Intended for healthcare professionals

Letters Supporting clinicians after medical error

Supporting “second victims” is a system-wide responsibility

BMJ 2015; 350 doi: (Published 06 May 2015) Cite this as: BMJ 2015;350:h2341
  1. Kevin Stewart, clinical director, clinical effectiveness and evaluation unit1,
  2. Rebecca Lawton, professor, psychology of healthcare2,
  3. Reema Harrison, research fellow3
  1. 1Clinical Standards Department, Royal College of Physicians, London NW1 4LE, UK
  2. 2University of Leeds and Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
  3. 3School of Public Health, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
  1. kevin.stewart{at}

The “second victim” phenomenon—the inability of clinicians to cope with their emotions after a medical error or adverse event—can be devastating for the clinician affected.1 It also has implications for patient safety and safety culture, so responsibility for dealing with it goes beyond individual clinicians.

Second victim experiences are worse if clinicians have negative experiences of investigations or feel that they were dealt with in a punitive manner; these doctors become less likely to report future incidents and, if senior, their attitudes will influence the behaviour of junior staff.2

A Royal College of Physicians survey of 1755 senior physicians reinforces previous findings.3 Most physicians had been involved in serious adverse events and most had experienced second victim effects; 60-75% described sleep disturbance, anxiety, or stress and a small but significant proportion described effects similar to post-traumatic stress disorder. Although most had used formal incident reporting systems only a minority described useful learning; 25% were involved in incidents that they knew they should have reported but didn’t. Factors contributing to this included a belief that nothing would change, fear of punitive action, and the psychological effects of having been involved in a previous event.

Most physicians turn to friends and colleagues for support because only 5% have a formal mentor. However, 80% describe a determination to improve as a result of an adverse event, suggesting that in the right circumstances they could be engaged in a learning process.

A transparent NHS safety culture will be achieved only if we recognise and address the second victim phenomenon.4 This is more than “clinicians unable to cope with their emotions after a medical error,” although we recognise the importance of providing support, including mentoring to individuals. Because the attitude and behaviour of policy makers, regulators, and other external bodies can be part of the problem, these bodies must also be part of the solution.


Cite this as: BMJ 2015;350:h2341



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