"The pain and suffering are just too great for me to manage": A qualitative study of emotional distress among anesthesiologists after challenging clinical events.

BACKGROUND Anesthesiologists manage acute clinical events that can cause emotional distress. These experiences can lead to mental health challenges and affect clinicians' ability to provide care. However, the literature regarding specific factors of clinical events that cause emotional distress is limited, and their impact remains understudied. The objectives were to explore elements within anesthesiologists' practice environment contributing to distress associated with clinical events and elicit emotions and symptoms regarding clinical events that are distressing long-term. METHODS Anesthesiology faculty members at an academic institution were invited to engage in 30-minute individual qualitative interviews. They were prompted to reflect on a clinical event that caused them lasting emotional distress. Questions were based on risk factors for post-traumatic stress disorder, focusing on two time periods: during the event and after it. To maintain study rigor, a trustworthiness framework was used that emphasized four components: transferability, dependability, credibility, and confirmability. A thematic analysis approach with two coders followed, with an audit trail maintained throughout. RESULTS Twenty anesthesiology faculty members representing nine anesthesiology subspecialties were interviewed. Risk factors leading to emotional distress represented three areas: the clinical event, context, and patient. Clinical-related risk factors included clinical errors, a physician's first time encountering a clinical scenario, lack of adequate clinical support, and unexpected outcomes. Contextual risk factors involved legal and professional repercussions, mistreatment by non-anesthesiology colleagues, personal stress, and unsupportive leadership. Patient-related risk factors included having developed a close relationship with the patient, a patient's similarity to the clinician or their loved ones, and young patient age. Participants described emotions such as sadness, guilt, shame, helplessness, and self-doubt, and physical symptoms of emotional stress, flashbacks, and intrusive thoughts. CONCLUSIONS Anesthesiologists experience profound and lasting emotional impacts from challenging clinical events. Future research should evaluate interventions to mitigate these impacts on anesthesiologists' mental health and career longevity.