Moving Away from Second Victim Syndrome

A recent article published on titled “Second victim syndrome: a doctor’s hidden struggle” outlined the concept of second victim syndrome and its impact on physicians experiencing burnout. In this article, I’d like to offer my perspective on this concept and how we can better approach it to prevent burnout and promote well-being.

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What is “Second Victim Syndrome?”

Second victim syndrome is a term coined in 2000 by Dr. Andrew Wu that refers to the psychological trauma that a physician may experience in cases of medical error. In a case of medical error, the patient is the first victim and the physician or healthcare professional is the second victim.

Severe cases of harm can lead to severe feelings and thoughts. Mild and moderate cases of harm still stir these feelings and are generally under appreciated for long-term effects. In these cases, the hospital performs root cause analyses and tries to determine ways to prevent errors in the future, while the physician is left alone to deal with the psychological trauma.

These analyses are appropriate if there are lessons learned. Often the system wants or insists that a new lesson is learned. Most frequently the root cause is not new to the system, though it may be new to that physician. To many physicians, the root cause analysis prioritizes the process and even the analysis rather than the humans involved. When lessons are learned, this is a great thing. When NOT, they may not realize the additional harm that is caused to the humans in overanalyzing the medical error. Whether an error actually occurred is not as simple as you might think. Similarly, who made the error makes it even more confusing. Internally, human minds are processing this information very rapidly, while the system processes at a different pace. The humans are further isolated and the feelings are can be GREATLY exacerbated.

So what can we do to help physicians deal with second victim syndrome?

Changing the Language from “Second Victim Syndrome”

First, what if we change the language of "Second Victim Syndrome?"

Many physicians don't want to be considered a victim (nor should we be). Healing, recovery, and learning is strengthened by the concept of moving out of the victim mindset. What if we just call these “adverse outcomes?” What if we appreciated that all involved in the adverse outcome have needs to heal, recover, and learn?

Emotional First Aid & Employee Assistance

Second, the best programs are not in place for surgeons and physicians to leverage when they need assistance. We need to get past “solutions” that are essentially just lipstick on a pig, and invest in real education and resources. For instance, we don't teach healthy empathy and very little attention is placed on emotional intelligence or skills in our training.

Few physicians are even aware if an employee assistance program exists or they might not have access if they are not employed by a hospital or system. Even when available, surgeons are internally and culturally least likely to reach out for support or "feel" that the support "doesn’t get us." Physicians and surgeons are not trusting of confidentiality and safety, as often these have been violated by the system. Lastly, physicians might accept support, but only after repeated offers. We have much more training in giving versus receiving care and support.

We need to offer peer-support that is built around the individual. Each situation is unique, and right now our healthcare system isn’t offering the support physicians need. Too often the support is lacking adequate funding, scheduling conflicts with clinical or personal time, and clarity of physician purpose and goals. There are best practices for peer-support, and we all have to be willing to embrace them.

We all know there’s a long way to go in creating the change our system requires. When medical errors do happen, what if we started with a truly confidential physician-to-physician conversation with someone who understands what we are going through?

With a vast array of resources, including physician coaching, advocacy blogs and podcasts, health and exercise guidance, and resilience training, SurgeonMasters provides a supportive, nonjudgmental, and enriching environment for self-development. Coaching is one avenue that provides an environment for confidential peer-to-peer connections.

Reach out to to learn more.

The Two Sides of Burnout

Photo by karenfoleyphotography/iStock / Getty Images

Photo by karenfoleyphotography/iStock / Getty Images

We talk a lot about surgeon burnout – how to prevent and treat it. Burnout can be incredibly detrimental to a surgeon’s emotional health, as well as their ability to treat patients and provide the best possible care. But from one perspective, burnout is not a bad thing.

The Stigma of Burnout

The stigma of burnout is that only the weak experience symptoms. In reality, many of us feel the effects and there are a myriad of factors that contribute to burnout, including some which impact high performers.

Burnout also has two sides:

  1. The system abuser side

  2. The surgeon abused side

So the fact that our system burns out good surgeons (and might even burn out some of the best even faster) is NOT a good thing. 

However, many people look on in shock as an abused person returns to an abuser. How can they do that? Don't they understand that they are enabling the abuser? Couldn’t the abused make the choice not to allow the abuse to continue by:

  • Saying no?

  • Setting boundaries?

  • Walking away?

All of these actions would seem like rational, intelligent choices to most people.

Emotional exhaustion often results from the stress of caring for traumatized or suffering patients. It can also stem from processing empathy in unhealthy ways. Lack of fairness in, respect for, and control of one’s work are major contributors to depersonalization (cynicism). When a surgeon experiences those symptoms and a reduced sense of personal accomplishment (purpose) IN THAT AREA of their life, that surgeon is considered a victim of burnout. If they then move their energy into something that provides them more satisfaction, that would seem like a good thing for the surgeon!

The victim is choosing to no longer be a victim. The rational choices seem to be either stop the abuse or leave the abuser.

The Loss is to the System Abuser

So the loss is to the profession (the system abuser) and the many patients that a better-treated surgeon could have served. I repeat! The loss is to the system. The loss is to the abuser. Maybe we should stop, or at least figure out ways to lessen the abuse. Disease and injuries are hard enough to handle. Maybe the system could not pile on?

If you are dealing with burnout in your practice, SurgeonMasters has educational materials like web-conferences, podcasts, online CME webinars and other resources to help you attain a lifestyle friendly practice consistent with your goals.