Surgeon Perception and Attitude Toward the Moral Imperative of Institutionally Addressing Second Victim Syndrome in Surgery

BACKGROUND: Second victim syndrome (SVS) is described as when healthcare providers encounter significant moral distress after traumatic patient care events. Although broadly recognized in medicine, this remains underrecognized in surgery, and no systemic approaches exist to mitigate potential harms of SVS among surgeons. When SVS is left unaddressed, surgeons not only suffer personal psychological harm but their ability to care for future patients can also be compromised. The aim was to examine surgeons' perceptions and attitudes regarding mitigation of SVS. STUDY DESIGN: This study was conducted at a tertiary-care university hospital using a mixed-methods approach coupling quantitative and qualitative assessments including a 13-item survey, follow-up focus group, and semistructured interviews, The Wilcoxon signed rank test was used for quantitative analysis and content analysis used to report qualitative findings. RESULTS: Surgeons believe SVS is a universal experience among surgeons that healthcare institutions have a moral obligation to address. Surgeons further believe that any effective mitigation strategy must receive legal protection similar to morbidity and mortality conferences. The culture, tenor, and tone of review processes after surgical complications can either reduce or exacerbate the burden of SVS. Successful interventions must be easily accessible, voluntary, and culturally acceptable. Surgeons may suffer greater SVS compared with nonprocedural physicians as adverse events can be inevitable in operation and may potentially be a high-frequency outcome depending on patient population. CONCLUSIONS: Surgeons agreed that healthcare organizations have a moral imperative to assist surgeons in navigating the psychosocial impacts of SVS after adverse surgical outcomes. The success of mitigation strategies was viewed as ethically relevant to patients and surgeons and dependent on the culture, tenor, and tone of the process.