Acknowledging the Second Victim: A Message from the CORD Resilience Committee

Submitted by Cara Kanter, MD (Temple University) on behalf of the Mental Health Task Force of the CORD Resilience Committee


“There is no place for mistakes in modern medicine” wrote Dr. Albert Wu in an article published by the British Medical Journal in 2000; an article in which he coined the term ‘second victim’ and finally shed light on a problem plaguing the medical community for decades if not centuries. Human error is a widely accepted reality in most contexts. “People make mistakes.” “To err is human.” We hear these refrains time and again in response to unfortunate avoidable outcomes in society at large. We do not hear them so much around the hospital, where the unfortunate avoidable outcomes are increased patient suffering and loss of life. It is clear that healthcare workers are held to different standards. There is no place for mistakes in modern medicine.

The term ‘second victim’ refers to the healthcare provider who experiences psychological distress in response to an adverse patient outcome in which he was involved. The first victim is the patient himself. Second victims often face crippling guilt, shame, and self-doubt in the face of medical errors that cause patient harm. Second Victim Syndrome (SVS) encompasses the constellation of symptoms of psychological and emotional trauma experienced by the second victims. SVS sufferers have increased susceptibility to burnout, depression, substance abuse, poor personal hygiene and strained interpersonal relationships, persuading some to leave the profession altogether, contemplate or commit suicide. It is clear that unrecognized and untreated SVS can have a severe impact on the second victim as well as the healthcare system as a whole. We cannot stand to lose our most compassionate and empathetic healthcare providers who risk bearing the emotional brunt of medical errors.

Emergency physicians with our density of clinical decisions, interruptions, large patient volumes, and circadian rhythm issues are at unique risk for SVS. In addition, our working conditions do not allow us to decompress and reflect on medical errors after the fact as we are obligated to shift our focus to our other patients. The CORD Resilience Committee is committed to identifying, treating, and preventing SVS. As SVS is gaining recognition throughout the medical community, many hospitals are developing programs to increase awareness and assist healthcare providers when adverse events occur. In particular, peer to peer (P2P) support is increasingly recognized as an important factor in positive outcomes. Frankly, we want to talk with others who have stood in our shoes and have navigated the waters before.

The Mental Health Task Force of the CORD Resilience Committee has designated a SVS/P2P Working Group tasked with:

  • Identifying programs and institutions with already established SVS/P2P programs.
  • Developing a toolbox of resources to assist programs and institutions in developing their own SVS/P2P programs.

If your institution has a Peer-to-Peer Support program that is established or being developed please send the information to the SVS/P2P Working Group so that we can develop a complete listing.  

Contact: Alicia Pilarski (apilarski@mcw.edu) or Cara Kanter (Carolyn.Kanter@tuhs.temple.edu)

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