How Does Second Victim Syndrome Affect (veterinary) Surgeons?

 

This is reprinted from a human medical publication. IMHO it is just as applicable to vets. It's a longish read but well worth it.

How Does Second Victim Syndrome Affect Surgeons?

Joël Pitre, Dr|04 April 2024

Second victim syndrome (SVS) refers to the trauma experienced by a healthcare provider following a medical complication or error. It is estimated that nearly 50% of healthcare providers will face this syndrome at least once in their career. Moreover, as much as 20% of hospitalized patients may experience a complication. Some specialties are particularly exposed to SVS, including surgery, obstetrics and gynecology.

Most published research does not focus on surgical specialties, even though surgeons face stressful situations and technical challenges daily, making them particularly susceptible to SVS. Strength and emotional control are part of the typical surgeon stereotype. Consequently, the occurrence of a surgical complication is most often approached only from a technical standpoint without accepting its emotional consequences.

A Study Involving 13 Publications

An analysis, conducted by a team from Singapore, examined published data on SVS in surgical settings. Thirteen qualitative studies, either cross-sectional or in the form of semistructured interview reports, were selected. The studies were conducted in the United States, the United Kingdom, Canada, and France. The analysis focused on a cohort of 1069 surgeons from various specialties. The psychological, physical, and professional impacts of SVS were distinguished, as were the factors affecting the response to the causal event.

Psychologically, the most frequently described negative feelings were guilt, depression, anxiety, frustration, and embarrassment. These feelings had social, personal, and professional repercussions, including self-restriction of leisure activities and insomnia. Most of these negative feelings lasted between 1 week and 1 month after the causal event and were more pronounced in female surgeons and those in aesthetic surgery.

Negative Feelings

Guilt was the most commonly expressed feeling (18.1%-89.1%), because of the unique relationship that surgeons have with patients, primarily based on responsibility. Guilt was more pronounced in cases of patient death, especially among practitioners with close relationships with their patients and families. It was also the most persistent negative feeling, sometimes with intense reminiscences about complications encountered in the past and amnesia of names, families, and faces. Guilt often coincided with depressive symptoms, which affected between 12.5% and 52% of surgeons according to studies. Anxiety (18.1%-66%) was also frequently described as disturbing, invasive, and restless. It was often associated with anger and frustration and sometimes manifested as rudeness toward patients or the operating room team. Beyond provoking negative feelings, an error or the occurrence of a complication affected judgment and self-confidence, leading to rumination, analysis, and questioning of what could have prevented the complication. This reaction could sometimes result in excessively cautious attitudes that affect performance, with shifts to other specialties or even early retirement. For some, SVS manifested physically as headaches, weight fluctuations, nausea, abdominal pain, and palpitations. However, these symptoms were often short-lived.

Professional Impact

SVS impaired professional performance, led to avoidance behaviors, and often had medical-legal or disciplinary implications. Most surgeons believed that their professional behavior had not been optimal, and this judgment frequently resulted in the cessation of certain activities or types of interventions, with this conservative attitude sometimes to the detriment of patients.

Similarly, surgeons became more meticulous in maintaining medical records and tracing consent. More generally, surgeons were concerned about their reputation and suffered from professional dissatisfaction, especially given the prevalent criticism and condemnation in this highly competitive environment. The perception of a lack of support from peers was amplified by the absence of support from hospital institutions, with the fear of seeing their positions (including accreditation and salary) questioned.

However, surgical complications could sometimes be beneficial because they forced surgeons to rethink and reflect on their roles, as well as that of their service and institutions. On an individual level, some surgeons said that they became more cautious, more vigilant, and better understood safety issues. At the service and institutional level, improvements were noted in procedures (such as computerized records), protocols (such as checklists, timeouts, and equipment checks), and communication with administration.

Predictors of SVS

The factors influencing the reaction to a surgical complication depended on the circumstances and nature of the complication, the surgeon's personality, and the assistance received. A complication was better received if the patient was older, had comorbidities, or had an unexpected anatomical problem than it was if it occurred in a young, healthy individual. A complication following emergency surgery was more easily tolerated than one after a scheduled intervention. Conversely, a perioperative complication, due to a judgment error or technical problem, was very poorly received. This was also the case for certain events (such as death, infection, hemorrhage, anastomotic fistula, or unintentional injury) or sequelae (such as amputation or paralysis).

The individual response depended on personality and experience, which, while helpful, also exacerbated responsibility. Different personality types were observed within the cohort. Some were very close to their patients (showing, eg, empathy, listening, and meeting expectations). Others isolated themselves, repressed their emotions, moved forward, and tried not to be distracted in their future decisions. Conversely, others completely collapsed after the complication. Finally, another approach was observed with reassurance and rationalization regarding complications being part of the job, being necessarily multifactorial, and requiring time and self-work.

Culture of Blame

This range of responses contributed to the variability in the intensity of SVS. Participants in these studies admitted their lack of skills to manage complications from a nontechnical point of view. Younger individuals highlighted their isolation in this area and the lack of or poor quality of training. In this competitive and reportedly unsympathetic environment marked by easy criticism, morbidity and mortality reviews (MMR) were experienced by some as an opportunity for public blame instead of a source of learning and improvement.

As a result, surgeons remained on the defensive, cutting the dialogue short. Even if the atmosphere could be constructive, the debate was mainly focused on technical issues rather than on psychological consequences. Finally, the lack of administrative support was emphasized, contributing to this culture of blame, with mainly punitive responses and without analysis of the underlying systemic causes.

Many practitioners would have liked standardized help in the form of a break from their activities, discussions with colleagues to facilitate communication with patients, and formal psychological assistance. When this type of help was standardized, the atmosphere during MMR was much calmer. Exchanges with colleagues were by far considered the most effective help (81%), especially for younger individuals. Many would have liked to stop for a while, but very few did, getting back on track immediately after the event.

A Change in Culture

This study contradicts the stereotype of surgeons being in control of their emotions. On the contrary, they can be affected by feelings of guilt, depression, and self-questioning after a complication. These negative ideas can cause burnout, post traumatic shock, and even suicidal thoughts. A recent study of 622 academic surgeons, experienced or in training, showed that 15.9% were currently depressed and 13.2% had had suicidal thoughts in the past year. These destructive phenomena are self-perpetuating, and medical errors are clearly associated with depression, anxiety, post traumatic shock, alcohol consumption, and burnout.

The authors advocate not only for information and programs focused on SVS in training but also for a change in culture within the surgical environment. This change could benefit from the feminisation of surgical specialties because this study and other research show that female doctors (like junior doctors) are not only more prone to SVS but also more open to exchanges and assistance from their peers and the institution. Note that quantitative studies are susceptible to inherent bias, either by over- or under reporting, which can affect the evaluation of the prevalence and impact of SVS.

This story was translated from JIM, which is part of the Medscape professional network, using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.

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