Issue 3 / 30 January 2012

HOW would you respond if a colleague disclosed an adverse patient event to you?

Based on the findings of a recent survey in the Archives of Surgery, this is an important question for all doctors.

The study revealed that 53% of doctors surveyed had been involved in a serious adverse patient event in the past year. While 63% of the doctors were willing to seek support following an adverse patient event, a number of perceived barriers to seeking support were reported including lack of time (89%), uncertainty or difficulty with access (69%), concerns about lack of confidentiality (68%), negative impact on career (68%) and stigma in seeking support (62%).

The study found that the most popular source of support for doctors was their medical practitioner colleagues (88% of respondents), compared with mental health professionals and employee assistance programs, which less than 50% of the survey respondents would consider for support.

The authors postulated that the “most effective physician support system involved peers who have the unique qualification of ‘having been there’ — of having had similar experiences with stressful situations such as errors and/or litigation in the past”.

We know that adverse patient events and the threat of litigation are some of the most severe sources of stress in doctors’ professional lives.

All of us can remember an incident involving patient care where things did not go to plan and, at times, with the consequence being serious harm to a patient. Some of us become the “second victim” of the event — a term originally coined by US patient safety expert Professor Albert Wu in 2000.

Second victims have been defined as “healthcare providers who are involved in an unanticipated adverse patient event, in a medical error and/or a patient related injury and become victimized in the sense that the provider is traumatized by the event. Frequently, these individuals feel personally responsible for the patient outcome. Many feel as though they have failed the patient, second guessing their clinical skills and knowledge base”.

How can we support ourselves and our colleagues when faced with these situations during our careers? Interviews with health care providers involved in adverse patient events confirm that individuals have their own unique way of coping, yet experience a predictable post-event recovery trajectory.

Six stages of recovery were identified:

    1.    Chaos and accident response
    2.    Intrusive reflections, including “what if” questions
    3.    Restoring personal integrity, involving seeking support from a trusted individual
    4.    Enduring the inquisition
    5.    Obtaining emotional first aid
    6.    Moving on — dropping out, surviving or thriving. Importantly, “thriving” in the sixth stage was identified in health care providers who made something good come from the experience.

Dr Wu concluded his discussion about the second victim with the following “assignment” for the practising doctor: “Think back to your last mistake that harmed a patient. Talk to a colleague about it. Notice your colleague’s reactions, and your own. What helps? What makes it harder?”

He says it is important to encourage a description of what happened, and to begin by accepting this assessment and not minimising the importance of the mistake. He notes the importance of asking about and acknowledging the emotional impact of the mistake, and to ask about how the colleague is coping.

We owe it to our colleagues, our patients and our profession to support colleagues when they are at their most vulnerable, and hopefully protect them from emotional impairment and ensure they reach the “thriving” category of “moving on”.

We should all take some time to reflect on how we will support a colleague to prevent the development of a second victim. After all, we are the most valued and valuable support for our colleagues who are involved in an adverse patient event.

How will you respond?

Dr Sara Bird is the manager of medico-legal and advisory services at MDA National.

Posted 30 January 2012

One thought on “Sara Bird: Treating the second victim

  1. Beryl Shaw says:

    When I presented 2 x 1hr workshops at the Sydney GPCE I asked the doctors who were booked in to send me emails prior of what problems they may have had in communication with patients.
    The 2 people who responded then allowed me to use their story as a learning exercise for the whole group they were in.
    The value of this was huge! Everyone learned – and most of all, each of these doctors expressed their grateful thanks because I’d helped them understand their part in the problem and what to do next time.
    Follow up showed this learning continued in practice.
    And one of the firm commitments I’d requested was total confidentiality for everyone – they were happy to do this. This did not exclude them from using the lessons, but without identifying the individual who had allowed their story to be told.
    Double advantage for everyone. And of course I always love knowing that I’ve helped with my ‘wordsmith’ skills; added to by my long experience of illness and hospitalisations. Even the worst can be a blessing, when we learn from it.

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