Association Between Second Victim Syndrome And Burnout Among Physicians At A Single Center
Helen A. Potter, MD, Monica S. O'Brien-Irr, MS, RN, Matthew W. Henninger, EdM, Catherine Flanagan-Priore, PhD, Peter Winkelstein, MD, MBA, Linda M. Harris, MD.
University at Buffalo, Buffalo, NY, USA.
OBJECTIVES: “Second Victim Syndrome” refers to the negative mental and emotional after-effects physicians may experience following adverse patient outcomes. We evaluated the impact of “Second Victim”(SV) status on physician self-efficacy, burnout, perceived stress and sleep patterns. METHODS: Physicians at a university hospital voluntarily participated in an anonymous, survey which included SV status, General Self-Efficacy Scale (GSE), Copenhagen Burnout Inventory (CBI), Perceived Stress Scale (PSS) and Insomnia Severity Index (ISI). Total possible survey points were: GSE:40, CBI:95, PSS:40, ISI:28. Student t-test for independent samples and Mantel-Haenszel were used to compare SV with non-second victims(NSV). RESULTS: Of the 115 respondents, 85(74%) provided SV status: 48% female, 93% non-Hispanic white, 35% surgeons, 53% in practice >20 years. There were 24(28%) self-reported SVs. Demographics were similar between groups. GSE scores were comparable: SV vs. NSV:(31.4 vs. 32.6; P=.13), but fewer SVs reported that they could accomplish their goals; (79.2 vs. 88.7%; P=.03). Overall, 56% physicians had CBI scores consistent with moderate burnout. Mean CBI scores were similar for both groups:(56.6 vs. 52.4; P=.17). Work-related:(22.9 vs. 21.9; P=.44) and personal burnout:(18.9 vs. 17.3; P=.17) were comparable, but SVs more commonly reported patient-related burnout:(15.3 vs. 12.9; P=.039). Second victims responded “often or always” more frequently to questions regarding patients being “hard to work with” (8.3% vs. 1.6%; P=.03), “frustrating” (12.5% vs. 3.3%; P=.02), “draining energy”(16.7% vs. 5%; P=.018), or “wondering how long they could continue to work with patients” (16.7% vs.11.5%; P=.039). There was no difference in mean PSS for lack of control:(11.7 vs. 10.5; P=.28) or ability to cope with existing stressors:(10.0 vs. 10.6; P=.34). Mean insomnia scores were comparable:(9.4 vs. 7.7; P=.22) but SVs experienced problems with waking too early more often:(29.2% vs. 14.5%; P=.01). Official debriefing, individualized counseling or coaching to cope with the event were top resources desired by SVs (54%). Mandatory time off or mandatory meetings with a psychiatrist/psychologist were least favored(8%).
CONCLUSIONS: Over 25% of physicians have experienced SV sequalae which do not distinguish by demographics. Despite high level GSE, moderate burnout was present in >50% of physicians irrespective of SV status. Patient-related burnout was particularly evident among SVs. These numbers are alarming and should be promptly addressed by medical societies and hospitals. A valuable starting point may be offering individualized counseling for all physicians.
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