If a medical professional is deemed to have caused or contributed to a medical error with moderate or severe consequences, it is only natural that they would experience some level of disappointment, distress, or guilt. A recent study of physicians in North America revealed that approximately 92% had experienced a “near miss” or dangerous error.
Some physicians will be tremendously distressed in these situations, an emotional problem called the “second victim” phenomenon. When patients are harmed due to a medical mishap, the effects may extend beyond merely the patient and have an impact on the family, the medical practitioners involved, and reputation of the organization. The “second victim” distress experienced by the provider involved has been known to last for months—or even years.
Origin & Symptoms
The “second victim” phenomenon was first identified by Dr. Albert Wu, a professor with Johns Hopkins School of Public Health. Many providers endure feelings of shame, inadequacy, depression, and even post-traumatic stress disorder (PTSD). They further explained that the organization the doctor works for can play a large role in the ability to “move on” from the incident. There are six stages of recovery that are cited.
Six Stages of Recovery
- Chaos & Accident Response: Feelings of turmoil, shock, and distraction—needs someone else to take over
- Intrusive Reflections: Feelings of self-loathing and a lack of confidence; may keep rethinking (re-enacting) the incident
- Restoring Personal Integrity: May be uncertain of where to turn; may experience negative reactions from colleagues
- Enduring the Inquisition: May face internal investigation and fear losing job or licensure
- Obtaining Emotional First Aid: Feels lack of support; may face uncertainty about who to confide in
- Moving On:
- Dropping out: Changing their place of employment or profession
- Survival: Coming to “grips” with the mistake and improving the outlook
- Thriving: Using the experience as something to learn from
Prevalence of Condition
Study estimates show that roughly 57% of physicians had made a “serious error”. Of respondents, 44% admitted that an error had a negative impact on the confidence in their own abilities. Approximately 80% of surgeons said they experienced an “adverse event” in the past year.
Difficulty in Seeking Support
Far too many victims essentially “suffer in silence” and may not proactively reach out for support. Programs that are designed to support these individuals generally require other employees, supervisors, or management to initiate assistance. According to the American Society for Healthcare Risk Management, only 18% of organizations have established procedures for supporting those employees who experienced a troubling event.
Best Organizational Practices
- Identify facility resources—possibly clergy or psychiatric staff?
- Develop a program with education about the second victim phenomenon and reduce bias or stigma
- Obtain support from key leaders in the organization
- Seek legal counsel to determine protocol regarding confidentiality
- Develop policies that encourage people to use the resources
- Assess utilization, effectiveness, and make continuous improvements