Letter to the Editor
Physician's perception as second victim after an error during clinical practice
Percepción del médico como segunda víctima tras un error durante la práctica clínica
a Universitat Internacional de Catalunya (UIC Barcelona), Sant Cugat del Vallés, Barcelona, Spain
b Jefe de Sección de Medicina Interna, Hospital del Mar, Docencia Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
c Jefatura del Servicio de Atención al Ciudadano, Hospital del Mar. Docencia, Universidad Pompeu Fabra, Barcelona, Spain
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Docencia, Universidad Pompeu Fabra, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Percepción del médico como segunda víctima tras un error durante la práctica clínica" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">While practising health care, unforeseen incidents occur that may affect patient safety. Almost one in 10 patients is affected by an adverse event (AE) during their hospitalization period.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The consequences of this fact cause these patients to become the first victims, but they are not the only ones affected. In the year 2000 Albert Wu introduced the term 'second victim'<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> to refer to any health care professional who is involved in an AE, error and/or injury to the patient and who can also become a victim traumatised by the incident.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Attending to these professionals has become a priority for health care authorities, and this is reflected in the 2015–2020 National Strategic Plan showing the importance of providing support to healthcare providers.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In this sense, there are studies that enumerate different stages of care for the second victim. They describe the initial support carried out by the professional's own colleagues, to finally develop a stage in which they can be attended by specialised professionals.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Our intention is to analyse the physician's perception as possible second victims of an error while practising health care, as well as explore the management of the incident. For this, we have conducted a descriptive study using a self-administered <span class="elsevierStyleItalic">on-line</span> survey, sent to the doctors of the Consorci Parc de Salut Mar Hospital (n = 555) during the months of February to June 2018. Of these, 102 professionals replied.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The average profile of the participant is a medical female aged between 31 and 50 years belonging to a medical speciality with more than 3 years of professional experience. 79.4% (81) of the doctors surveyed either experience or have perceived themselves to have been involved in an incident that has affected patient safety.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Medical professionals have a poor perception of the care they receive from the organisation after an AE, since they believe that they are not provided with sufficient support. Specifically, we detected that 41.1% of the participants (42) considered that the hospital does not offer psychological support after an incident. The models of care for the second victim emphasized the need to receive support from their peers, as the first action.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,5</span></a> In our study we found that 52% (53) of the doctors perceive that their team supports them after an event of this nature.</p><p id="par0030" class="elsevierStylePara elsevierViewall">In relation to AE, 64.7% had to inform patients of the error and 55.9% (57) had doubts about the care processes and if the clinical decisions were correct after being involved in the incident. These professionals claim that they have not received enough training on how this communication should be carried out with the patient or their relatives. In addition, 70% of doctors are afraid to face legal consequences arising from the incident (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), although 52% (53) of doctors have not observed an increase in claims in their department after reporting the error.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Finally, feelings of guilt, perception of insecurity, and/or symptomatology compatible with emotional <span class="elsevierStyleItalic">shock</span> are evident in our study. For all these reasons, support for the second victim should be increased from the institution itself, becoming a participant in the solutions, and providing the doctor with tools to be able to provide effective and constructive communication with the patient and their family.</p><p id="par0040" class="elsevierStylePara elsevierViewall">We believe that it would be of great interest to create 'action guidelines' for the care of second victims by the hospital itself, which should be based, among other things, on peer support, as well as emphasising emotional and psychological well-being, because the feelings of guilt and emotional distress in these cases are high. In addition, it would be advisable to enhance training in communication, so as to deal better with these situations.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Financing</span><p id="par0045" class="elsevierStylePara elsevierViewall">This work has been financed by the <span class="elsevierStyleGrantSponsor" id="gs0005">Quality Programme of the Consorci Parc de Salut Mar Hospital</span> in its call for aid of projects to improve the quality of care in 2017.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Financing" ] 1 => array:2 [ "identificador" => "xack457152" "titulo" => "Acknowledgments" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martos C, Gutierrez J, Giraldo P. Percepción del médico como segunda víctima tras un error durante la práctica clínica. Med Clin (Barc). 2020;154:283–284.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="3" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Probability</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">N = 102 \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">High \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Average \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">Low \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Percentage (No.) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Percentage (No.) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Percentage (No.) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Error with severe consequences in the hospital \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38.2 (39) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39.2 (40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22.5 (23) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Error with severe consequences in the department \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.6 (22) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36.3 (37) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41.2 (42) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Apologising after an error \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41.2 (42) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40.2 (41) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18.6 (19) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fear of facing legal consequences \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">69.6 (71) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25.5 (26) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.9 (5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Fear of losing professional prestige \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">58.8 (60) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30.4 (31) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.8 (11) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2270879.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Probability of incident with severe consequences in hospital.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The incidence and nature of in-hospital adverse events: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E.N. De Vries" 1 => "M.A. Ramrattan" 2 => "S.M. Smorenburg" 3 => "D.J. Gouma" 4 => "M.A. Boermeester" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Qual Saf Heal Care." "fecha" => "2008" "volumen" => "17" "paginaInicial" => "216" "paginaFinal" => "223" "itemHostRev" => array:3 [ "pii" => "S0002934315002521" "estado" => "S300" "issn" => "00029343" ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Medical error: the second victim" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Wu" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.320.7237.726" "Revista" => array:6 [ "tituloSerie" => "BMJ." "fecha" => "2000" "volumen" => "320" "paginaInicial" => "726" "paginaFinal" => "727" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10720336" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The natural history of recovery for the healthcare provider “second victim” after adverse patient events" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.D. Scott" 1 => "L.E. Hirschinger" 2 => "K.R. Cox" 3 => "M. McCoig" 4 => "J. Brandt" 5 => "L.W. Hall" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Qual Saf Heal Care." "fecha" => "2009" "volumen" => "18" "paginaInicial" => "325" "paginaFinal" => "330" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estrategia de Seguridad del Paciente del Sistema Nacional de Salud" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.D.E. Sanidad" 1 => "S.S.E. Igualdad" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "WWW" => array:2 [ "link" => "https://www.msssi.gob.es/ciudadanos/prestaciones/centrosServiciosSNS/hospitales/docs/CNH2015.pdf" "fecha" => "2016" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Caring for our own: deploying a systemwide second victim rapid response team" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.D. Scott" 1 => "L.E. Hirschinger" 2 => "K.R. Cox" 3 => "M. McCoig" 4 => "K. Hahn-Cover" 5 => "K.M. Epperly" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/s1553-7250(10)36038-7" "Revista" => array:6 [ "tituloSerie" => "Jt Comm J Qual Patient Saf." "fecha" => "2010" "volumen" => "36" "paginaInicial" => "233" "paginaFinal" => "240" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20480757" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack457152" "titulo" => "Acknowledgments" "texto" => "<p id="par0050" class="elsevierStylePara elsevierViewall">We thank the doctors participating in this study for letting us know their perception of the possible errors when practising health care and their experience in this regard.</p><p id="par0055" class="elsevierStylePara elsevierViewall">We especially recognise the work of María Fernández-Capo, Nuria Penella and Xavier Castells in the revision of the previous manuscripts.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000015400000007/v1_202004071208/S238702062030067X/v1_202004071208/en/main.assets" "Apartado" => array:4 [ "identificador" => "43309" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000015400000007/v1_202004071208/S238702062030067X/v1_202004071208/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S238702062030067X?idApp=UINPBA00004N" ]
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