In the March 2000 issue of BMJ, Dr. Albert Wu introduced the concept of the “second victim” in healthcare—recognizing that physicians who experience adverse patient outcomes often suffer from anxiety, depression, and profound shame. This phenomenon, now known as “Second Victim Syndrome” (SVS), extends beyond medical errors to encompass the emotional and physical toll of any unexpected patient outcome on healthcare providers. The term “second victim” acknowledges that while the patient is the primary victim, the healthcare provider can also experience significant trauma.
As emergency medicine physicians, we’re trained to handle high-stress situations, make split-second decisions, and save lives. But what happens when, despite our best efforts, things go wrong?
The Impact on Emergency Medicine Physicians
Emergency medicine is a high-stakes specialty where the potential for adverse events is ever-present. In fact, over 25% of emergency medicine physicians and 27% of emergency medicine nurses experience SVS according to StatPearls. The rapid pace, complex cases, and need for quick decision-making can amplify the risk of errors and, consequently, the likelihood of experiencing SVS.
According to the Emergency Medicine Residents’ Association, symptoms of SVS include:
- Anxiety and depression
- Self-doubt and loss of confidence
- Sleep disturbances
- Guilt and self-blame
- Fear of future errors
- Job dissatisfaction
These symptoms can persist for months or even years, affecting both personal well-being and professional performance.
Recognizing SVS in Ourselves and Colleagues
As a community of emergency physicians, it’s important to learn to recognize the external signs of SVS. Look out for:
- Changes in behavior or mood following a difficult case
- Increased absenteeism or reluctance to take on challenging cases
- Expressions of self-doubt or guilt
- Isolation from colleagues or withdrawal from social activities
Supporting Emergency Medicine and Other Physicians After Adverse Events
Physicians who experience adverse events need supportive, blame-free environments for recovery and learning. Advances in Medical Education and Practice outline effective ways healthcare organizations can support physicians with SVS:
- Respect providers’ good intentions and acknowledge human fallibility
- Offer compassionate support and counseling
- Treat psychological impact as an emergency requiring immediate attention
- Enable providers to contribute to system improvements by sharing insights
- Create opportunities for both personal recovery and organizational learning
The Resilience In Stressful Events (RISE) program, developed by Johns Hopkins, is a helpful example of how health care organizations can effectively address SVS. Started in 2011, this program established a team of peer responders who provide on-call support to providers before, during, and after adverse events – an approach based on needs articulated by the providers themselves. Establishing successful programs like RISE requires executive buy-in, recruitment and training of peer responders, and staff education on how to use the program. Ultimately, focusing on systemic solutions rather than individual blame is crucial for both the physician and the health care organization to move forward.
Recap
Second Victim Syndrome represents a critical challenge in emergency medicine and medicine in general that requires commitment at both institutional and personal levels. As healthcare organizations increasingly recognize the profound impact of adverse events on physicians, implementing structured support systems and fostering a blame-free culture focused on learning are essential to ensuring top-quality patient and physician care.
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