Surgeon Perception and Attitude Towards the Moral Imperative of Institutionally Addressing Second-Victim Syndrome in Surgery.

Abstract

Second victim syndrome (SVS) is described as when health care providers encounter significant moral distress after traumatic patient care events. Although broadly recognized in medicine, this remains underrecognized in surgery and no systemic approaches exist to mitigate potential harms of SVS amongst surgeons. When SVS is left unaddressed, surgeons not only suffer personal psychological harm but their ability to care for future patients can also be compromised. The aim was to examine surgeons' perceptions and attitudes regarding mitigation of SVS. This study was conducted at a tertiary-care university hospital using a mixed-methods approach coupling quantitative and qualitative assessments including a 13-item survey, follow-up focus group, and semi-structured interviews The Wilcoxon signed-rank test was used for quantitative analysis and content analysis used to report qualitative findings. Surgeons believe SVS is a universal experience amongst surgeons that healthcare institutions have a moral obligation to address. Surgeons further believe that any effective mitigation strategy must receive legal protection similar to morbidity and mortality (M&M) conferences. The culture, tenor, and tone of review processes after surgical complications can either reduce or exacerbate the burden of SVS. Successful interventions must be easily accessible, voluntary, and culturally acceptable. Furthermore, surgeons may suffer greater SVS compared with non-procedural physicians as adverse events can be inevitable in operation and may potentially be a high frequency outcome depending on patient population. Surgeons agreed that healthcare organizations have a moral imperative to assist surgeons in navigating the psychosocial impacts of SVS after adverse surgical outcomes. The success of mitigation strategies was viewed as ethically relevant to patients and surgeons and dependent on the culture, tenor, and tone of the process.