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.
The response to an adverse outcome can be both physical and emotional. For example, in the immediate aftermath of an adverse outcome, second victims can experience increases in blood pressure and heart rate, muscle tension, and rapid breathing. Difficulty concentrating, appetite and sleep disturbances, flashbacks, and suicidal ideation can follow. Second victims experience a range of emotions including sadness, fear, guilt, anger, embarrassment, and humiliation. Second victim syndrome is one of the personal stressors that contribute to physician burnout, and the symptoms can last for months or even years.
Some commentators compare second victim syndrome to post-traumatic stress disorder. Second victim syndrome can develop in the absence of burnout, but a physician’s involvement in a medical error may be an additional stressor that exacerbates the physician’s feeling of burnout.
5 Tips for Addressing Second Victim Impact
Surveys indicate that second victim syndrome has been experienced by nearly half of all health care providers. One study found that 90% of physicians interviewed felt that health care organizations failed to provide sufficient assistance when dealing with second victim syndrome despite the fact that 82% desired that kind of support. Consider the following strategies to counter the stress associated with this phenomenon.
Organizational awareness of the second victim phenomenon and an institutional response plan are critical to minimizing the 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. Organizations need to develop a comprehensive plan and provide accessible, effective support for all clinicians experiencing second victim syndrome. Having these programs in place can start to break the cycle of burnout at an organizational level.
Peer and social support initiatives should be established and promoted widely so clinicians know that support is available, what can be expected, and how to access help when they experience such an event.
Clinicians may need professional counseling or guidance referrals, one-on-one interactions, mentoring, or group debriefing. Physicians are unlikely to seek help for burnout or the stress, depression, and anxiety that arises from various aspects of medical practice. Administrators and physician leaders can play a major role in removing the stigma of seeking help and eliminating the fear of reprisal for admitting distress.
Disclosure is the act of releasing all relevant factual information. Research indicates that disclosure may help physicians process the emotions associated with an unanticipated outcome. 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. Disclosure, done properly, is a powerful tool in promoting transparency and preserving relationships.
Organizations can nurture a nonpunitive culture surrounding unanticipated outcomes. Developing a culture of safety is a core element to improve patient safety and care quality.