Why the term “second victim” needs to be abandoned

I strongly believe the term “second victim” needs to be abandoned. I suspect this term serves a purpose in making the topic of medical errors more palatable to healthcare workers. But I don’t think the choice of words is appropriate. I hope I can explain why.

A term is needed to refer to healthcare workers who have been involved in a medical error—and “second victim” is much shorter than the phrase “healthcare worker involved in a medical error”. I want to make clear that in no way am I trivializing the horrible experience of knowing that action meant to help a patient caused harm instead. (I live in Seattle, where several years ago a nurse died by suicide after making an error in drug dosing that led to an infant’s death.) I fully support initiatives by healthcare institutions to establish “Care for the caregiver” programs.

But the term “second victim” is not appropriate.

One of the earliest uses of the term is an editorial in the British Medical Journal published in 2000 called “Medical error: the second victim. The doctor who makes the mistake needs help too”. This term has become very, very popular. Google the phrase “medical error victim” and look at the results. Notice the proportion that refer to the patient. Then do a Google image search. You will see stock photos of distraught physicians. We have a problem. We have a big problem.

The healthcare profession has a long history of being physician-centered. This term brings the concern right back to physicians. And that is not where the emphasis needs to be. Harmful medical errors maim and kill patients. It is patients’ bodies and families that are torn apart. The term “second victim” deflects attention from that reality.

While I was at Telluride patient safety camp last summer, participating in a discussion with medical residents, one resident mentioned “second victims”. I tried to explain why that term is viewed as inappropriate by many of us on the other side of medical errors. She suggested that maybe the families could be referred to as “third victims”. I said no, it is not right for people to be assigning themselves the title “victim”. It is insulting to those injured and killed by medical errors.

I don’t even like to call my father a victim of a medical error. Lately I have been saying he died after a serious medical error. If I can change the language I use, so can the healthcare system.

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