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Supporting the second victim of an adverse healthcare event


Sara Bird


21/12/2017 2:35:48 PM

Healthcare providers can also be victims in the case of an adverse patient event.

News teaser
A second victim is generally defined as a healthcare provider who is traumatised following an unanticipated adverse patient event.

One of your colleagues, Dr Simon,* calls you on a Friday afternoon to say he has just received a letter from the Australian Health Practitioner Regulation Agency (AHPRA). Enclosed with the AHPRA correspondence is a long letter from a patient complaining that Dr Simon had failed to diagnose her breast cancer and she is now terminally ill.
 
Dr Simon had been distraught when the patient was first diagnosed with breast cancer, especially since he felt he had not appropriately followed up her concerns about symptoms while she was breastfeeding. The receipt of the letter from AHPRA has now increased his distress.
 
What can you do to help your colleague?
The term ‘second victim’ was coined by American physician Prof Albert Wu in 2000.1 A second victim is a healthcare provider who is involved in an unanticipated adverse patient event, in a medical error and/or a patient-related injury, and becomes victimised in the sense that the provider is traumatised by the event.
 
These individuals frequently feel personally responsible for the patient outcome and many feel as though they have failed the patient, second-guessing their clinical skills and knowledge base.2
 
Doctors’ initial reactions to adverse patient events often include numbness, detachment, distress, confusion, anxiety, grief and depression, withdrawal or agitation, and re-experiencing the event. Added symptoms that are related to medical errors include shame, guilt, anger, self-doubt and loss of confidence.3 Difficulty concentrating is also common, and the doctor may be significantly impaired in performing their usual role. The symptoms may last from days to several weeks.
 
Some doctors go on to experience more long-term consequences, such as flashbacks, avoidance of situations associated with the trauma and increased arousal, including sleep disturbance and irritability. Some doctors even consider leaving the profession.
 
Doctors who are involved in a complaint or other medico-legal issue can also experience significant morbidity. A UK survey revealed that:4

  • 16.9% of doctors with a current/recent complaint reported moderate–severe depression, compared to 9.5% of doctors with no complaints
  • 15% of doctors with a current/recent complaint reported moderate–severe anxiety, compared to 7.3% of doctors with no complaints
  • doctors with a current/recent complaint were 2.08 times more likely to report thoughts of self-harm or suicidal ideation.
Assisting a colleague after an adverse event and/or complaint
Healthcare peers are the most important and popular source of support after an adverse patient event.5 Strategies for assisting a colleague include:
  • encouraging a description of what occurred
  • beginning by accepting the assessment
  • not minimising the importance of the event
  • acknowledging the emotional impact of the event, ie ‘This must be very difficult for you. How are you doing?’
  • assisting the colleague in identifying other forms of support.
Other forms of support include contacting a medical defence organisation (MDO) for advice about how to deal with the letter from AHPRA. It is often useful for doctors who are dealing with an adverse event or complaint to consult with their treating GP, and doctors should avoid self-diagnosis and treatment. Other support resources include the Doctors’ Health Advisory Service and the RACGP’s GP Support Program.
 
Postscript
In this case, you encouraged Dr Simon to describe his concerns and feelings, and recommended that he contact his MDO as soon as possible for advice on how to respond to the letter from AHPRA. You also suggested that he make an appointment to see his GP. You regularly followed up with Dr Simon every couple of weeks to ask how he was going, continuing to do so until the AHPRA complaint was resolved seven months later.
 
* This case is fictitious.
 
This article is provided by MDA National. They recommend that you contact your indemnity provider if you need specific advice in relation to your insurance policy.



AHPRA Australian-Health-Practitioner-Regulation-Agency second-vicitim





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