When Things Go Wrong

Dr. S is a regular at weekly morbidity and mortality (M the seasoned nurse whose patient decompensated overnight; the pharmacist who overlooked a medication interaction; the therapist whose patient relapsed and committed suicide. For surgeons, the impact is particularly palpable when decisions and actions in the OR cause direct and immediate harm. We replay and relive these moments, suffering quietly, wishing we had done better. Following Mr. P's death in the OR that day, each member of the team was visibly affected. A minute of silence was observed, the air heavy as though carrying everyone's unstated grief. Unfortunately, we do not know who from that day is still grieving, because we never stopped to ask. When we lose a family member or friend, our culture has developed long-held rituals to help us grieve and recover. Yet, when we lose a patient, we rarely stop for longer than a minute of silence, or a presentation at M some adaptations are healthy, but others are harmful and could put our careers and personal lives at risk. System-wide efforts are needed to better recognize the impact that challenging cases have on healthcare providers, and to identify colleagues who are struggling. This requires a culture that supports second victims as much as it promotes the safety of our patients. Second victims most commonly turn to peers for help.2 To this end, peer support programs have been described as a means to support colleagues in times of need.5,6 We recently established a Second Victim Peer Support program in our Department of Surgery with the goal of identifying and supporting our own colleagues at risk following difficult cases. Through this program, surgeons and trainees are identified by peers following major intraoperative or other catastrophic adverse events, and a confidential outreach effort is made to each individual to let them know that they are not alone, and that a trained peer supporter (a surgeon) is immediately available to chat. Additional resources are provided when appropriate. The program is supported institutionally within the umbrella of “peer-review activities” and is therefore protected from litigation, similar to Morbidity & Mortality conferences. Indeed—and perhaps unexpectedly—most of the surgeons we reach out to accept the offer to speak with a peer supporter. Since the program's inception last year, we have conducted close to 50 outreach interventions (to residents and attendings), with the significant majority (82%) of those contacted expressing their willingness to speak with a peer supporter. Feedback from second victims after speaking with a peer supporter has been overwhelmingly positive. Most report feeling relieved to have someone to speak to, and to know that others have been in their shoes. In a short period of time the program's impact on our culture is being felt, and a collective sense is building that nobody should be left to struggle alone. Ironically, discussions with peer supporters tend to shift the focus of conversation away from failure and vulnerability, and instead toward personal resiliency and a sense of rejuvenation. In this context, we believe that a robust second victim peer support program provides a much-needed counterbalance to some of the negative forces in the workplace that lead so many physicians toward burnout. Table 1 lists the components of our Second Victim Peer Support program, and steps that can be followed to launch similar programs elsewhere.TABLE 1: MGH Department of Surgery Second Victim Peer Support Program—Key Components and Tips for Getting StartedIt is time to accelerate our collective efforts to mitigate the widespread impact of the second victim phenomenon. As Dr. S continues to recover in the wake of his patient's death, we must be conscious of the many other second victims among us. They, too, may simply be waiting for someone to start the conversation.