Table 1.
Themes and subthemes, with supporting illustrative quotations from interviews.
| Theme 1: AEs have an individual psychological impact | |
|---|---|
| 1.1: Initial emotional response | “There was obviously immediate sadness. I felt very sorry for him.” - S006 |
| “So, the immediate anxiety that … have I forgotten something in my homework thing.” - S006 | |
| “Driving home … I'm thinking about the whole operation, non-stop.” - S008 | |
| “Devastated, devastated, obviously, really upset.” - S007 | |
| “It was incredibly frightening at the time and a bit traumatic.” - S015 | |
| “I was absolutely devastated.” - S016 | |
| 1.2: Late emotional response |
[“And how'd you feel about the event now?”] “Still awful. She’s had 15 years dialysis because of me. If I’d maybe done a better job. If I’d changed things, who knows?” - S007 |
| “You don’t forget about it. And it carries with you. And you still think about it. And every time you see their name, you shudder.” - S007 | |
| “There are definitely ones … where I've gone right that was my mistake … and those I have kind of for a long time, harboured the guilt.” - S006 | |
| “You still feel bad, but it’s not at the same intensity.” - S013 | |
|
[“How do you feel about that event now?”] “Same as I did then I think which is it was very upsetting.” - S018 | |
| Theme 2: The surgical environment influences response | |
| 2.1: The benefits of a cohesive unit | “I've talked about my supportive colleagues, … and there’s definitely a sense that we're doing this as part of a team, not just on your own, that's very good.” - S006 |
| “But certainly the most input that I got was the conversation afterwards with a few people. This is what happened. What do you think? And then chatting about it. That’s definitely the best feedback.” - S008 | |
| “Because it didn’t feel like support. It was just organic.” - S004 | |
| “I called a colleague in to help me, and it was a bit of a difficult dynamic between the two of us as consultant colleagues … The fact that it came in this case that was just a real challenge with it.” - S010 | |
| “I suppose I'm very lucky. I work in a unit where, actually, when something bad happens, everybody goes and talks about it.” - S013 | |
| “For me personally, there probably is services, but it wouldn’t be something that would be useful for me.” - S008 | |
| 2.2: The impact of scrutiny following an AE | “Not only do you question your own judgement, but my fear is that you've got somebody else in the team who’s also questioning your judgement and questioning your skills.” - S010 |
| “At times, what I've thought about changing my mind is not because I felt it was the wrong thing to do, but it’s more about the perception of your peers … in a heavily scrutinised environment.” - S004 | |
| “The anxiety now is driven by the fact that there’s an external body that will take these statistics without knowing the context and process them in a way that can be deleterious to my department and to my colleagues.” - S004 | |
| “Just in my mind I was thinking ‘what do they think about me? Do they think I’m competent to do this operation?’ I don’t think they were but I certainly felt that way.” - S017 | |
| “It seemed to me to be about looking for blame. There was quite aggressive questioning not just of me but of everybody… I think it was destructive.” - S018 | |
| “The M&M meetings are actually quite important, and you have to recognise if you've done something wrong … Why did you do that? What affected you? And how can you stop that? How can everybody else stop doing that? And you can’t be personal about that.” - S007 | |
| Theme 3: Changes in practice following an AE | |
| 3.1: Learning from mistakes | “It’s clear at that particular point that I wasn’t very good at it or particularly amazing, but I suppose I'd use that to push to get a bit better.” - S003 |
| “Do not let it go to waste. There'll be a learning opportunity from here … You have to learn from it so you can improve.” - S008 | |
| “You have a responsibility to do that. For every patient that comes to harm, you must reflect on it and see if there’s anything you can learn.” - S009 | |
| “I have actually gone to see how my colleagues do their arterial anastomoses, because although I thought I had a technique that worked well for me at the time clearly it didn't.” - S003 | |
| 3.2: Changes to decision making | “If your decision was right and the outcome was bad, that doesn’t mean you should change your decision next time.” - S006 |
| “Once you have multiple, multiple things and you can’t learn from it, then there’s maybe a deeper issue.” - S008 | |
| “I think I have noticed that my an anastomotic time has got slightly longer since this happened and so I think maybe even perhaps subconsciously I am checking a bit more than before.” - S016 | |
| “I think it’s impacted my approach to complex transplant counselling, and how I think it’s really a multi-step process” - S004 | |
| 3.3: Shifts in risk attitude | “It was a temporary shift definitely to more conservative … just because it jits your confidence” - S008 |
| “Adverse events close to the time invariably impact on your attitude to risk. But I think as time passes, you go back to your steady state of what your risk appetite is, and that’s obviously based on what you feel is the right thing for the patient” - S004 | |
| “We do take a lot of risks for our patients, but that’s counteracted by the fact that a life on dialysis is a miserable life with high risk of death as well.” - S010 | |
| “The easiest thing to do is to be risk averse … and that to my mind is very bad medicine because patients are not getting the treatment that they deserve.” - S018 | |
| “If your first case is a complete disaster, I think that will … have a massive impact on the rest of your career, and will make you much more conservative and much less willing to accept risk.” - S003 | |
| Theme 4: The influence of personality on responses | |
| 4.1: The importance of robustness | “And you put an end to it. And I'm pretty good, once I put an end to it - that’s it. I don’t think about it anymore.” - S008 |
| “The lesson from this is actually just reinforced that you have to almost pause your own trauma and process it later.” - S004 | |
| “But reflecting back on it … I don’t think I could do anything differently. And I think from a psychological point of view, that’s really helpful.” - S010 | |
| “The challenge is to make sure that you remain as a functional surgeon, isn’t it? That’s the importance in some respects, I think recognizing that you have a job to perform as a surgeon is still important, that you need to keep things in perspective and continue to work.” - S012 | |
| “But you’ve got to be able to deal with it, and not let it crush you. And I don’t have an answer to how you do that, you’ve got to find works for you, everyone is different.” - S009 | |
| “Frankly, your emotions, in my opinion, are in that situation, secondary. You just got to put them away somewhere, compartmentalise them.” - S004 | |
| 4.2: Purpose as a protective mechanism | “Is my core purpose to massage figures of our department, or is it to do what the patient would have wanted me to do in their best interests? I've come to the conclusion, if I had not put that kidney in, I would have done it more for departmental statistics rather than for the individual.” - S004 |
| “You're here for a purpose. You're given skills. You're given training and education. There’s somebody actually needing your help that you’re trained to do. That's your job.” - S007 | |
| “You have to have faith in your ability as a surgeon and recognize that complications happen, but also to have faith in the process that okay, yeah it is a devastating outcome for this particular patient, but to have faith that what we do generally actually makes a huge difference” - S012 | |
| “What is the purpose of my existence? Well, when things go wrong, it’s for me to take responsibility for it.” - S006 | |