In the pursuit of improved patient safety, healthcare authorities have employed various strategies to increase learning and reduce the number and impact of medical errors. Irrespective of the institutional and organizational measures to prevent future medical errors or adverse events, the individual healthcare professional is faced with the predicament of being unable to undo what has been done, when a patient has suffered severe injury or death.

In 2000, Albert Wu coined the term ‘second victim’ to describe healthcare professionals involved in adverse patient events, medical errors and/or patient related injuries.¹ An abundance of research papers has explored the second victim phenomenon and demonstrated increased risk of burnout, distress, depression, anxiety, guilt, PTSD, troubling memories, and fear of future errors.² It has been suggested that these emotional, cognitive and behavioral reactions in the aftermath of adverse events may be linked to the higher risk of substance abuse and suicide among physicians compared to the general population.³ Currently, only few organisations provide formalised support for second victims.

While medical sociologists have explained the inherently fallible nature of medicine in the 1970’ies,⁴ healthcare professionals may experience that there is little or no place for mistakes in modern medicine embedded in a society with increased expectations of infallibility and perfection. Defensive medicine is commonly defined as a deviation from standard medical practice due to fear of malpractice liability claims. Based on some of my research on second victims,^5–7 this article will argue that healthcare professionals may adopt a defensive assurance behaviour in clinical practice by prescribing more diagnostic tests and medical treatment. Not only to avoid malpractice suits or complaint cases, but as a self-protective mechanism at a deeper psychological and existential level. It is proposed that a means to mitigate overdiagnosis is understanding how this self-protection may be a key driver for the individual healthcare professional, and that healthcare organisations and educational institutions should provide second victim support programs.

References

1. Wu AW. Medical error: the second victim. The doctor who makes the mistake needs help too. Bmj. 2000;320(7237):726-7.

2. Busch IM, Moretti F, et al. Psychological and psychosomatic symptoms of second victims of adverse events: a systematic review and meta-analysis. Journal of Patient Safety. 2020;16(2):e61-e74.

3. Gazoni FM, Durieux ME, et al. Life after death: the aftermath of perioperative catastrophes. Anesthesia and Analgesia. 2008;107(2):591-600.

4. Gorovitz S, MacIntyre A. Toward a theory of medical fallibility. The Hastings Center Report. 1975;5(6):13-23.

5. Schrøder K, La Cour, et al. Guilt without fault: a qualitative study into the ethics of forgiveness after traumatic childbirth. Social Science & Medicine. 2017;176:14-20.

6. Schrøder K, Janssens A, et al. Adverse events as transitional markers - Using liminality to understand experiences of second victims. Social Science & Medicine. 2021;268:113598.

7. Schrøder K, Jorgensen JS, et al. Blame and guilt - a mixed methods study of obstetricians’ and midwives’ experiences and existential considerations after involvement in traumatic childbirth. Acta Obstetricia et Gynecologica Scandinavica. 2016;95(7):735-45.