January 16, 2023

“Second victim” trauma in medicine

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.

Mistakes happen

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.

What is second victim syndrome?

Second victim syndrome, also known as “second victim response” or “second impact syndrome,” refers to the emotional and psychological impact on healthcare providers who have been involved in a medical error or adverse patient event. These events can be traumatic for healthcare providers, who may feel responsible, guilty, and/or distressed as a result. They may also experience a sense of loss, grief, and/or shame, and may struggle with the emotional and psychological aftermath of the event.

In addition to the patient who is directly affected by the error, there is also a "second victim" in the form of the healthcare provider who was involved in the error.

The term “second victim” was coined by Dr. Albert Wu, a professor of health policy and management at Johns Hopkins Bloomberg School of Public Health, to describe the impact of medical errors on healthcare providers. It highlights the fact that, in addition to the patient who is directly affected by the error, there is also a “second victim” in the form of the healthcare provider who was involved in the error.

What is the impact of medical errors on healthcare staff?

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.

What can employers do to support clinician “second victims”?

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:

Recognize the impact of medical errors: It is important for employers to recognize the emotional and psychological impact of medical errors on their staff. This includes acknowledging the feelings of guilt, responsibility, and distress that can arise as a result of these events.
Offer support: Employers can provide a range of support to staff who have been affected by medical errors, including debriefing sessions, counseling, and other forms of support. It is important to create a safe and supportive environment in which staff feel comfortable seeking help.
Implement systems to prevent medical errors: Employers can implement systems and processes to help prevent medical errors from occurring in the first place. This can include protocols for medication administration, policies for hand-off communication, and training on patient safety.
Promote a culture of safety: Employers can create a culture of safety within their organization by emphasizing the importance of patient safety and encouraging staff to speak up if they have concerns. This can help to prevent medical errors and create a positive work environment for healthcare providers.

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.

How to cope with second victim syndrome

There are several strategies that healthcare providers can use to cope with and overcome second victim syndrome. The most important is number 1:

Remember you are only human. People make mistakes. You can replay in your mind a million different ways it could have gone. None of this will change what happened, so accepting it and your own humanity is essential.
Seek support: It is important for healthcare providers to have a support system in place, whether it is a colleague, supervisor, or mental health professional. Talking through the event with someone can help to process and make sense of the experience.
Take care of oneself: It is essential for healthcare providers to prioritize self-care after a medical error or adverse patient event. This can include taking breaks, getting rest, and engaging in activities that provide relaxation and stress relief.
Reflect on the experience: Reflecting on the event can help healthcare providers to understand what happened and identify any areas for improvement. It can also help to mitigate feelings of guilt and responsibility.
Participate in debriefing sessions: Many healthcare organizations offer debriefing sessions for staff who have been involved in medical errors or adverse patient events. These sessions provide a safe space for staff to discuss their experiences and receive support from their colleagues and leaders. Seek counseling: For some healthcare providers, the emotional and psychological impact of a medical error or adverse patient event may be significant. In these cases, it may be helpful to seek counseling from a mental health professional.
Connect with trusted people. Whether it’s a loved one, friend, family, colleague, or a doctors’ peer-support group, PLEASE reach out. You are not alone. Support, perspective, and time will all help you get through this.

Conclusion

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.

Dr Corrigan

A recovering physician who left medicine after burning out and more. Overachiever. Impostor syndrome. Had never heard of Corrigan's Secret Door* until it was too late. Thankfully now in a way better place. Co-founded Physicians Anonymous with intention to solve physician burnout, mental illness, and addiction. Hopes to prevent future medical career disasters through peer support, advocacy, policy change, and innovation. * https://physiciansanonymous.org/corrigans-secret-door-and-other-stories/

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