Docs/Nurses are Victims: Response to British Medical Journal Editorial on "Second Victims"



Last week three prominent patient safety advocates (Helen Haskell, Carol Hemmelgarn, and Patty Skolnik) along with a University of Kentucky Professor (Melissa Clarkson) authored an editorial for the British Medical Journal titled, "Abandon the term 'second victim.'"   Here is the article.  Please draw your own conclusions.  I will briefly summarize the article here -- I hope I am fair and accurate -- and then provide my own feelings. 

First, I have met Helen, Carol, and Patty.  In fact, Helen and her husband were some of the first people I met when launching Sorry Works! over 14 years ago.  These three women are outstanding individuals who have done impactful work in memory of their children who were taken by medical errors.  They are good people, and I am sure Professor Clarkson (whom I have not met) is an equally good person.   

The editorial encourages the medical community to stop using the term "second victim" to describe physicians, nurses, and other healthcare professionals who have been involved in medical errors.  The editorial cites a number of reasons, including the term minimizes the suffering by consumers (the "first victims"), can be offensive to patients and families who suffered errors, and by placing the victim title on doctors and nurses possibly lessens the chances of consumers receiving answers, apologies, fair compensation, and other forms of accountability and reconciliation following medical errors.  There is a strong voice in the editorial that sounds like, "We the authors have buried family members due to medical errors, we don't like the term 'second victim,' so please stop."   Again, I hope and pray I am being fair in my summary.  Also, I open this space to the authors if they wish to offer a rebuttal, including correcting any errors I made, or just to further this important discussion....

My feelings....I too buried a family member due to medical errors, and also had another family member seriously injured by medical errors.  I understand this pain. I had a lot of anger when I began Sorry Works! over 14 years ago.  There was a lot of anger and grief in my earlier writings and speeches and it was directed squarely at the medical community that inflected harm on my family and -- along with the insurers and lawyers -- didn't have the integrity to be accountable.   

As I continued my work in Sorry Works! my eyes were opened and my heart softened. I began to see doctors and nurses as human beings, and learned how they suffered sometimes worse than consumers when things go wrong.  Doctors and nurses quitting or retiring early, family problems (divorce, abuse), and even suicide because all too often they are not given proper emotional support post-event.  I also learned that no doctor or nurse tries to harm patients.  Sure, there are some very incompetent and sloppy clinicians, but even those folks try to do good every day.  Lastly, I have met and spoken with thousands of doctors and nurses who have no clue what to say or do post-event, and too often tell horror stories of unethical and even threatening advice from lawyers, claims managers, and others...

I firmly believe that doctors and nurses are victimized by the curriculum of medical and nursing schools that still do not adequately teach them how to communicate and function post-event. In fact, we all know that for a long time schools and residency programs instructed young clinicians never to say "sorry" or talk post-event.  Thankfully, those days are in the rear view mirror, but most communication and empathy training for young clinicians is still not adequate. 

I firmly believe that doctors and nurses have been and continue to be victimized by some lawyers, claims managers, and insurers who insist on unethical behavior post-event. Clinicians have been and continue to be powerless to "do the right thing" when they feel threatened by lawyers and others...

I firmly believe doctors and nurses are victims because they are set up by poor training and unethical legal and claims advice while receiving no emotional support. They are victimized by a system that has failed them and still needs much reform....

Now, I think the authors and I can agree that victim is an overused term, at least in American society, and it can be as an excuse to do nothing or exhibit other negative behaviors.  When dealt a bad hand in life you can lay down and die or rise up and fight.  I believe there are many doctors and nurses who know they are the victims of a bad system, but do want change.  More and more clinicians are embracing disclosure & apology, but part of this embrace is asking for the support offered by 2nd victim programs.  They want help, and, in my experience, they do embrace the term "second victim." The authors cite a focus group study from Ireland to make the claim docs don't like the term "second victim" ---  one small study outside the US is hardly a consensus or even representative of our situation here in the States.  That citation was a stretch....  

I think the authors are correct to worry about the continued lack of accountability for injured patients and families, but I believe the worry is better placed by looking at lawyers, claims managers, and C-suite execs who are still too content to sit back and do nothing when something goes wrong.  Their angst over 2nd victim terminology is, I believe, misplaced when it comes to the issue of accountability.   

Moreover, I hope the authors can agree with me that we must address the language and behavior of some patient safety advocates, HR executives, politicians, and even prosecutors who want to strongly punish and shame doctors and nurses for making mistakes.  If this "gotcha" chorus is not tamped down then we will revert to the days of complete deny and defend....this is a real threat. 

Lastly, we need to do more work integrating disclosure programs and 2nd victim support programs.  Too often healthcare organizations have one or the other, but not both together.  The good news is the skill sets required by disclosure and 2nd victim are mostly the same, but it will take work to make it happen.  I would rather spend energy in this vein versus debating word choices and attempting a re-branding campaign.  

Again, I offer this forum to the authors if they wish to respond and continue the discussion.

Sincerely, 

- Doug   

Doug Wojcieszak, Founder, Sorry Works!
618-559-8168 (direct dial)
doug@sorryworks.net (direct e-mail)