Explore This IssueApril 2023
“Delivery of healthcare, and perhaps especially surgery, is inherently stressful. When the outcome for the patient isn’t what was intended, it is easy to forget that the humans providing that care suffer as well,” said David E. Eibling, MD, a professor in the department of otolaryngology–head and neck surgery at the University of Pittsburgh in Penn., and chairman of the Second Victim Committee at the VA Pittsburgh. “Recognizing that one’s colleagues may be suffering following such an event requires insight and compassion, as well as willingness to offer support. The emphasis on such interactions should be on the individual, not the event. Expressing concern and listening are often the most important aspects of such interaction.”
Medical errors, which may have no adverse consequences or can be devastating for patients and their families, can also compound the work-related stress that physicians experience. Aside from medical malpractice lawsuits, the physical and emotional burnout related to medical errors is well-known. A 2007 study reported that physicians experienced increased anxiety, loss of confidence, sleeping difficulties, reduced job satisfaction, and harm to their reputation following medical errors (Jt Comm J Qual Patient Saf. 2007;33:467–476).
A Second Victim
“Any physician or surgeon who has made a medical error is at risk for anxiety and stress; surgeons may experience loss of confidence, sadness, shame, impaired sleep, loss of professional fulfilment, or clinical depression,” said Michael J. Brenner, MD, an associate professor in the department of otolaryngology–head and neck surgery at the University of Michigan Medical School in Ann Arbor. “Some surgeons will experience a post-traumatic stress disorder-type response to such medical mishap incidents.”
In an article published in 2000, Albert Wu, MD, a professor and director of the Center for Health Services and Outcomes Research at Johns Hopkins University in Baltimore, coined the term ‘second victim’ to convey that adverse events impact more than the injured patient (BMJ. 2000;320:726–727). The first victim of the event is the patient and their family, and the second victim is the caregiver involved in the event. Second victims can be residents, surgeons, nurses, or any health professional.
“At our recent presentation at the Triological Combined Sections Meeting, most respondents reported that if they had experienced the second victim syndrome, they still felt affected by the experience, reflecting the indelible mark left on surgeons when a patient suffers harm,” Dr. Brenner said.
Peter Weisskopf, MD, chair and consultant in the division of otology in the department of otolaryngology at the Mayo Clinic in Phoenix, explained that surgeons are trained to take “extreme responsibility” for everything related to their patients. They also have zero tolerance for errors. “These two factors can make any error seem like a huge black mark against you as a person. We internalize these and then are afraid to share them for fear of legal or social identification as a ‘bad doctor.’ This all feeds into the impostor syndrome that many physicians note,” Dr. Weisskopf said.