Intended for healthcare professionals

Rapid response to:

Editorials

Supporting clinicians after medical error

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h1982 (Published 15 April 2015) Cite this as: BMJ 2015;350:h1982

Rapid Response:

Must second victims always be in the wrong?

It was with great interest that we read your editorial on “second victims” in this week’s BMJ. The concept of “second victims” as described seems to revolve around medical error and the psychological consequences of these events on the clinician.

The usual duties of a surgeon meet Criterion A of the Diagnostic and Statistical Manual version 5 (DSM 5) [1]for post-traumatic stress disorder (PTSD) and acute stress disorder (ASD). There is an expectation that surgeons will be entirely habituated to this “run of the mill trauma” and that they will continue to deliver care in spite of preceding events.

Specialist training in surgery is known to be a stressful experience [2]in which efficient and accurate learning is key to success. The symptoms of PTSD/ASD disrupt sleep, mood and concentration[1]. Clearly, PTSD/ASD amongst trainees is likely to be harmful to learning.

We agree that future studies should focus on organisational culture as well as the willingness of individuals to access support services. We would argue that waiting for error as a trigger rather than signs of stress, may have the unintended appearance that support is punitive or stigmatising. Using a validated scoring system [3] we aim to understand the prevalence of PTSD/ASD type symptoms within surgical trainees, current approaches to supporting them and their uptake.

This study will take the form of a web based survey, the link for which is below. The results so far have been fascinating. Of 120 respondents 42% report that their training has suffered due to PTSD/ASD symptoms but only 15% have received any support. We would be grateful if any surgical (pan-specialty) trainees reading this rapid response could participate.

www.surveymonkey.com/s/traumasurg

1. American Psychiatric Association DTF. Diagnostic and Statistical Manual of Mental Disorders: DSM 5. 5 ed. Arlington, VA: American Psychiatric Association, 2013.
2. Lazarus A. Traumatized by practice: PTSD in physicians. J Med Pract Manage 2014;30(2):131-4
3. Weiss D, Marmer C. The Impact of Event Scale- Revised. In: Wilson J, Keane T, eds. Assessing Psychological trauma and PTSD: a practitioner's handbook. New York: Guilford Press, 1997:399-411.

Competing interests: No competing interests

20 April 2015
Christopher V Thompson
Specialty Registrar Colorectal Surgery
Mr Nigel Suggett (Consultant Colorectal Surgeon UHB), Miss Jodie Fellows (Principal Clinical Psycologist BSMHFT)
University Hospital Birmingham
Mindelshon way, Birmingham, B15 2GW