Why this patient safety advocate argues it's time to stop using 'second victim'

Senior patient
The term "second victim" refers to the devastated health professional following a medical error. But the term seems to remove accountability for mistakes and places the needs of healthcare workers above injured patients, argues one patient safety advocate. (Getty/Pradit_Ph)

Melissa Clarkson was devastated when her father died following a delayed transfer from a rural hospital to a burn center about seven years ago.

A health informatics Ph.D. student at the time, she tried to determine what to do after patient harm occurred. Instead, she found a body of literature around the term "second victim" focusing on the emotional impact providers experience when one of their errors causes patient harm.

"That term didn’t sit so well with me," Clarkson said.

As she began blogging about her experience, she came across plenty of other families of patients who died as a result of medical errors who were uncomfortable with the term as well.   

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At the same time, she learned plenty of medical professionals, including a particular nurse she interacted with in Kentucky, were staunch defenders of the term they'd learned about in their training.

So, in an editorial published in the latest edition of The BMJ, Clarkson offered the concerns she and many patient advocates share. Her goal was to introduce the perspective to the medical community in a venue most likely to be found through searches in PubMed, a free search engine providing access to references and abstracts on life sciences and biomedical topics.

"This is where the term was introduced," Clarkson said. "I think we need to talk about this in the same venue."

The term was first coined by Professor Albert Wu at Johns Hopkins Bloomberg School of Public Health, who published a personal view (PDF) in The BMJ on the idea in 2000 to describe those who suffer emotionally when the care they provide leads to harm. 

"The problem is the term and what the term implies. The effect of the term almost using it as a way to prioritize the view of the caregivers over the situation of the patient," Clarkson said.

Beyond that, she said, the term seems to remove accountability. "When I sat down to write the editorial, I realized when people label themselves as victims, they are saying something happened to them. It changes the way they look at their role."

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While Rebecca Lawton, a professor of the psychology of healthcare at the University of Leeds and the Bradford Institute for Health Research, recognizes the concern that using the word victim might imply a lack of responsibility, she said the term was needed to push the health system to recognize health providers' need for support. She has previously published articles supporting the term not only for recognizing the devastation experienced by individual clinicians following an error but the broader implications for patient safety and safety culture.

"We have seldom, if ever, encountered a health professional who does not punish themselves for errors that harmed a patient," Lawton wrote. "Unhelpful coping responses can lead to harmful behaviors, such as obsessive checking, ordering repeated tests and other defensive medicine practices, as well as adverse personal impacts. We suggest that, until better terminology is agreed, these consequences justify the term ‘victim.'" 

Clarkson said she and other patient family members and patients touched by medical errors support efforts by health systems seeking to find ways to "care for the caregiver." But although she's seen increased attention on the needs of professionals after a medical error since Wu introduced the term, there's been a dearth of research or support for the needs of harmed patients or their families.

"It’s time to abandon the term second victim," Clarkson wrote in her op-ed. "We know who the actual victims of medical errors are because we arranged their funerals and buried them."