Abstract
OBJECTIVES: Second victim syndrome refers to the negative mental and emotional after-effects physicians may experience after adverse patient outcomes. We evaluated the impact of second victim status on physician self-efficacy, burnout, perceived stress, and sleep patterns.
METHODS: Physicians at a university hospital voluntarily participated in an anonymous, survey which included second victim status, General Self-Efficacy Scale (GSE), Copenhagen Burnout Inventory (CBI), Perceived Stress Scale (PSS), and Insomnia Severity Index. The total possible survey points were: GSE, 40; CBI, 95; PSS, 40; and Insomnia Severity Index, 28. The Student t test for independent samples and Mantel-Haenszel were used to compare second victim with nonsecond victims.
RESULTS: Of the 115 respondents, 85 (74%) provided second victim status: 48% female, 93% non-Hispanic White, 35% surgeons, and 53% in practice for more than 20 years. There were 24 (28%) self-reported second victims. Demographics were similar between groups. GSE scores were comparable: second victim versus nonsecond victim: 31.4 vs 32.6 (P = .13), but fewer second victims reported that they could accomplish their goals (79.2 vs 88.7%; P = .03). Overall, 56% of physicians had CBI scores consistent with moderate burnout. Mean CBI scores were similar for both groups 56.6 vs 52.4; P = .17). Work-related burnout (22.9 vs 21.9; P = .44) and personal burnout (18.9 vs 17.3; P = .17) were comparable, but second victims more commonly reported patient-related burnout (15.3 vs 12.9; P = .039). Second victims responded often or always more frequently to questions regarding patients being hard to work with (8.3% vs 1.6%; P = .03), frustrating (12.5% vs 3.3%; P = .02), draining energy (16.7% vs 5%; P = .018), or wondering how long they could continue to work with patients (16.7% vs 11.5%; P = .039). There was no difference in mean PSS for lack of control (11.7 vs 10.5; P = .28) or ability to cope with existing stressors (10.0 vs 10.6; P = .34). Mean insomnia scores were comparable (9.4 vs 7.7; P = .22), but second victims experienced problems with waking too early more often (29.2% vs 14.5%; P = .01). Official debriefing and individualized counseling or coaching to cope with the event were top resources desired by second victims (54%). Mandatory time off or mandatory meetings with a psychiatrist or psychologist were least favored (8%).
CONCLUSIONS: More than 25% of physicians have experienced second victim sequalae, which do not distinguish by demographics. Despite high-level GSE, moderate burnout was present in more than 50% of physicians, irrespective of second victim status. Patient-related burnout was particularly evident among second victims. These numbers are alarming and should be addressed promptly by medical societies and hospitals. A valuable starting point may be offering individualized counseling for all physicians.
