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Second Victim Syndrome and Peer Support during COVID-19

By Dr. Susan Wilson, MD

The COVID-19 pandemic has impacted everyone, especially those of us in healthcare. Our way of practicing medicine has been changed; some would say forever. We find ourselves not only affected clinically, but also emotionally. As a result, clinicians are experiencing more stress and anxiety than ever before. These feelings are not new, but have been heightened in the face of the pandemic.

Physicians are perceived as self-reliant, emotionally stoic, and pillars of the community. Society expects perfection from our healthcare system, and turns to us in times of medical crisis. We as clinicians need to recognize our humanity; doctors are people too, with the same emotional needs as any other individual. In fact, one could argue that the demands of medicine require an even greater level of emotional support than other professions.

It is important to acknowledge where the emotional stress comes from, so we can understand how to deal with it. The term “Second Victim Syndrome” (SVS) was first coined by Dr. Albert Wu in 2000. This refers to the phenomenon of a clinician becoming victimized by an unanticipated adverse medical event; the patient is the primary victim, but the clinician is affected secondarily. This syndrome can impact all members of the healthcare team, including doctors, mid-level providers, nurses, therapists, pharmacists, and techs. Examples include sudden death, missed diagnosis, medication error, complication of procedure, and even malpractice lawsuits. These events trigger physical and emotional reactions, which in turn impact the ability of the clinician to perform at his/her optimal level. Additionally, there are 6 well-described phases that those suffering SVS go through: 1. Chaos and accident response (Clinician is in a state of shock, and is unable to concentrate) 2. Intrusive thoughts (excessive rumination about events, and thoughts of self-doubt) 3. Restoring Integrity (regaining trust of colleagues and restoring self-confidence) 4. Enduring the Inquisition (investigation of the event) 5. Emotional First-Aid (Peer Support) 6. Moving on (Clinician ultimately will thrive, survive, or move on). Second victim syndrome has been associated with increased rates of burnout, substance abuse, and even suicide.

With regards to the COVID-19 pandemic, clinicians are experiencing increased levels of exhaustion (both emotional and physical), compassion fatigue, and moral injury. All of these components, along with the pre-existing stress of adverse medical events, creates a toxic environment within which healthcare professionals (HCPs) are expected to practice. It is no wonder that issues of burnout, depression, and suicide among HCPs are of great concern.

Now that we’ve identified what affects us, how do we address the issue? This is where Peer Support becomes a vital part of the picture. As described by Riessman in 1989, Peer Support refers to a process through which those with shared common experience come together as equals to give and receive help, based on the knowledge that comes through shared experience. Physician coaches are the ideal peer supporters, as they have both shared experience of HCPs, and the training to provide this assistance. Peer Support is provided through confidential, non-judgmental sessions wherein the clinician is afforded a “safe space” to discuss his/her feelings. Techniques of active listening and open-ended questions allow the clinician to debrief, often gaining insight into their emotional state. The goal is to support the clinician through the acute event, providing “emotional first-aid” as the initial step to recovery.

Although Peer Support has traditionally been thought of as the “treatment” for SVS, one can see how it can be applied to a myriad of scenarios, many of which are a direct consequence of the pandemic. It is also important to note that issues we are seeing with the pandemic are not new, but have been magnified by the stress put on our healthcare system during this time. Providing emotional support to our clinicians who are in distress needs to be accomplished with a proactive, not reactive strategy. Waiting until someone is actually burned out, depressed, or suicidal is not the answer; this assistance needs to be seen as a mainstay in our medical community. It is important to realize that because of the pandemic, we are in a perfect storm right now. Issues of SVS, exhaustion, compassion fatigue, and moral injury are all at their highest levels, and are all contributing to overall clinician distress. Now is the time to change the culture of medicine.

Where do we go from here? Education and outreach both to individual clinicians and hospital administrators is vital. Until HCPs have an advocate in the C-Suite that can champion their wellness, we will continue to struggle with the concept of emotional support for our clinicians. While HCPs have historically been accountable to administration (i.e. productivity, patient safety, Press Ganey scores), it is time for institutions to be accountable to their employees. This includes providing the wellness tools necessary for a healthy work environment.

Acknowledging that we are not invincible superhumans is an important first step towards achieving the emotional fitness that we all deserve. The pandemic has magnified the distress that HCPS are experiencing; hopefully, this situation will provide the impetus to change our dysfunctional medical environment. In the meantime, accessing Peer Support for adverse events remains an important tool to buoy HCPs through this turbulent time.

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