A Rose by Any Other Name……


We all know how the rest of that sentence goes, and we all know how that story ends: tragedy, in the sake of a name.

As the Adam Kay “This Is Going to Hurt” drama accurately portrayed, real life “stories” are ending in tragedy simply because of a name! That name is “second victim”.

“Second victims are healthcare employees who are involved in an unanticipated adverse patient event, a medical error and/or a patient-related injury and become victimized in the sense that the employee is traumatized by the event. Frequently, these individuals feel personally responsible for the patient outcome. Many feel as though they have let the patient down, second-guessing their clinical skills and knowledge base1.”

Undoubtedly, the first victim is, and always will be, the patient and their family. Efforts should be focused on providing them with the support and information they need in the aftermath of a safety incident. The Ockenden Report 20222 has sadly highlighted how patients and families were not listened to, and learning from safety incidents did not happen. The recommendations from this report aim to ensure this never happens again, but clearly there is much work to do.

The term second victim, since its conception by Wu in 2000, has caused controversy amongst patients and health care professionals. It can foster negative opinions, from patients who feel the healthcare staff who make mistakes should be called “perpetrators” not victims, to healthcare professionals, who don’t like to perceive themselves as victims. The first time I heard the term, I must admit I felt the same.

The controversy with the term has meant that “second victim” is not discussed readily, resulting in limited support being offered to staff before, after and during involvement in patient safety incidents, putting their psychological safety and mental health at risk. Long term sequalae of being involved in a patient safety incident can include symptoms of anxiety, depression, post-traumatic stress disorder and in extremis suicide.

As an Obstetrics and Gynaecology doctor, I have witnessed second victims. I have seen incredible doctors leaving the specialty, not only after being involved in a patient safety incident, but some due to the fear of being involved in a patient safety incident! I have been a second victim, during which time I felt guilt when holding my own children, feeling like I didn’t deserve them.

The speciality of Obstetrics and Gynaecology has a significant number of patient safety incidents and the potential for the worst outcomes. It is a well-known fact that many doctors leave the speciality (30%), many after involvement in a patient safety incident. Despite this, the term second victim is still not widely known or talked about. When I introduced the term to a senior consultant, her response was “it’s nice to put a name to something I’ve been experiencing for 30 years.” There are resources available, (i.e. www.secondvictim.co.uk) but as second victimhood isn’t talked about, staff are missing out on much needed opportunities for support. I wonder had those amazing doctors who left our speciality been aware of second victimhood and the support available would they have left?

If the COVID-19 pandemic has taught us anything, it is that our staff are not dispensable. They are not heroes with capes, they are humans, and humans make mistakes. These people making mistakes are the same people who put their lives at risk to care for the country in a time of a global pandemic, and the very least we can do for them is support them when they need it most.

So “What’s in a name? that which we call a rose by any other name would smell as sweet”, and a second victim by any other name still deserves the support to recover and learn from their error or mistake; for the benefit of the individual, their future patients, the organisation in which they work and the NHS as a whole.

To read more about the term second victim and the controversies / evidence behind it, see the secondvictim.co.uk website, and read our spotlight piece.

  1. http://www.secondvictim.co.uk
  2. Findings, conclusions and essential actions from the indepedendent review of maternity services at the Shrewsbury and Telford Hospital NHS Trust – final Ockenden report (publishing.service.gov.uk)

This blog was written by Dr Shireen Hickey, Obstetrics and Gynaecology Registrar and Clinical Leadership Fellow (2021-22) at the Improvement Academy.