The Unspoken Trauma Of Adverse Patient Events

Picture of surgeons in the background. With text in the foreground that reads"Unspoken Trauma Of Adverse Patient Events: The Impact on Healthcare Professionals."

Healthcare professionals often suffer in silence after a serious adverse patient event, but understanding the concept of the Second Victim is the first step toward healing. 💔

Last week, I shared a video that really hit close to home for our Glauc Flock. 

Surgical Complications: It’s part of the job.

Your comments got us thinking and we wanted to explore a bit more about the concept behind it—Second Victim.

I took inspiration from an article by Drs. Carolyn J. Sachs and Natasha Wheaton. They delved deep into this phenomenon and shed some light on the struggles healthcare providers face when we experience adverse events or medical errors. 

Let’s dive in and break it down.

What Is A Second Victim?

The term “second victim” refers to the healthcare professional involved in an unanticipated adverse patient event, medical error, or patient-related injury. Healthcare professionals are the “second victims” because the patient is the “first victim.” Since its first description over 20 years ago, it has expanded beyond physician errors to include any healthcare professional involved in a traumatic medical event. 

These events tend to cause more psychological harm to healthcare providers when left unaddressed.

Extreme And Pervasive Stress Is Common

Multiple studies document what we already know from our own experiences and the experiences of our colleagues. We suffer psychological distress following serious adverse events with our patients. 

Second victims often suffer intense psychological symptoms including:

  • Troubling memories 
  • Anxiety/concern
  • Anger toward themselves 
  • Regret/remorse
  • Distress
  • Fear of future errors
  • Embarrassment
  • Guilt
  • Sleeping difficulties

These symptoms are experienced by most of us at some point in our career. Intense symptoms might be happening more than you think. 

Extreme and pervasive stress is reported by:

  • 27% of emergency nurses, 
  • 25% of emergency physicians, 
  • 22% of ICU nurses, 
  • 22% of surgery residents, 
  • 17% of anesthesiologists
  • 15% of trauma surgeons

When left unaddressed, secondary victim symptoms can become Secondary Victim Syndrome, which can lead to a diagnosis of post-traumatic stress disorder (PTSD).

The 5 Emotional Stages Following An Adverse Patient Event

Healthcare professionals commonly go through several stages after an adverse patient event:

  1. Intrusive reflections: Replaying and second-guessing details of the event.
  1. Fear of rejection: Worrying about others’ perceptions of what happened and that others may doubt their competence.  
  1. Enduring inquisitions: Ruminating over how they could have avoided the adverse event
  1. Seeking emotional first aid: Turning to others for support in processing the event.
  1. Final disposition: Finding meaning in the experience and continuing their practice, merely surviving the event, or leaving the profession.

Processing an adverse patient event can take years.

8 Keys To Providing Emotional Support

  1. Step away for privacy: Swiftly guide your colleague to a quiet spot away from the commotion of the event.
  1. Ask gentle questions: Break the ice with open-ended questions like “How are you feeling?” or “Do you feel like talking about it?”
  1. Be a listening ear: Let them lead the conversation. They might prefer a quick chat, or need more time to open up.
  1. Check-in: Offer to call them later that day or the next to see how they’re doing. You could even connect them with a peer supporter or professional for extra support.
  1. Give them space: After the chat, give them some alone time to process their thoughts before jumping back into work. 
  1. Support departures: If they need to leave work, help them figure out coverage, if possible. 
  1. Provide resources: Before parting ways, make sure they have access to referrals for emotional, psychological, or professional help if needed. 
  1. Avoid unhelpful phrases: Stay clear of “Tell me what happened,” “Everything will be OK,” or “Don’t worry about it.” 

Health Organizations Must Support The Second Victims In Their Ranks

Research suggests a 3-tiered program is an effective place to start:

  1. Immediate emotional first aid at the time of crisis
  2. Access to formally trained peer supporters who can relate
  3. Referral to mental health professionals as needed

Healthcare organizations can formalize support systems and send an explicit message that we don’t have to cope alone and deserve compassion.  

A Cultural Shift Is Needed To Mitigate Burnout, Job Loss, Suicide Risk 

Without support, the downstream effects of Second Victim Syndrome can be devastating:

  • Increased burnout, cynicism, and intention to leave the profession
  • Potential for significant medical errors due to poor concentration
  • The heightened risk of substance abuse and suicide

There must be a mindset change to recognize us as humans, not just flawed robots. A mindset change toward support and away from shame. 

Healing Is Possible

We deserve support.

We are all human.