Aviation-style safety checklist and confidential helpline for surgical community to prevent mental health crisis

The UK’s sole trade union for surgeons and the surgical team; including anaesthetists; has announced the launch of a counselling service, a bullying and harassment helpline and a collaboration with an esteemed clinical psychologist to address an epidemic of surgeon burnout.

With waiting lists of around 7 million, the pressure on a diminishing workforce is at an all-time high, yet surgeons – when compared to other professions – have been less likely to seek support for mental health issues, such as stress, anxiety and depression.

The Confederation of British Surgery (www.cbsgb.co.uk), which is the UK’s only trade union to be recognised under UK law to protect the welfare of the whole surgical team, recognises the need to address stress before it impacts mental health, and is now offering resources that will specifically address the pressures of surgery, such as adverse events, medico-legal stresses and the seismic shift from traditional leadership approaches, with the key being in addressing potential issues at an early stage.

A counselling service is provided free of charge to members of the Confederation via Health Assured (https://www.healthassured.org/employee-assistance-programmes/), which is renowned for offering inclusive and bespoke support with a real focus on wellbeing. Support is offered via comprehensive 24/7 telephone helplines, therapeutic interventions, critical incident stress management, and face-to-face assistance. The holistic service also includes webinars, debt support, personal legal information, access to a health and wellbeing portal, mood trackers, a chat facility, mini-health checks and other wellbeing resources.

Additionally, CBS is developing additional resources that complement the Health Assured offering, by the development of a checklist that is quick to use, allowing surgeons to avoid adverse events by checking they are mentally fit and prepared to operate. This is based on the aviation pre-flight checklist; similar to the Federal Aviation Administration’s which has the acronym IAMSAFE, encouraging a pilot to self-check for illness, medication, stress, alcohol, fatigue and emotion prior to take-off. The surgeon checklist, with the acronym FEBRILE, is being spearheaded by CBS to enable surgeons to check they are able to safely carry out surgery, and to highlight any issues that might need addressing.

Fear: Rating of worry levels, from manageable to overwhelming

Energy levels: A check of physical wellbeing

Balance: Is there a healthy work/life balance, with adequate space for hobbies, fitness and downtime?

Resources: Access to support resources in the workplace

Inappropriate coping strategies: Is there any reliance on alcohol, drugs, medication, or any other potentially detrimental approach?

Life Events: Whether they’re experiencing any big changes, such as divorce, children leaving for college, bereavement or similar

Effective leadership: Whether there is a reassuring direction from management

To advise and support this launch, CBS has brought esteemed clinical psychologist Dr. Richard Sherry on board as the clinical psychologist-in-residence. Dr Sherry, whose roles have included working as the former Head Clinical Psychologist for the Inpatient’s treatment for the US military; the Clinical Psychologist for Essex Fire and Rescue and; latterly, he has helped develop the Aerospace component for the BPS an Aviation and Aerospace Psychology, for which he is an specialist registered member. His long-standing interest and expertise in developing healthier systems has led him to his current area of work in strengthening the ecosystem within hospital and surgical teams. Dr. Sherry says:

“What surgeons do directly impacts the health outcome of their patients, the patients’ families, their staff, and the functioning and reputation of their hospital. By virtue of these factors, it is a very high stress occupation, and surgeons are in a vulnerable position, psychologically. We are emphasising that it is ok to say, ‘I am human’, and to address their needs; consider the age-old oxygen mask aeroplane analogy: if you don’t keep yourself alive, how are you going to help others? Checks, checklists, balancing, and technical tools will all lead the way to a more enfranchised and holistically healthful working environment.”

Adverse events in surgery, such as wrong patient, wrong site, wrong procedure, or retained foreign body, account for high-level stress in surgeons, who are rarely offered support during investigations. According to GMC research, five doctors under investigation committed suicide between 2018 and 2020. Empowering surgeons to positively seek support prior to burnout is key in reducing adverse events in surgery, which account for over £2 billion in legal expenses annually. With more support for surgeons and improved mental health resources, adverse and never events are also likely to decrease.

In conjunction with Dr. Sherry and surgeon Board members (with experience in the Forces, Human Factors and medicolegal issues) the CBS service will also be rolling out other resources to help surgeons identify when/if they need support, such as crisis toolkits, traffic light systems and flow charts. Mark Henley, consultant plastic surgeon and President of The Confederation of British Surgery says:

“Surgery can be a high-stress field, in which psychological support should be paramount yet unfortunately has been lacking. Sadly, as shown in studies, surgeons are less likely than other professions to seek help or even recognise that they need support in their time of need. CBS understands the unique set of pressures in our discipline, and is pro-actively working to tailor counselling packages and support toolkits specifically for this high-risk group of people. We seek to support our valued members in navigating this anomalous landscape.”

The Confederation is also piloting a bullying and harassment helpline, currently available to all members of the British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) with a view to rolling this service out to all the Surgical Specialties through the Presidential Forum of the Federation of Surgical Specialties Association (FSSA), the umbrella organisation for all surgical specialty societies.


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