Medicine is not a perfect science. Clinicians – even highly trained, experienced, and expensive ones – are human beings and therefore subject to error. Then there is the modern medical-industrial complex in which most (Western) clinicians work. It is under-resourced, time-pressured, litigious, and blaming. It also expects doctors, especially the least experienced ones (residents/trainees) to work the longest hours for the least pay and with the least senior doctor supervision. When things go wrong, it is easy to focus only on the “first victim” and forget those around them affected by the error – especially the clinician who made a mistake, also known as the “second victim” in medicine.
So, regrettably but inevitably, errors occur. Fatigue or cognitive load and their related cognitive impairments are the most common underlying causes.
These are caused by the excess hours worked by doctors (80 hrs a week in residency is the official maximum in the US) and the cost-cutting (read staff-reducing) measures found, especially in for-profit clinical groups.
Furthermore, since the advent of electronic health records (EHR), doctors spend 2hrs on records for every 1hr with patients — including 86 minutes of charting out of normal working hours.
The latter is so common it has a medical term — “pajama time”.
Airline pilots and other shift workers have mandatory breaks after a number of hours of concentration. This is to protect the public and the pilot. Why not surgeons, ER docs, or psychiatrists?
Patients get harmed, sometimes horribly. Litigation and professional disciplining ensure. For the vast majority of physicians, to make a mistake is unacceptable.
Then it happens and someone gets hurt, someone we have sworn to treat and try to heal.
This article is intentionally not focusing on the first victims of medical error — the patients. Nor is it ignoring them. This in no way means we do not care or regret every single medical error. However, to highlight the wider effects, in this article we are intentionally focusing on the impact on the second victim — the physician — to increase awareness of the impact on physicians, including depression and suicide.
Medical errors can have a significant impact on healthcare staff, both emotionally and psychologically. They may experience a range of negative emotions, including guilt, shame, grief, and distress. They may also feel responsible for the error and struggle with feelings of loss and grief for the patient and the impact of the error on their care.
Medical errors can also lead to burnout and compassion fatigue among healthcare staff. These conditions can result in decreased job satisfaction and an increased risk of turnover, which can have negative consequences for patient care and the overall functioning of the healthcare organization.
In addition to the emotional and psychological impact, medical errors can also have practical consequences for healthcare staff. They may face disciplinary action or legal repercussions, which can have a significant impact on their careers and livelihoods.
It is important for healthcare organizations to recognize and address these impacts in order to support their staff and ensure the ongoing delivery of high-quality care.
Employers can take several steps to support healthcare providers who have been affected by second victim syndrome:
By addressing the needs of their staff, healthcare organizations can help to prevent burnout and ensure that their providers are able to continue to provide high-quality care to their patients.
There are several strategies that healthcare providers can use to cope with and overcome second victim syndrome. The most important is number 1:
Medical error is, sadly, inevitable. By all means learn from it, improve your practice, take the hits. But remember to be kind to yourself. You are only human, and humans make mistakes. Self-compassion, acceptance, connection, support, are key to surviving medical error and “second victim syndrome”.
By implementing these strategies, healthcare providers can overcome second victim syndrome and continue to provide high-quality care to their patients without harming themselves.