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Adverse events (AE) truly have a profound impact on Obstetricians and Gynaecologists in Australia. By contrast, complications are the big taboo and no-go zone within our community. It seems we are reluctant to discuss negative treatment outcomes due to shame, self-disappointment and fear of litigation. Traditionally as doctors we are a symbol of strength and hence have to put up a brave face despite feeling alone in the depths of our feelings of angst and guilt.

Sometimes we can’t even remember our complications. Sigmund Freud suggests that involuntarily we involuntarily block out specific memories that are in conflict with our self-image. If we are to be strong, leading the pack and used to recommending treatments to our patients, we will block out all memories that are discordant with that image.

In March 2013 we conducted an online survey amongst obstetricians and gynecologist from Australia and New Zealand.  Some of our colleagues have shared their stories with us and we summarized those in the previous blog.

The main paper is now available online in the Australian and New Zealand Journal of Obstetrics and Gynaecology (ANZJOG) (http://www.ncbi.nlm.nih.gov/pubmed/24359293). 

The aim of the survey was to assess the impact complications have on the lives of Australian O&Gs specialists. We also assessed the knowledge and attitude towards the reduction of the impact and the current use of QA (Quality Assurance) activities related to AE. Lastly we also evaluated the existing support systems and coping strategies.

Here are the findings in a nutshell:

• Participation rate of the survey was high with 26% and the participants’ distribution represented the population of Australian O&G specialists.
• 17% of participants had to involve their MDO in the last 2 years but colleagues from New Zealand were less likely to need MDO support in the past 2 years.
• When complications occur majority agreed that it would affect their sleep (80%), family and social relationships (55%) and physical health (48%).
• During times of complications, support came from colleagues (83%), family (82%), MDO (72%) and friends (68%). Employers, AMA and RANZCOG were perceived as least supportive. Nearly 80% wished they could talk to some one they trust when complications occur.
• The majority of respondents thought that their own performance was similar (63%) or superior (34%) to their colleagues.
• We also asked about the usage of quality assurance (QA) tools. Almost all participants (93%) take part in Morbidity and Mortality meetings and more than half (52%) conduct their own, private clinical audit. Subspecialists more often than specialists or trainees use QA tools and colleagues who work in Public Hospitals use QA tools less often. Colleagues who had to engage their MDO within the last 2 years were significantly more likely to use QA tools.
• What reduces anxiety about complications? Knowing their own complication rates seems to help to improve their clinical skills and alleviate stress. Interestingly majority of respondents expressed interest in knowing their colleagues’ complication rates and thought that it would help them to cope better with stress.

So, what can we learn from these results?

Complications have a profound impact on O&G ‘s, their professional, personal and family lives;

O&Gs’ own inability and inexperience to deal with complications together with pressures from workplace bureaucrat, contribute to fatigue, exhaustion and burn out. The taboo of surgical complications, the difficulty to speak openly about the pressures worsens the situation and may lead to burnout.

Mainly MDOs as well as colleagues, friends and family provide support for Australian O&G specialists in professionally difficult times. Unfortunately, RANZCOG dropped the bundle and is not seen as supportive.

The use of QA tools such as self-audit which allows for easy comparison of outcomes with colleagues could take pressure away, let adverse events appear in a more rational light, and possibly improve confidence.

Hopefully this blog inspired you to read the full article in ANZJOG.

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