Why support Second Victims

There is now a huge amount of evidence from different countries and across different professional groups that being involved in a patient safety incident, particularly one where the patient is seriously harmed or dies can be very distressing (Sirriyeh, Lawton and Gardner, 2010). The feelings of guilt, shame, incompetence, anxiety that are reported to be experienced by staff in these situations are heightened when the individual feels that it was their error or mistake that caused the adverse event. Of the 1,463 doctors we surveyed in the UK (Harrison, Lawton and Stewart, 2014), 76% believed that the experience of a patient safety incident had affected them personally or professionally, 74% reported stress, 68% anxiety, 60% sleep disturbance and 63% lower professional confidence. Moreover, 81% became anxious about the potential for future errors. It is not only doctors who suffer. In fact, in another study (Harrison et al., 2015) we found that nurses showed higher levels of distress following an adverse event than doctors.

For many people the emotional impact of the error is short-lived, but for some the effects are long-lasting. In our sample, 8% of doctors reported symptoms associated with post-traumatic stress disorder. This is why the term ‘second victim’ was coined. The emotional impacts of making an error are many, but there are other impacts too that make it so important that we don’t ignore, or even punish further, those that have been involved in an adverse event. There is evidence that a loss of confidence and distress that is often exacerbated by the incident investigation process can lead to burnout, hyper-vigilance and the practice of defensive medicine. Without support, second victims may even choose to leave the profession. From a moral standpoint, supporting people in distress is essential. There is also a safety and financial imperative to do so.

Sirriyeh, R., Lawton, R., Gardner, P., & Armitage, G. (2010). Coping with medical error: a systematic review of papers to assess the effects of involvement in medical errors on healthcare professionals’ psychological well-being. Qual Saf Health Care, 19(6), e43-e43.

Harrison, R., Lawton, R., & Stewart, K. (2014). Doctors’ experiences of adverse events in secondary care: the professional and personal impact. Clinical Medicine, 14(6), 585-590.

Harrison, R., Lawton, R., Perlo, J., Gardner, P., Armitage, G., & Shapiro, J. (2015). Emotion and coping in the aftermath of medical error: a cross-country exploration. Journal of patient safety, 11(1), 28-35.