Mental Health Complication Management wondering about the impact of their mistake. There were heart-breaking comments from the participants within this study who felt that they had lost credibility not only in the eyes of other practitioners but also from their families. 5. Obtaining emotional ‘first aid’. Unanimously the participants looked for someone who understood what they were experiencing and could guide them forward. 6. Moving on or dropping out, surviving or thriving. All the participants, despite strongly wanting to drop out, managed to find a way through their trauma and not only survive, but they thrived and developed better practice because of it.
Second victim in aesthetics After collating the data from my eight participants, themes were drawn from the transcribed interviews. A very brief synopsis of the themes are outlined below. 1. Physical symptoms of the patient Physical symptoms of the patient became one of the first themes to emerge due to its importance to the participants. All participants discussed the presenting factors of the VO that they and their patient had experienced. Participants described the visual signs of VO. One participant said, “It was going blacker before my eyes”, another described it as, “Oh my goodness, her lip is blue”, and a third said, “Her lip; it turned white”. Although I had not anticipated this theme, I believe it’s important to recognise it because although these three complications were VOs, they all described different presenting factors which may be confusing to new or inexperienced practitioners as they may not understand that the symptoms of a VO can present very differently. This in turn could result in to misdiagnosis, leading to inappropriate treatments and less than satisfactory patient outcomes. 2. Visceral feelings The participants were graphic in describing and recalling their initial feelings when they experienced a serious AE; these feelings had also ranked as high importance within the literature. One participant described it as, “One of the worst feelings of my entire life; I wanted to be sick”, while another said, “I actually felt like I had run somebody over. That’s how bad I felt”, and another stated 64
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All of the participants discussed the impact of events as so overwhelming that they wanted to give up their aesthetic careers feeling, “Absolutely terrified – I was in a blind panic”. One participant went as far as describing feeling so panicked they felt as though they wanted to, “Throw themselves off a bridge”. All the initial reactions described by the participants to a serious AE were strong visceral reactions. In highlighting this it may help to prepare practitioners for these negative and unsettling emotions that are experienced in the initial stages of experiencing an AE. Without exception, the participants all described a feeling of denial and this was documented as a sub theme, as was justification. Within this sub theme, many of participants attempted to justify what had happened by using words such as, “I was so busy, I was running from room to room,” or “I had used that product before and it had always been fine”. 3. Longer-term feelings Despite the participants experiencing negative emotions, going into denial and attempting to justify their actions, they each managed to take control of the situation and ensured that the patients made a full recovery. However, despite this, the participants described a subsequent wave of emotions that affected them in the longer term. They began to experience feelings of fear, blame, shame and guilt and these were unanimous within the study. These feelings sat alongside empathy for the patient that had suffered the AE. Each participant discussed negative feelings relating to delivering a treatment that should have enhanced the patient’s life in some way, but had ultimately led to harm. 4. Intellectualising The participants demonstrated resilience and emotional recovery unanimously. Recovery occurred when they were allowed time to reflect. It was not addressed how much time was needed for this recovery. A paper by Chan et al. discussed two major coping strategies that could be employed Aesthetics | June 2020
in the aftermath of an AE. The first was problem-focused strategy, which involved developing constructive attitudes and behavioural changes, while the second was emotion-focused strategy.9 Emotionfocused strategy was employed by the participants wherein they managed their personal distress by accepting responsibility and implementing positive changes to their practice to reduce future error. They used problem-focused strategy wherein they constructed new ideas about their practice and adopted behavioural changes. 5. Lessons learnt Each participant had a plan of varying degree as to what they would do in the event of a significant AE. These plans ranged from ‘phone a friend’ to being fully rehearsed and ready; most of them having the Aesthetic Complications Expert (ACE) Group guidelines to hand and having read through these guidelines.11 Wu and Steckleberg discussed that the disclosure of adverse events is necessary if practitioners are to learn from mistakes and improve patient safety.4 Participants described not only feeling better after disclosure but also discussed changes they made to their practice following their experience. Without exception, the participants changed their consultation process. They also described tightening up on their documentation and ensuring full disclosure of potential risks and side effects to the patients. However, no matter how prepared they were, none of them felt prepared for the shock of feelings that they experienced. 6. Help and support Harrison et al. suggests that supporting clinicians in the aftermath of an AE may prevent future errors and SV burnout.10 In a web-based survey of 5,300 faculty members (898 surveys completed and returned) by Scott et al., it was found that organisational respite was the most frequent type of support desired by their participants.2