Medical complications or errors are part of the medical practice of all surgeons. Complications happened yesterday, happen today, and will happen tomorrow. We can reduce them, but we cannot erase them. Twenty percent of hospitalized patients will suffer from a medical complication. Society must accept this. Patients must know that when they accept a procedure, they accept its possible complications. Nobody can run from that. Are the patients the only victims of those complications?
When complications/errors occur, surgeons and peers tend to address the complication only from a technical perspective. What was the technical error or bad decision that caused the complication? Which factors caused the error or bad decision? How can we technically avoid that same complication in the future? What were the consequences for the patient? Are there any legal issues? These are the only frequently asked questions.
Because surgeons believe and are believed to be psychologically strong, nobody cares about which consequences a surgeon faces after a medical complication or error. A surgeon does suffer after a complication from one of his procedures. The trauma a healthcare professional can experience after a medical complication or error is the Second Victim Syndrome. Surgeons are at high risk of it.
A publication from Dr. Joël Pitre in Medscape (April 2024) states that Second Victim Syndrome can cause shame, guilt, anxiety, depression, lack of empathy, burnout, and posttraumatic stress, along with social and physical consequences. About 50% of healthcare professionals will experience Second Victim Syndrome at least once during their career. Guilt (18.1%-89.1%) and depression (12.5% - 52%) were the most frequently reported feelings and symptoms, especially in cases of a patient’s death, and close relationship with the patient and relatives. These feelings were usually associated with anxiety, frustration, and rudeness with the operation room team. One important and negative consequence of the Second Victim Syndrome is the professional impact. Some surgeons will start doubting their capabilities and skills, will have their performance affected, will stop performing some activities and types of interventions, and even early retirement. Dr. Joël Pitre says that this attitude is sometimes detrimental to patients. According to some surgeons, the lack of support from peers and hospital institutions amplified the negative feelings. However, many say that they become more vigilant, and cautious, and started spending more time on patient consent after a complication.
Reaction to a complication or error was influenced by the circumstances and nature of the complication, the surgeon’s personality (some move forward but others collapse), and assistance received. Without surprise, complications were better tolerated if the patient was older and with comorbidities, and after emergency surgery. The author points out the culture of blame within the surgery environment with easy criticism as negative. Many say that the constant morbidity and mortality reviews are presented as an opportunity to point the finger at the responsible instead of an opportunity to learn and change future decisions and procedures. Additionally, administration boards prefer punitive actions, instead of understanding and changing institutional causes for complications and errors (e.g. lack of adequate instruments and devices, unavailability of imaging exams, lack of other specialties, colleagues refusing to evaluate the patient and constantly saying – “that is not my patient”). In fact, after a complication, everybody tends to run away from the responsibility. Institutions must provide surgeons with all the instruments and devices they need to make the best decision and perform surgery in the most safety environment. We all know that the main objective of administrations is to save money, and this is an indirect cause of complications and bad decisions.
This culture of blame makes surgeons behave defensively when the opposite should be promoted in this stressful situation. Because of this culture, medical reports and surgery descriptions are written only after patient discharge by some doctors. This undermines any attempt to improve. An accurate analysis of all the factors contributing to the complication is only possible with an open discussion with peers. Additionally, doctors state that discussion with peers was paramount for overcoming the Second Victim Syndrome. This is the only way to promote changes that can avoid similar errors and complications in the future. If this culture of blame perpetrated by peers and administrations is not eliminated, a positive change will never be possible.
Dr. Joël Pitre ends the article with interesting information. Second Victim Syndrome is associated with burnout and suicidal thoughts among surgeons. A culture of blame, the absence of psychological assistance, and the absence of support from peers and institutions are the reasons. This must stop! “This change could benefit from the feminization of surgical specialties because (…) 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.”
In sum, although with different levels of severity, all surgeons suffer from Second Victim Syndrome. Complications must be addressed from a technical perspective in an out of a guilt environment, to promote changes that can avoid future errors. Psychological assistance and support from peers and institutions are crucial to avoid professional consequences that can ultimately affect the patients (e.g. surgeons refusing to do some procedures).
Surgeons also suffer from their complications and errors. Surgeons are humans, not machines. Surgeons do care about their patients, machines do not.
Link to article:
Joël Pitre. How Does Second Victim Syndrome Affects Surgeons? Medscape, 2024.
Dr. Carlos Eduardo Costa Almeida
General Surgeon