, one on one.”
Dickstein concludes, “All participants learned that they were
not inferior or incompetent, as this healing process began.
While they won’t forget their error, the physicians realize that
they are human beings and will not continue to be weighted down
by the guilt they were carrying.” Dickstein was recently chosen
as one of 20 female psychiatrists (among 339 female physicians
from the Civil War to the present) featured in the interactive
exhibition, Changing the Face of Medicine, on view at the
National Library of Medicine in Bethesda, MD.
“Society offers no sanctuary for safe release, nor community of
caring to hold the anguish of physicians,” states Rabbi Goldie
Milgram, Dr. Bub’s wife and partner in facilitating the
workshop. “The pillorying they experience in the press and legal
system diminishes the nobility of the dedication of their lives
as healers. We cannot afford to have our finest trained health
professionals so damaged.” The workshop was inspired by a
Biblical ritual for helping people to forgive the unintentional
mistakes of leaders. Rabbi Milgram explains, “When I saw the
text of Leviticus 4:22-26, I thought how impressive, this
ancient wisdom tradition didn’t seek to overturn or shame a
leader for an unintentional mistake. Instead, they creatively
applied the sacrificial system to acknowledge the mistake before
the community, creating the basis for communal forgiveness. In
speaking with my husband, he agreed - medicine needs to reclaim
some version of this.”
“So we adapted the ritual by creating a simple ‘altar of
awareness.’ After reminding participants that the word doctor
means teacher, participants engaged in a ritual honoring their
most memorable teachers,” explained Dr. Bub. “Having connected
them to the noble lineage of medicine as a learning/teaching
profession, participants were then led through guided imagery
that transformed the river stones they were holding into the
metaphoric burden of their medical mistake upon their spirits.
They then wrote their principle emotions on the stone. Words
such as shame, guilt, fear, and sadness were most frequently
used. After sharing with a partner, the stones were placed on
the altar, followed by a flower symbolizing the pain and
suffering of their patients.” Rabbi Milgram added, “For many,
expressing their emotions in a community of support for the very
first time was an intensely moving experience, one that will
assist in freeing them to learn from their mistakes rather than
suffer from them.”
This workshop represents just one component of offered by Dr.
Bub through his Advanced Physician Awareness Training. This
program, designed for medical professionals, assists physicians
in enhancing their communication and relationship skills with
patients, through both private mentoring sessions and workshops
offered across North America. Bub is also the author of
Communication Skills that Heal (Radcliff Medical Press, Fall
2005). His dynamic, experiential trainings have been offered by
NAJC, NICABM, APA, and AAPP. He has taught at medical schools
and in hospital systems, such as the University of Minnesota and
Kaiser Permanente, as well as at retreat centers, including
Esalen and Elat Chayyim.
A leader in
the AMA Physician Health Initiative, Dr. Bub's mentoring
articles such as “Listening Myths in Medicine” appear in Medical
Economics. His extensive professional background includes
graduation from the University of Cape Town Medical School;
certification in Gestalt therapy; membership in the New York
Gestalt Institute; chaplaincy training at the Hospital for
Special Surgery; twenty-five years experience in family practice
in Pennsylvania, also serving as a residency preceptor and
president of the hospital medical staff; and at AJR-NYC,
developing curriculum and teaching on communication and brief
counseling skills.
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