Risk Tips to Support “Second Victims” & Medical Indemnity Guidance
When a patient safety incident occurs, patients are the “first victims”, — and healthcare organisations and clinicians have a duty to respond with honesty, transparency and appropriate support. However, adverse events also take a significant personal and professional toll on clinicians themselves. This is why having not just the right medical indemnity insurance, but the right medicolegal team behind you, is so important.
Strategies to support “second victims”
By acknowledging and proactively addressing the patient safety incident-stress-error cycle, clinicians can work towards effectively managing the situation. You may find the following helpful when dealing with the stress associated with an adverse patient outcome.
1. Be open and honest with the patient/family
When things go wrong, healthcare providers have an ethical responsibility to disclose unanticipated patient outcomes. It is essential to investigate, explain and apologise to the patient. For further guidance on your ethical obligations, please refer to GMC guidance, “Openness and honesty when things go wrong: The professional duty of candour”. Whilst clinicians may feel uncomfortable and anxious discussing adverse outcomes with patients and/or families, when done properly, disclosure can reduce the negative impact of adverse outcomes and support a culture of transparency and safety.
Clinicians should inform their medical indemnity insurance provider of such incidents immediately and in line with their policy terms. Early notification allows your indemnity team to provide timely guidance, protect your legal position and minimise the risk of escalation.
2. Participate in peer review meetings
An adverse patient outcome, whilst unfortunate, can present an ideal learning opportunity to analyse your personal performance and the system in which you practice, to help identify contributory factors.To maximise learning during the review, it is important to consider the methodology to be adopted. Adopting a systems approach can be a significant factor in ensuring that the maximum benefit is derived from the exercise. This approach focuses on the interaction between individuals and the systems within which they work. This can provide a more meaningful approach to understanding why the adverse event occurred, as it does not seek to blame individuals! An example of a systems thinking approach is the Chartered Institute for Ergonomics and Human Factors “Systems Engineering Initiative for Patient Safety Model”.
3. Keep reasonable hours
Healthcare providers involved in an adverse outcome often resolve that “this will never happen again” and pursue self-improvement to ensure it never will. However, this approach can be problematic when, in an effort to enhance performance, you demand even more of yourself (particularly working more hours). This can result in fatigue which may backfire and increase the likelihood of further adverse events.
4. Emphasise people skills
If you feel anxious, fearful, or dissatisfied, you might find it challenging to relate well to patients. These feelings can impair the doctor/patient relationship, which may adversely affect the mutual trust, critical to effective communication and good outcomes. Acknowledging these emotions and working to connect and engage with patients can help relieve such stress.
5. Identify your support systems
Your personal relationships may also suffer because of emotional distress. To address this, identify your support systems, ie, those with whom you can share your feelings and concerns without sharing specific information about the adverse patient outcome.
Expressing your personal feelings and concerns to one of your support systems, such as your spouse, a trusted friend, or a colleague, can help re-establish your emotional equilibrium.
6. Maintain a healthy work/life balance
Most people realise the benefits of maintaining a work/life balance. However, maintaining a “balanced” lifestyle is even more critical in this situation. At the very least, try to take care of your physical health. Consider how your eating habits, physical activity, sleep schedule etc. might affect a balanced lifestyle.
7. Monitor consumption of alcohol
Be cognisant that during times of emotional stress, some individuals have a tendency to improperly self-medicate or abuse alcohol. You may find it prudent to consult your own GP if the emotions resulting from an adverse patient outcome are significantly impacting your sense of wellbeing.
8. Seek professional help
Managing stress on your own is not always possible. You may need to seek professional help if you find you are struggling.There is a widely recognised stigma amongst doctors around admitting the need for selfcare and asking for help, — but seeking support is a sign of strength, not weakness. PMP’s medicolegal team, available 24/7, is trained not only in legal guidance but in supporting clinicians through the human side of adverse outcomes. This support is included as part of your PMP medical indemnity cover — at no additional cost. If you are concerned about your wellbeing and wish to seek confidential professional advice, there are several organisations providing excellent resources and face-to-face help, such as:
NHS Practitioner Health.
The GMC Doctor support service,
BMA Wellbeing and support services,
Resources
The Second Victim Support website has numerous resources available, including Top tips for surviving the process after being involved in a patient safety incident.
If you are a PMP policyholder and have been involved in a patient safety incident, please call the PMP medicolegal helpline immediately. Our medical indemnity insurance cost is transparent, competitive and reflects the full breadth of support we provide, — including 24/7 medicolegal access and specialist legal representation. Contact us to find out more.
