Introduction
Healthcare is complex and patient care can often involve unpredictable
factors1-3. Whether due to this complexity or the
limits of human cognition and physical endurance, errors can be expected4,5. These errors, formally referred to as ‘medical
error’ within the literature, are estimated to be the third leading
cause of morbidity and mortality in North American
countries6,7. The medical error literature identifies
common preventable human errors such as improper medication
administration, iatrogenic injury from surgical procedures, and mistaken
patient identity8. Several studies have described that
the highest proportion of preventable medical errors happen in the
emergency department with the most common type of error being diagnostic
errors that lead to disability or death 9-14. Herein lies a potential
problem: if the error is classified as preventable, with whom does the
responsibility lie? Is it fair to individual physicians to classify the
rate of preventable errors as part of safety and quality improvement
initiatives? How might the perception that their error was preventable
affect their perception of their own competence? Perhaps more
critically, how might this perception impact their sense of
responsibility? Pertaining to these questions, there is a highly focused
literature on how diagnostic errors promote a rhetoric of individual
clinician vigilance, through de-biasing, cautiousness, and personal
reflection15-22. On one hand, theories on how
cognitive biases impact diagnostic error offer a sensitive approach:
physicians make errors because of cognitive limitations and innate
tendencies. On the other hand, this focus is paired with strategies to
correct for these tendencies, thereby increasing the pressure on the
individual clinician to ‘correct or prevent’ their own errors. Another
perspective points to knowledge and experience gaps as the main factor
in diagnostic error23. While this may imply a need for
a more effective medical residency curriculum, there is still pressure
on the individual clinician to self-assess and address gaps.
The exact rate of diagnostic errors is debated24,
however, the impact of these errors on patients is only one focus of a
growing literature6,25-28. Recently the impact that
these errors have on the well-being of first responders and physicians
has also been explored29-37. Among physicians,
emotional responses to medical errors can last from days to years, and
may include feelings of underperformance or failure, shame, self-doubt,
fear, guilt, embarrassment, anger, depression, posttraumatic stress
injury, and suicide29-36. Research demonstrates that
medical errors can have long-term impacts relating to lack of
confidence, concentration, memory, and impaired work
performance37-40. Other studies report anxiety about
future errors, difficulties sleeping41, or prematurely
leaving the medical profession42-43. Due to the
impacts of unanticipated adverse patient events, injuries, and errors,
the physician has been referred to as the “second victim” in a
seemingly vicious cycle33,44-50. The “second victim”
often loses confidence in themselves, takes on a level of responsibility
for the patient outcome, and begins to undervalue their clinical
skills44-50. Historically, postulated reasons for this
include cultures of blame, shaming from colleagues, and the degree of
perfectionism that exists within clinical
medicine51-52.
Despite the growing attention on the physician as “second victim,” how
physicians recover from errors and how or if they learn to move forward
is a space that is underexplored. Shepherd et al. (2019) identified
several dimensions that influence how physicians learn from
errors34. We explore one of those dimensions more
closely: understanding the emotional response. In particular, we wanted
to better understand the process by which physicians shared experiences
of error with supervisors, colleagues, and/or trainees, and if there are
common patterns among their post-error recovery and growth.