Abdus Salam Khan, MD FACP – February, 2017
Healthcare delivery is a complex task as it depends on plenty of unknowns and also human interactions. There are plenty of chances that the care although done with good intentions may result in a bad outcome. This bad outcome creates victims. The person who gets to bear the brunt of this mistake is called the first victim. We all know it and we try our best to help this victim. But there are other victims who require us to be equally compassionate about them. The second victims are the people in the midst of these mistakes, people who were part of the healthcare delivery team, people who actually have caused these mistakes/errors.
How common is this phenomenon? To our astonishment I would like to say it is more common than anyone can imagine. It is also important to note that the second victims usually suffer in silence with no support and feel abandoned and lonely. Because of having no such culture and understanding they cannot discuss these issues with anyone because of fear of blame and shame.
Let me ask you all to think about your medical career and identify coming in contact with the second victims. At times being blamed for a bad outcome but at times being responsible for it, we may be one of the second victims ourselves. And all other times we may remember seeing others go through this phenomenon.
The definition of second victim can be put out as follows:
“Second victims are healthcare providers who are involved in an unanticipated adverse patient event, in the 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’s outcome many feel as though they have failed the patient, second-guessing their clinical skills and knowledge base”.
After the bad outcome, everyone is concerned about the first victim. That is, the patient who was the subject of the error or bad outcome, but no one looks out for the second victim. These people go through periods of agony and distress and eventually settle with sometime good and sometimes bad resolution.
Those people go through several stages in their recovery process. These stages were described as:
1. Chaos and accident response
2. Intrusive reflections
3. Restoring personal integrity
4. Enduring the inquisition
5. Obtaining emotional first aid
6. Moving on, which can lead to
a. Dropping out
b. Surviving
c. Thriving
During these times of going through professional and personal distress, any positive outside interaction can help the second victim handle outcome favorably, when they reach the last steps. Although we believe that asking for help could be seen as a sign of weakness or guilt by others, the research has shown that providing support is pivotal and leads to good resolution.
Since no such help at any level exists at any level in Pakistan and the second victims are left on themselves to go through the stress, we have started a support group. We hope that the people understand the phenomenon of second victim and provide support to them. This requires understanding at all levels of care and generally results in over all safe patient care and quality healthcare delivery.
In my next blog I will discuss the strategies that the world has implied to help the second victims and what we need to do in Pakistan to promote the safety of our healthcare providers on the face of any bad outcome.
You can reach me at askhan65@yahoo.com