What is a second victim?

The term “second victim” was first introduced by Dr Albert Wu.₁ The author described the impacts of errors and mistakes on doctors and argued that little attention had being given on physician’s welfare and on how to handle to this problem. So, for the suffering and the need for help, doctors should be considered second victims of any medical error.

In the next years, the subject gained the attention of the researchers and a growing body of evidence was collected. In 2009, Scott et.al ₂ proposed a comprehensive definition, comprising every healthcare worker and a broader range of causes of trauma. Second victims were defined as healthcare providers who are involved in an unanticipated adverse patient event, in a medical error and/or a patient related injury and become victimized in the sense that the provider is traumatized by the event. Frequently, these individuals feel personally responsible for the patient outcome. Many feel as though they have failed the patient, second guessing their clinical skills and knowledge base. ₂

A new definition

In 2020, the European Researchers’ Network Working on Second Victims (ERNST) was established by the European Cooperation in Science and Technology (COST) as COST Action 19113.

One of the core objectives was to develop the theoretical conceptualization of the second victim phenomenon and to develop a common understanding of its definition. It was considered that the current definitions of Wu (2000) and Scott and colleagues (2009), mentioned before, are in some cases unclear. Also, they were both developed in the United States and did not include current insights.

A systematic review of the literature was performed, followed by a series of meetings and a final expert consensus.

A new definition was proposed based on three concepts :

• involved persons
• content of action
• impact

Here’s the proposed definition:

“Any health care worker, directly or indirectly involved in an unanticipated adverse patient event, unintentional healthcare error, or patient injury and who becomes victimized in the sense that they are also negatively impacted.”₃

1. Wu AW. Medical error: The second victim. BMJ. 2000;320:726–7. 
2. Scott SD, Hirschinger LE, Cox KR, McCoig M, Brandt J, Hall LW. The natural history of recovery for the healthcare provider “second victim” after adverse patient events. Qual Saf Heal Care. 2009;18:325–30
3. Vanhaecht, K., Seys, D., Russotto, S., Strametz, R., Mira, J., Sigurgeirsdóttir, S., Wu, A. W., Põlluste, K., Popovici, D. G., Sfetcu, R., Kurt, S., & Panella, M. (2022). An Evidence and Consensus-Based Definition of Second Victim: A Strategic Topic in Healthcare Quality, Patient Safety, Person-Centeredness and Human Resource Management. International Journal of Environmental Research and Public Health, 19(24), 1–10. https://doi.org/10.3390/ijerph192416869