Background The second victim effect is defined as emotional distress experienced by providers involved in mistakes. This study characterises events contributing to the second victim effect among a diverse sample of physician mothers, describes the impact on both provider and patient and seeks to determine the association between experiencing a mistake and burnout.
Methods In this mixed-methods study, an anonymous, cross-sectional survey was posted to an online network of over 65 000 physician mothers on 17 June 2016. Self-reported involvement in a mistake provided opportunity to describe the error and impact on both provider and patient. Free-text responses were qualitatively coded to identify error types. Hypothesising that making a mistake contributes to burnout, self-reported burnout was examined using a single question. We used logistic regression to estimate the association between involvement in a mistake and burnout, adjusting for practice years, setting and specialty.
Results 5782 members completed the survey for an estimated response rate of 16.5% based on 34956 active users during the survey period. 2859 respondents reported involvement in a mistake (49%), which was associated with higher reported burnout (p<0.0001). 56% of those reporting a mistake provided descriptions. Qualitative analysis revealed that self-reported treatment errors were more common and diagnostic errors were most often reported to result in greater patient harm. Of those involved in a mistake, 82% reported feelings of guilt; 2.2% reported reducing clinical workload, taking leave or leaving the profession.
Conclusions Physician mothers involved in errors experience negative outcomes and may be at increased risk for burnout. Additional research should focus on strategies to mitigate burnout associated with the second victim effect, particularly among women physicians and those with family responsibilities.
- human error
- medical error, measurement/epidemiology
- near miss
- patient safety
- adverse events, epidemiology and detection
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Contributors KG and US conceived and designed the study. NR performed quantitative analysis. KG and SL performed qualitative analysis with support from US. CM and EL provided key input throughout the study design, analysis and interpretation of data. EL led the data acquisition process. US had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. KG drafted the manuscript, and all authors critically reviewed the manuscript, approved the final version and meet ICMJE criteria for authorship.
Funding US is supported through grants from the National Cancer Institute (K24CA212294) and the Agency for Healthcare Research and Quality (P30HS023558). EL is supported by the National Cancer Institute (R21CA212201, the National Institute on Aging (K76AGO54631) and the National Institute of Health (DP2CA225433). The funders had no role in the design, data collection, analysis or presentation of results.
Competing interests None declared.
Patient consent Not required.
Ethics approval Committee on Human Research at the University of California, San Francisco, reviewed and approved this study 16–19306.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Please contact the authors for inquiries regarding the data sets supporting this article, excluding free-text responses which may include potentially identifying information.