The Second Victim

I recently had at work what we call an "adverse event". These are cases where something goes poorly, either because of an error, or just the natural progression of disease, but everyone feels it. A kid is very sick, or passes away, or is harmed in some way, and it shakes all of us out of our happy pediatric comfort zone. I obviously can't go into details, because HIPAA, but it hit home for me a concept that I wanted to share.

In 1999, when the Institute of Medicine published their famous (infamous?) "To Err is Human", detailing the widespread prevalence and effects of medical errors, a brave physician from Johns Hopkins thought to go one step further. In his sentinel paper, "Medical Error: The Second Victim", Albert Wu outlined the idea that medical errors, and all adverse patient events, harm more than just the patient and their families. He observed that "although patients are the first and obvious victims of medical mistakes, doctors are wounded by the same errors: they are the second victim".

I can feel the cynicism rising up right now: How can doctors even compare their "suffering" to a patient death? Shouldn't they feel bad if they've done something wrong? Shouldn't we focus on the medical errors and stopping them instead of telling doctors "it's okay" after they mess up?

Those are all valid questions, and the answers to the last two are surely "yes", but that's not the whole story. Second victims have symptoms very similar to PTSD, experience higher rates of depression and burnout, and can have impaired performance due to maladaptive coping behaviors, decreased confidence, or fear of making a further mistake. I will attest that these are not theoretical; they are very real. And I think we can all agree that if we can avoid these effects, that's a win.

We are about to launch our own Peer to Peer Support Network at work to help second victims, and this experience has taught me a lot of things that I hope to carry forward..

I've learned that adverse events are going to happen, and that we all make mistakes. Let me repeat that: We all make mistakes. It just so happens that in our job, mistakes can range from forgetting to bring someone a blanket to causing a death, and that's terrifying. We make hundreds of decisions every day in a very stressful environment. We set up our systems to try to prevent as many errors as possible, but you can't remove the human element. We have to learn from our mistakes instead of letting them cripple us.

I've learned that I work with amazing people. One of the nurses I work with found out I was upset about the patient and said, without hesitation, "You know we all stand behind you because we know the kind of doctor you are." The other doctors, who had every right to critique the situation, instead offered their support and acknowledgement that our jobs are very difficult and we all have these days. It makes all the difference in the world to be able to have that support at work, which makes me excited to train as a peer supporter.

I've learned it's important to take a deep breath and remember why we do this. It can be so easy to get caught up in a busy day and miss the small details, miss the opportunities to really meet our patients where they are and be part of that encounter. Yesterday, with this fresh on my mind, I spend a few extra minutes in each room, talking to families, being thorough, not letting the 18 patients in the waiting room get to me. And I could feel it make a difference. I was a better doctor because of it. Hitting that reset button every now and then, without waiting for an adverse event, is crucial.


Finally, I've been reminded that I'm not doing this of my own accord. God called me to this profession, has given me the things I need to succeed, and can decide what to do with me from here on out. And that's okay. I don't have to be perfect, because He is. He is bigger than the adverse events, than the mistakes, than the bad outcomes. He also cares for His children and gives us the tools we need to move forward if we let Him.

Those who are healthy

Working in urgent care and emergency rooms, we see whatever walks through the door. That means whatever. It means the 64-year-old with appendicitis (yes, at the Children's ER), the 8-year-old who ran over his ankle with a motorized scooter and has severed nerves and blood vessels, and the toddler who had a black marker stain on his foot. At one in the morning. True story.

In the midst of all the real emergencies, it's so easy to become cynical towards the families bringing their kids in with marker stains (and trust me, it happens WAY more often than you would think!). It's so easy to judge parents, grandparents, foster parents who I think should know when to bring their kid in and when it's okay to watch at home. I get frustrated that after motrin, a popsicle, and a sticker, they look just peachy and ready to go home.

Then I read in the Gospel of Luke about the call of Levi, where Jesus tells the similarly judgmental Pharisees that "Those who are healthy do not need a physician, but the sick do." Can you see the 2x4 shaped mark on my head? Obviously no one wants to bring their kid to the Urgent Care at three in the morning. No one wants their kid to be crying and sick and miserable. They came because they need a physician. Even if all that physician needs to do is reassure them, give their kid a popsicle, and tell them what to expect for the next few days. Even if all that physician needs to do is check for an ear infection, eyeball a rash, or, yes, clean off the marker stain with an alcohol wipe.

And what a privilege it should be to treat those kids. What a privilege it should be to offer a little bit of hope, help, or healing. No matter what.

The last few days I've tried to remember that as I walk into my shift, to bring compassion to every patient, not just the ones who I think are sick enough to see me. After all, they wouldn't be there if they didn't need something.