EXECUTIVE SUMMARY

The practice of calling clinicians the “second victims” in adverse events may be misguided. It could send the wrong message to both clinicians and patients.

  • The term is meant to recognize the emotional impact of adverse events on doctors and nurses.
  • It may run counter to patient safety culture.
  • “Second victim” may cause some healthcare providers to avoid needed assistance.

In the effort to more effectively and humanely address adverse events in healthcare, one common method has been to consider the clinicians involved the “second victims.” But is it time to stop that practice?

This terminology has been used to highlight the effects on clinicians who are part of a patient’s adverse outcome, signifying that in addition to the patient being a victim, the doctor or nurse also can be traumatized. While well meaning, the “second victim” terminology may produce detrimental effects, says Melissa Clarkson, PhD, MDes, MA, assistant professor in the Division of Biomedical Informatics at the University of Kentucky in Lexington.

The intention behind the phrase is legitimate, Clarkson says. She does not doubt that clinicians can suffer greatly after a harm event, and she strongly believes that they deserve recognition and assistance. But the terminology is wrong, she says.

“It became apparent to me over the years that patient advocates are uncomfortable with this term. But at the same time, I was seeing it used more and more and more,” Clarkson says. “Healthcare providers would come out of training sessions about harm events and suddenly they’re using this term all the time.”

Clarkson recalls once questioning the use of the term with a nurse, who countered that it was appropriate and expressed strong beliefs about how nurses were the second victims in tragic circumstances.

“There’s something about that term that puts people in a mindset that leads down a path that is not consistent with patient safety,” she says. “I’ve had experiences where doctors or nurses were passionately defending how they are victims, to the point where I said ‘You have taken this to a level that is not appropriate.’”

Those experiences, combined with concerns from patient advocates, led Clarkson to write an editorial for a medical journal questioning the use of “second victim.” The article prompted some strong feedback from readers who thought she was minimizing the potential effect of tragedies on doctors and nurses. (An abstract of the editorial is available online at: https://bit.ly/2TM1ttB.)

Clarkson says the issue is more nuanced than some people think, and that the term comes with more effects than the desired outcome of recognizing healthcare workers’ trauma.

“We’re not saying that healthcare providers should just suck it up and not get help. We’re saying that viewing this through the lens of being a victim may unconsciously remove from the healthcare professional the responsibility for safety,” Clarkson says. “We think of victims of sex trafficking and domestic violence, and with those victims it is not on them to shape the situation they’re in. But with healthcare providers, that term ‘victim’ is just not appropriate.”

The terminology has even expanded to call healthcare organizations the third victim, which Clarkson says is a bad trend. “It’s out of control. People need to take a step back and remember that there is a responsibility in healthcare for patient safety, at the organizational level and the individual level,” she says. “When you bring the concept of victim into that, it messes up that line of responsibility.”

But people who use the term “second victim” are not forgoing all efforts at patient safety. If the term helps some doctors and nurses feel better, then what is the harm? Clarkson says the problem is all in the mindset that it encourages.

“A victim is passive, and we don’t have an expectation that victims address the situation they are in. It’s not their responsibility. We expect society as a whole or someone else to fix the situation that makes them a victim,” she says. “That mentality goes against the culture of patient safety, which encourages people to be proactive and step up.”

Clarkson also says physicians, more so than other clinicians, tend to bristle at the “victim” label. If a care-for-the-caregiver program is promoted as being for second victims, physicians — and any other healthcare professionals who shy away from the term — may be reluctant to attend and get the help they need, she says.

It is not common to call the patient who was harmed the “first victim,” Clarkson notes. That is because the word connotes helplessness and being the subject of someone else’s harmful actions; yet it is acceptable to use the same terminology with healthcare providers, she says.

“We don’t do programs for patients telling them they might be a victim of an error while they’re here in the hospital, and we don’t talk about injured patients as the victims of whatever happened,” Clarkson says. “But we’re educating care providers to see themselves as victims. There’s an incredible disconnect there.”

As an alternative, Clarkson favors plain terminology such as “physician involved in a harm event” or “nurse involved with an error.” Others have suggested the term “traumatized caregiver,” which she says may sound extreme but still is better than “second victim.”

“There are different options and they all can work as long as you’re not using the victim terminology,” Clarkson says. “It’s not appropriate to teach people to see themselves as victims when they actually are responsible for ensuring patient safety.”

SOURCE

  • Melissa Clarkson, PhD, MDes, MA, Assistant Professor, Division of Biomedical Informatics, University of Kentucky, Lexington. Phone: (859) 323-7232. Email: mclarkson@uky.edu.