A recent article published on kevinmd.com 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.
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 Team@SurgeonMasters.com to learn more.