Second victim phenomenon in the era of COVID-19

In recent years, the wellbeing of healthcare providers has gained increasing awareness. Now in the era of the COVID-19, never is healthcare provider wellness more important.

In 2000, Albert Wu coined the term “Second Victim Syndrome” (SVS) which describes the emotional experiences of a medical provider in the aftermath of a clinically challenging event. ¹ Since that time, the term has grown in convention and now numerous institutional programs exist to help recognize and attenuate the effects of this syndrome.

Previously published works on this phenomenon introduce discussion regarding the semantics of the word “victim” in describing healthcare providers who experience SVS.^2,3 These works suggest that the traditional connotation of the term “victim” may decrease the accountability of healthcare professionals by diminishing their role in the adverse event, thereby producing sympathy for the healthcare worker who may in fact have been at fault for the adverse outcome. They argue that using the term “victim” places the focus on the provider instead of the patient (i.e. – primary victim) and loved ones who directly suffered the effects of the adverse event. ³ Additionally, some members of the medical community warn that this term may deemphasize the experience of patients and stigmatize affected clinicians. ⁴

In essence, some might feel that shifting any focus from the patient lessens the significance of the patient’s experience of the disease and resulting outcome. However, we should not view this scenario as an either-or condition but rather as a complex, multifaceted circumstance that affects the patient, healthcare provider, and the entire medical system, all of which require focused care and attention in order to heal and move forward in an effective and dignified manner.

The term “second victim” has traditionally referred to a provider who suffered in the aftermath of an unanticipated adverse outcome. In light of the COVID-19 pandemic, we might consider how providers experience a similar emotional and distressing reaction and actually fit a more encompassing definition of “victim”- in other words both a primary and second victim. Throughout the pandemic response, providers have suffered anxiety, depression, feelings of lack of institutional support as well as being a witness to significant morbidity and mortality of patients. Furthermore, some healthcare providers have suffered the effects of COVID-19 by actually contracting the disease at work, thereby being further victimized by these circumstances. Although, much debate has arisen over the use of the term “victim,”^3,4 healthcare providers are in fact victims due to this pandemic, both mentally and physically of this unanticipated healthcare crisis.

Frontline healthcare providers face significant challenges unique to the COVID-19 pandemic and experience harm to their wellbeing. The pandemic has been extremely stressful to providers across the globe and has likely forever altered the way medicine is practiced worldwide. Specifically, the COVID-19 pandemic is unique in that the world was unprepared to predict or handle the outcome. This is seen in the shortages of personal protective equipment, testing kits, and available treatments and guidelines. Thus, healthcare workers could not anticipate outcomes or control many of the adverse outcomes to themselves or their patients. Indeed, the COVID-19 pandemic has unquestionably put excess psychosocial stress on medical providers, including an increased risk of acquiring trauma or stress-related disorders, such as depression, anxiety, and insomnia due to factors such as risk of exposure, PPE availability, job stress, isolation/quarantine, interpersonal distancing, and witnessing death at an extremely alarming rate.^5,6 In a recent review of providers facing the pandemic from 17 countries, it was estimated that 33% experienced anxiety and 28% suffered depression and these numbers grew even higher in providers with pre-existing conditions (56% and 55%, respectively). ⁷ The symptoms that providers experience as a result of COVID-19 are similar to those identified in a recent meta-analysis of providers suffering from SVS: troubling memories (81%), anxiety (76%), distress (70%), and sleeping difficulties (35%). ⁸

In wake of the COVID-19 pandemic, healthcare workers would argue that they are, in fact, at risk of being “victims” and this should be addressed in the support of our current healthcare workforce. Healthcare providers must balance the competing stressors of providing care in a compassionate and altruistic fashion to their patients while simultaneously carrying the burden of putting themselves and loved ones at risk of contracting this disease. When a caregiver contracts COVID-19 through his or her workplace, they are a “victim” of this disease. When a caregiver endures the psychosocial effects of lack of personal protective equipment, lack of sleep, and prolonged isolation due to their line of work, they are a “second victim” of this disease.

In all cases of adverse outcomes, it is important to fully address failures from the individual to the system level. Though “second victim” acknowledges the humanity of medical professionals, it should not protect them from full accountability for their role in a clinically challenging event. However, given the severity of the pandemic, providers should face little to no culpability for their desperate and altruistic efforts to provide humane care given the difficult and morally distressing situations they may have encountered (e.g., allocating scarce resources, managing limited space in emergency rooms and intensive care units). As we move forward through and after the pandemic, it is our hope that as much attention will be paid to the effects of COVID-19 on providers and to able to fully heal and bear the responsibility of competent care once again.