As rheumatologic care and treatments become more complex and the landscape of physician care becomes more demanding, rheumatologists are at increased risk for becoming “second victims,” according to Albert Wu, MD, MPH, professor of health policy and management and professor of medicine at Johns Hopkins University, Baltimore. In 2000, Dr. Wu first coined the term second victim in an article in the British Medical Journal to define the emotional trauma a provider experiences when a medical error occurs.1
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However, Dr. Wu cautions the second victim phenomenon can be brought on by stressors other than medical errors, including an unexpected or disappointing patient outcome. Additionally, the many chronic stressors physicians experience with patients and practice demands can make them vulnerable. Without support, any physician, including rheumatologists, can experience serious emotional harm and burnout.
Rheumatologists as Second Victims
Although rheumatologists may consider themselves to be at lower risk of becoming second victims compared with a surgeon who loses a patient unexpectedly, Dr. Wu believes rheumatologists are still at risk for several reasons.
“Rheumatologists are exposed to many stressors in providing longitudinal care for patients with multiple chronic conditions who are prone to disappointing outcomes, as well as increased risk for medical errors as treatment regimens become more complex,” Dr. Wu says. “Rheumatologists also face a range of stressors associated with their practice, such as productivity and financial pressures, as well as stressors associated with care requirements such as electronic health documentation.”
He encourages greater awareness across the specialty to help rheumatologists who become second victims. But he says, in general, physicians are the least likely healthcare providers to seek support. “There is a real ‘stiff upper lip, soldier on’ mentality among physicians who may feel it is a sign of weakness to ask for help,” Dr. Wu says. “I’ve personally heard of a physician who was severely traumatized by a series of adverse patient events who did not seek support for fear of looking weak among colleagues.”
Dr. Wu believes recognizing the need for peer support has reached a tipping point in healthcare, as the drumbeat of burnout grows louder and self-care and wellness are emphasized by accreditation bodies and professional organizations. He also sees a natural progression toward physicians accepting peer support as they more commonly work in multidisciplinary teams.
Formal Peer Support
Psychological first-aid is a formalized approach to peer support for second victims in place at several hospitals across the country, including Johns Hopkins University. For physicians, nurses and other healthcare providers who experience a stressful patient event, a peer-support program provides an outlet to discuss their experience and receive private, structured support from trained providers working in the institution.