THE SECOND VICTIMTAYLOR BERTSCHY, DO

OCTOBER 10TH, 2018

WHAT IF…

• 23yo G4P0 @ 38wga presents to the office for follow up after a visit to Labor and Delivery over the weekend.

• Guilt, shame, panic, anger, loss, sadness, ignorance, responsibility

THERE IS NO PLACE FOR MISTAKES IN MODERN MEDICINE

• “Doctors are only human”, but modern medicine has created an expectation of perfection. 1

ERROR IS SEEN AS AN ANOMALY, FOR WHICH THE SOLUTION IS TO PLACE BLAME

• Response to harmful and fatal medical errors tend to be ones of punishment and isolation. 3

• Although patients are the first and obvious victims of medical mistakes, doctors are wounded by the same errors. 1

REASSURANCE FROM COLLEAGUES IS GRUDGING OR QUALIFIED

• Do we face guilt through confession, restitution, and absolution?

• Are these allowed or discouraged?

• In the absence of healing, do physicians find dysfunctional ways to protect themselves?

• Do they feel wounded, lose their nerve, burn out, or turn to alcohol or drugs?

WHAT CAN THIS DO TO A PHYSICIAN?

• Question your decisions

• Treatments are no longer logical

• Order more tests, spend less time with patients

• Can lead to more poor patient outcomes

• Burn out

• Relationships deteriorate

• Drug and alcohol abuse

• Suicide

FESTER, that’s what

MANY FEEL ABANDONED

• In 2011, a 50yo nurse made a medical error that led to an overdose of calcium chloride and death of a critically ill infant

• The nurse was terminated after 27 years of service

• The nurse was fined and put on 4-year probation

• Despite her accomplishments, certifications, and continued efforts to expand her skills, she was unable to produce job offers

• 7 months later the nurse committed suicide 3

EMOTIONAL IMPACT OF MEDICAL ERRORS 2

• 61% had greater anxiety about making future medical errors

• 44% had loss of confidence

• 42% had trouble sleeping

• 42% were less satisfied with their job

KUBLER-ROSS STAGES • 1. Chaos and event repair

• 2. Intrusive thoughts

• 3. Restoring personal identity

• 4. Enduring the inquisition

• 5. Ongoing emotional first aid

• 6. Moving on or dropping out/or thriving

WHAT SHOULD WE DO?

RECOGNIZE

• Risk Factors

• High severity of morbidity or mortality

• Degree of personal responsibility

• Change in person’s normal behavior

• Late to work

• On edge, irritability

• Change in practice patterns

• Cynicism or sarcasm

• Change in sleeping or eating

• Loss of personal hygiene

• Loss of confidence 2

YOU ARE NOT ALONE

• It is not a sign of weakness to be a second victim

• Perhaps the characteristics that make you a sensitive and reflective physician make you susceptible to injury from mistakes

• Do not minimize the importance of the mistake

• Disclosing your own experience to reduce the colleague’s sense of isolation

• Acknowledge the emotional impact

NO LONGER SUFFER IN SILENCE

• Change the current culture of isolation and punishment

• Provide accessible and effective support

• Five Rights of Second Victims 3

• 1. Treatment that is just

• 2. Respect

• 3. Understanding and compassion

• 4. Supportive care

• 5. Transparency and opportunity to contribute

EXAMPLES

• University of Missouri Health System Second Victim Program

• OB Hospitalist Group CARE program

• Johns Hopkins Hospital RISE program

• https://www.youtube.com/watch?v=sY1uDmYyQGM#action=share

• What resources do we have?

REFERENCES

• 1. A. Wu. Medical Error: The Second Victim. BMJ. 2000.

• 2. T. Haelle. The Second Victim: Recognizing and Providing Support. OB.GYN. News. Sept 2018. Vol 53.

• 3. M. Grissinger. Too Many Abandon the “Second Victims” of Medical Errors. Pharmacy and Therapeutics. Sept 2014.