Despite recent advances in medical sciences, the utilisation of technology, and the spread of awareness on patient safety, medical errors still occur and impose a significant burden on healthcare facilities and society. Safety incidents have an impact on the doctor–patient relationship, leading to a defensive medical practice.
Objective
This narrative review aims to present an overview of the dimensions of medical errors and their consequences, with a focus on the second victim phenomenon and defensive medicine.
Methods
Search of the PubMed-indexed relevant publications in the English language. The full texts of the relevant publications have been summarised.
Results
This review explored the dimensions of medical errors and their consequences. The second victim phenomenon describes the physical symptoms and emotional experience of the healthcare practitioners involved in safety incidents. There is a limited number of structured support programs to help the second victims. Unfair media coverage of medical errors adds pressure and directs the blame rather than contributing to solving the problem. Defensive medicine originated due to the increasing litigation claims and represents a fundamental change in the doctor–patient relationship. It takes two forms: positive and negative defensive medicine.
Conclusions
This multidimensional presentation of the topic may be helpful to readers involved in such incidents or working to mitigate their consequences. Patients should understand they are not the only victims of the harm imposed on them. The staff involved should seek help, and healthcare facilities should offer support programs for staff involved in safety incidents. The general audience should receive the published material about medical errors in a reasonably neutral manner and avoid one-sided presentations in the media.
WienkeA. Errors and pitfalls: briefing and accusation of medical malpractice - the second victim. GMS Curr Top Otorhinolaryngol Head Neck Surg2013; 12: Doc10.
2.
Mohamadi-BolbanabadAMoradeGPirooziB, et al.The second victims’ experience and related factors among medical sta_. Int J Workplace Health Manag2019; 12: 134–145.
3.
DavidsonJEAganDLChakedisS, et al.Workplace blame and related concepts: an analysis of three case studies. Chest2015; 148: 543–549.
4.
Institute of Medicine (US). Committee on Quality of Health Care in America. To Err is Human: Building a Safer Health System. KohnLTCorriganJMDonaldsonMS (eds): National Academies Press (US), 2000.
5.
Department of Health. An organisation with a memory: report of an expert group on learning from adverse events in the NHS. The Stationery Office, 2000.
6.
ThomasEJStuddertDMBurstinHR, et al.Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care2000; 38(3): 261–271.
7.
BrennanTALeapeLLLairdNM, et al.Incidence of adverse events and negligence in hospitalized patients. Results of the harvard medical practice study I. N Engl J Med1991; 324(6): 370–376.
8.
WilsonRMRuncimanWBGibberdRW, et al.The quality in Australian health care study. Med J Aust1995; 163(4): 58–471.
9.
WuAW. Medical error: the second victim: the doctor who makes the mistake needs help too. BMJ2000; 320: 726–727.
10.
CoughlanBPowellDHigginsMF. The second victim: a review. Eur J Obstet Gynecol Reprod Biol2017; 213: 11–16. DOI: 10.1016/j.ejogrb.2017.04.002, Epub 2017 Apr 3. PMID: 28526169.
11.
ScottSDMcCoigMM. Care at the point of impact: insights into the second victim experience. J Healthc Risk Manag2016; 35(4):6–13.
12.
GrissingerM. Too many abandon the “second victims” of medical errors. P T2014; 39(9): 591–592.
13.
VanhaechtKSeysDSchoutenL, et al.Duration of second victim symptoms in the aftermath of a patient safety incident and association with the level of patient harm: a cross-sectional study in the Netherlands. BMJ. 2019; 9: e029923.-48.
14.
BurlisonJDQuillivanRRScottSD, et al.The effects of the second victim phenomenon on work-related outcomes: connecting self-reported caregiver distress to turnover intentions and absenteeism. J Patient Saf2021; 17(3): 195–199.
15.
NydooPPillayBJNaickerT, et al.The second victim phenomenon in health care: a literature review. Scand J Public Health2020; 48(6): 629–637. DOI: 10.1177/1403494819855506, Epub 2019 Aug 13. PMID: 31405351. 50.
16.
NewLLambethT. Second-victim phenomenon. Nurs Clin North Am2024; 59(1): 141–152. DOI: 10.1016/j.cnur.2023.11.011, Epub 2023 Dec 14. PMID: 38272580. 51.
17.
World Health Organization & WHO Patient Safety. Conceptual framework for the international classification for patient safety version 1.1: final technical report January 2009. World Health Organization, 2010. https://iris.who.int/handle/10665/70882
McLennanSREngel-GlatterSMeyerAH, et al.The impact of medical errors on Swiss anaesthesiologists: a cross-sectional survey. Acta Anaesthesiol Scand2015; 59(8): 990–998. DOI: 10.1111/aas.12517, Epub 2015 May 8. PMID: 25952281.
20.
HarrisonRLawtonRPerloJ, et al.Emotion and coping in the aftermath of medical error: a cross-country exploration. J Patient Saf2015; 11(1): 28–35.
21.
MokWQChinGFYapSF, et al.A cross-sectional survey on nurses' second victim experience and quality of support resources in Singapore. J Nurs Manag2020; 28(2): 286–293. DOI: 10.1111/jonm.12920, Epub 2020 Feb 11. PMID: 31789437.
22.
KargaMKiekkasPArethaD, et al.Changes in nursing practice: associations with responses to and coping with errors. J Clin Nurs2011; 20(21-22): 3246–3255. DOI: 10.1111/j.1365-2702.2011.03772.x, Epub 2011 Jul 8. PMID: 21736654.
23.
hardR. How perioperative nurses define, attribute causes of, and react to intraoperative nursing errors. AORN J2010; 91: 132–145.
24.
HarrisonRJohnsonJMcMullanRD, et al.Toward constructive change after making a medical error: recovery from situations of error theory as a psychosocial model for clinician recovery. J Patient Saf2022; 18(6): 587–604. DOI: 10.1097/PTS.0000000000001038, Epub 2022 May 27. PMID: 35617626; PMCID: PMC9422758.
25.
ChoiEYPyoJOckM, et al.Profiles of second victim symptoms and desired support strategies among Korean nurses: a latent profile analysis. J Adv Nurs2022; 78(9): 2872–2883. DOI: 10.1111/jan.15221, Epub 2022 Mar 21. PMID: 35307876.
RobertsonJJLongB. Suffering in silence: medical error and its impact on health care providers. J Emerg Med2018; 54(4): 402–409. DOI: 10.1016/j.jemermed.2017.12.001, Epub 2018 Feb 1. PMID: 29366616.
28.
DenhamCRMDTRUST: the 5 rights of the second victim. J Patient Saf2007; 3(2): p 107–119.
29.
The Joint Commission. Supporting second victims. Quick Safety2018; 39: 1–3.
ScottSDHirschingerLECoxKR, et al.Caring for our own: deploying a systemwide second victim rapid response team. Jt Comm J Qual Patient Saf2010; 36: 233–240.
BurlisonJDScottSDBrowneEK, et al.The second victim experience and support tool (SVEST): validation of an organizational resource for assessing second victim effects and the quality of support resources. J Patient Saf2017; 13(2): 93–102.
37.
ForteECNPiresDEPMartinsMMFPDS, et al.Nursing errors in the media: patient safety in the window. Rev Bras Enferm2019; 72(suppl 1): 189–196.
38.
WeeksWBMillsPD. Reduction in patient enrollment in the veterans health administration after media coverage of adverse medical events. Jt Comm J Qual Saf2003; 29(12): 652–658.
LiJWMorwayLVelasquezA, et al.Perceptions of medical errors in cancer care: an analysis of how the news media describe sentinel events. J Patient Saf2015; 11(1): 42–51.
41.
SandorAA. The history of professional liability suits in the United States. J Am Med Assoc1957; 163: 459–466.
42.
HersheyN. The defensive practice of medicine: myth or reality. Milbank Q1972; 50: 2–3.
43.
BerlinL. Malpractice and radiologists: special report. Am J Roentgenol1980; 135: 589–591.
44.
Study shows causes of claims. ACR Bulletin1985; 41: 8.
45.
AndersenMKHvidtEAPedersenKM, et al.Defensive medicine in Danish general practice. Types of defensive actions and reasons for practicing defensively. Scand J Prim Health Care2021; 39(4): 413–418.
46.
GarattiniLPadulaA. Defensive medicine in Europe: a ‘full circle. Eur J Health Eco2020; 21(2): 165–170.
47.
O’LearyKJChoiJWatsonK, et al.Medical students’ and residents’ clinical and educational experiences with defensive medicine. Acad Med2012; 87(2): 142–148.
48.
VandersteegenTMarneffeWCleemputI, et al.The determinants of defensive medicine practices in Belgium. Health Eco, Policy Law2017; 12(3): 363–386.
49.
AntociAFiori MaccioniARussuP. The ecology of defensive medicine and malpractice litigation. PLoS One2016; 11(3): e0150523.
50.
StrobelCJOldenburgDSteinhäuserJ. Factors influencing defensive medicine-based decision-making in primary care: a scoping review. J Eval Clin Pract2023; 29(3): 529–538. DOI: 10.1111/jep.13799, Epub 2022 Nov 26. PMID: 36433885.
51.
StuddertDMMelloMMSageWM, et al.Defensive medicine among high risk specialist physicians in a volatile malpractice environment. J Am Med Assoc2005; 293: 2609–2617.
52.
BishopTFFedermanADKeyhaniS. Physicians’ views on defensive medicine: a national survey. Arch Intern Med2010; 170: 1081–1083.
53.
MelloMMChrandaAGawandeAA, et al.National costs of the American liability system. Health Aff2010; 29: 1569–1577.
BraschiEStaceyDLegareF, et al.Evidence-based medicine, shared decision making and the hidden curriculum: a qualitative content analysis. Perspect Med Educ2020; 9(3): 173–180.
56.
MoynihanRGlasziouPWoloshinS, et al.Winding back the harms of too much medicine. BMJ2013; 346: f1271.
57.
PischeddaGMarinòLCorsiK. Defensive medicine through the lens of the managerial perspective: a literature review. BMC Health Serv Res2023; 23(1): 1104.
58.
Am Med News. Defensive medicine seeping into physician training, study says. 2012.
59.
AvrahamR. Clinical practice guidelines: the warped incentives in the U.S. healthcare system. Am J Law Med2011; 37(1): 7–40.
60.
JohansenMZhuL. Market competition, political constraint, and managerial practice in public, nonprofit, and private American hospitals. J Public Adm Res Theory2014; 24(1): 159–184.
61.
MoherDLiberatiATetzlaffJThe PRISM Group, et al.. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med2009; 6(7): e1000097.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
