Letter to the Editor
Prevention of harm in the second victim
La prevención del daño en la segunda víctima
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"documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "Med Clin. 2021;156:632-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Neonatal debut of ornithine transcarbamylase deficiency with severe hyperammoniemia" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "632" "paginaFinal" => "633" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Debut neonatal de déficit de ornitina transcarbamilasa con hiperamoniemia grave" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Esperanza Lepe Balsalobre, Rocío Cabra Rodríguez, José María Maesa Márquez" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Esperanza" "apellidos" => "Lepe Balsalobre" ] 1 => array:2 [ "nombre" => "Rocío" "apellidos" => "Cabra Rodríguez" ] 2 => array:2 [ "nombre" => "José María" "apellidos" => "Maesa Márquez" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775320302694" "doi" => "10.1016/j.medcli.2020.03.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775320302694?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621002394?idApp=UINPBA00004N" "url" => "/23870206/0000015600000012/v1_202106160926/S2387020621002394/v1_202106160926/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Prevention of harm in the second victim" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "633" "paginaFinal" => "634" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jordi Delás, Ana Lozano" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Jordi" "apellidos" => "Delás" "email" => array:1 [ 0 => "jdelas@ub.edu" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Ana" "apellidos" => "Lozano" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitari Sagrat Cor-Grupo Quironsalud, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Medicina, Universitat de Barcelona, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La prevención del daño en la segunda víctima" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We have read with interest the excellent article by Esperanza Gómez-Durán and Josep Arimany Manso on the attitude of the health professional after a patient has suffered harm, becoming a second victim.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Medical errors are considered the third leading cause of death after heart disease and cancer.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The use of the term second victim dates back to 2000 when Professor Albert Wu<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> first used the term and, despite the time that has passed, the rationale is still remarkably relevant. The advisability of colleagues themselves and the health system providing help to the doctor who is distressed by his or her error is repeatedly mentioned. However, we would like to emphasise, beyond the authors’ proposal for care, the importance of prevention. That would mean preparing, in the absence of a first and second victim, for the eventuality of a crisis and establishing policies to deal with it.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Wu comments that the emotional experiences following the error could be mitigated if a respected senior doctor had led an open discussion about the incident and the eventuality of the errors.</p><p id="par0020" class="elsevierStylePara elsevierViewall">It refers, therefore, to a system that commissions an expert doctor after knowledge of the medical error. But this same person could also provide preventive information.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Wu mentions that after the error you feel all alone, and this is one of the factors that should be anticipated. Many structural situations influence decision making, which may not be ideal. Various factors play a role, such as the type of patients considered less interesting for the scientific teams and the hospital itself, the lack of beds for admission or simply the pressure of care.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Considerations that seem to have arisen and are endorsed by a team and a context, but which disappear in the event of an error and have no extenuating value when asked by a judge. The loneliness described above is felt intensely when the error is presented by the group as the sole responsibility of the accused professional and assertions that, despite suggestions, there had always been a belief that the professionalism of the second victim would prevail in order to overcome the context and avoid harm to the patient.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The doctor is also cited as having an ethical responsibility to explain his error to the patient. And also, that, in this confession, the empathetic doctor has a better chance of being forgiven. But the preventive aspect must show that it is a previous empathetic approach, already in the course of care, that must result in a mitigation of pain for patients and relatives.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The perception that adequate time and attention has been given to the patient and to the study of the case undoubtedly lessens the pain of a poor outcome. The feeling that there has been no lack of interest and dedication brings events closer to the realm of the unpredictable and uncertain.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Patients and their context are cited as denying the possibility of error.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> This can happen sometimes out of admiration for the professional and sometimes as an element of consumption. The mistaken belief that if things are done well, the consumer should get a good product.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The abundance of current resources makes the professional even more accountable and seems to limit the possibility of an undesirable effect or error. Even if it is to the detriment of the doctor, we must remember that not everything is known and not everything is under control.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Some articles highlight greater suffering as a second victim in doctors who are also mothers.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> If it is already advisable for all professionals to take measures to avoid error, the knowledge of these references in these professions should reinforce the need to be prepared for the eventuality of error.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Delás J, Lozano A. La prevención del daño en la segunda víctima. Med Clin (Barc). 2021;156:633–634.</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" => "El profesional sanitario como segunda víctima del daño en la asistencia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "E.L. Gómez-Durán" 1 => "J. Arimany-Manso" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medcli.2019.09.005" "Revista" => array:6 [ "tituloSerie" => "Med Clin (Barc)." 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