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When adverse events happen in medicine, it is felt not only by the patient and the patient’s loved ones, but also by the clinicians and other medical team members caring for the patient. Known as the second victim syndrome in health care circles, it refers to a physician or other caregiver who sustains psychological harm as a result of being involved in an unanticipated and often traumatic patient outcome.

Fear of stigma, lack of confidentiality, and worry that they would have to report counseling on their license renewal applications are common reasons physicians fail to obtain necessary mental health treatment. To overcome these barriers and support clinicians dealing with second victim syndrome, organizations should promote the idea that seeking support is not a sign of weakness. To do so is a smart, responsible move.

The fear of litigation and shame associated with making a mistake can be paralyzing for health care professionals. However, remaining silent and isolated from the patient can increase physician distress when it conflicts with the physician’s perceptions of the ethical and moral duties associated with disclosure. This can exacerbate second victim syndrome—shame, anger, depression, inadequacy, loss of confidence—which is well documented among physicians who are involved in unanticipated outcomes and is a contributing factor in physician burnout. While patients should be the focus of disclosure, it is also important to consider the benefits of disclosure for physicians. Research indicates that disclosure may help physicians process the emotions associated with an unanticipated outcome and can increase physician/provider well-being.

Organizational awareness of second victim syndrome and an institutional response plan for it are critical to minimizing its stress on a clinician. Clinician support must become a predictable and required part of the health care operational response to stressful clinical events. Leadership engagement and a strong infrastructure for clinician support are essential to effectively address second victim syndrome, which can lead to physician burnout.

Physicians should be encouraged to discuss with family, friends, and colleagues the range of feelings that could occur—for example, sadness, fear, guilt, or anger—in response to an adverse event. (Any discussions of feelings should be distinguished from discussion of the facts surrounding patient care and the adverse event, which are confidential.) Unfortunately, there is minimal protected time for clinicians to comprehend and process an unanticipated or adverse event before moving on to their other responsibilities. The strategic placement of trained peers allows for real-time emotional support for clinicians and maximizes the limited time physicians have available.