COMMENTARY

No, Doctors Who Make Errors Are Not 'Second Victims'

Arthur L. Caplan, PhD

Disclosures

April 25, 2019

The Lingering Toll of Medical Errors on Physicians

Recent studies have shown that medical errors take a bitter toll on the clinicians who were involved in making those errors. In a survey of more than 3000 physicians in the United States and Canada, 92% reported previous involvement in events ranging from near misses to serious errors.

Physicians reported significant emotional distress resulting from their error, including loss of confidence in their professional skills, insomnia, and decreased job satisfaction. Fully 81% reported some degree of job-related stress linked to the event.

I have no doubt that clinicians involved in errors suffer and require support. But I do not agree with emerging arguments that we refer to those stressed by committing errors as "second victims."

The notion of the "second victim" has been gaining momentum within the medical field. An article in the May issue of the Annals of Surgery talked about the emotional harm and the damage done to the mental health of physicians involved in the "second victim phenomenon," in which clinicians who made an error that led to a patient's death or permanent injury are struggling with grief, regret, and guilt.

A victim is someone who is harmed but who is powerless to prevent that harm. You do not become a victim just by suffering or being stressed. When medical error occurs, responsibility must be assessed and assigned. Talk of victimhood is neither appropriate nor the best route to preventing further problems.

Steps to Reduce Error 'Victims'

Medical errors are the third leading cause of death in America trailing only heart disease and cancer. A 2018 Johns Hopkins study found that 250,000 people die every year in the United States owing to errors and mistakes. They noted that on the basis of a total of 35,416,020 hospitalizations, there was a pooled incidence rate of 251,454 deaths per year. That means that more than 9% of all deaths are caused by medical errors.

The number, incredibly, may actually be higher because physicians, funeral directors, coroners, and medical examiners do not always note on death certificates that human errors and system failures were involved in deaths. Yet, death certificates are what the Centers for Disease Control and Prevention rely on in compiling statistics for causes of hospital deaths.

Some progress is being made in both reforming systems to emphasize and increase safety and in dealing with patients who are harmed or killed.

Many states have enacted apology laws. These permit doctors and hospitals to explain to victims and their loved ones why and how they caused an injury during treatment without that disclosure becoming evidence in a legal case. "Early resolution" programs that combine apology, explanation, correction, and compensation also help victims. Developed nearly 20 years ago at the University of Michigan and Emory University, they try to help victims by giving a comprehensive resolution when deaths and injuries due to medical errors occur.

Any patient can be the victim of medical error. Any clinician can be involved in both culpable and nonculpable mistakes. But the road to fixing an unsafe system does not require making everyone involved a victim. Sure, support clinicians who are struggling with guilt or regret by all means, but let's demand long-overdue change from those in charge so that safety become a priority that makes the actual victims of error a rarity.

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