“Things went poorly for this newborn with a complex congenital anomaly, and I felt entirely responsible due to my decision,” says Steven Stylianos, Professor and Chief of the Division of Pediatric Surgery and Surgeon-in-Chief of the Bristol-Myers Squibb Children’s Hospital. Despite the tragic outcome, he remained personally involved in the infant’s care, speaking with the parents daily until the baby passed away. 

In 2000, the Institute of Medicine released To Err is Human: Building a Safer Health System, a book that estimated as many as 98,000 preventable patient deaths each year in the United States due to medical errors. 

The same year, Albert Wu, Professor and General Internist at Johns Hopkins Medicine, coined the term second victim syndrome (SVS) to highlight the lasting effects of medical complications on healthcare professionals. He explains that the term “second victim” reflected his belief that health workers can be “injured by the very same flaws in the healthcare system that cause patient harm.” 

SVS is used to describe the physical, psychological, and emotional impacts experienced by clinicians following their role in medical complications. While patients are recognized as the first victims in a medical complication, SVS acknowledges the suffering of healthcare providers, marked by shame, trauma and guilt because of these incidents. 

Common physical and psychological symptoms include insomnia, guilt, isolation, extreme sadness, depression, flashbacks, and self-doubt. These intense symptoms can lead to burnout, deeply impacting one’s personal and professional trajectories for prolonged periods of time. In fact, a literature review including over 27,000 surgeons revealed that burnout was associated with a 2.5-fold increased risk of medical error, furthering the cycle of pain and trauma.

Additionally, research shows that 50% of healthcare professionals will experience SVS at least once in their careers following involvement in an adverse event. The effects tend to be especially pronounced among surgeons, like Stylianos, whose roles carry higher levels of risk, stress, and complexity. A 2024 study also revealed that, in the aftermath of a surgical error, some surgeons resort to maladaptive coping mechanisms, with 6.5% reporting the use of alcohol and other substances as a means of managing their distress.

Furthermore, the weight of a complication can be exacerbated by an internalized belief among surgeons that the error was entirely their fault. This sense of personal responsibility is often reified within healthcare systems, where such accidents are frequently met with investigations, punishments, or judgments of incompetence. As a result, second victims who suffer in silence often experience a steady decline in job satisfaction, questioning their abilities even to the point of stepping down or quitting medicine entirely.

Wu’s work in describing SVS as a potential issue among healthcare professionals helped recognize the systemic factors that may contribute to medical errors or complications. Recent discussion around SVS is geared towards shifting the blame away from individual clinicians, while also working to reverse the deeply ingrained culture of perfectionism that exists in healthcare systems today. 

While the symptoms of SVS can be substantial, for surgeons and others, it is important to address and treat SVS soon after an adverse event to facilitate better outcomes for  healthcare professionals. Stylianos states, “The most important act to begin healing right after a serious adverse event is speaking with a peer and venting emotions to someone who understands the visceral feelings, someone who is non-judgmental, supportive.”

Peer support has emerged as one of the most effective interventions for helping second victims to cope. In one assessment of a surgery-specific peer support program, 81% of participants reported a positive impact on the culture of safety and support within their department. 

The forYOU team at the University of Missouri, led by Susan Scott, a nurse and professor, offers a confidential peer support network that has gained widespread  recognition and is implemented by many national healthcare institutions. The Scott Three-Tiered Interventional Model of Second Victim Support, outlines a structured progression of care; beginning with departmental mentoring, followed by peer support experts, and concluding with professional counselling. The intervention functions to provide immediate peer guidance by trained colleagues, both within and outside of a clinician’s specific medical unit.

Wu underscores the benefits of such initiatives, suggesting that “Through shared understanding, respect, and mutual empowerment, peer support helps people become and stay engaged in the healing process.” 

– Amanda Fernandes, Contributing Writer

Image Credits: 

Feature Image: Photo by Cedric Fauntleroy on Pexels; Creative Commons

Body Image: Photo by JC Gellidon on Unsplash; Creative Commons

Body Image: Photo by SHVETS production on Pexels; Creative Commons