Episode 92: How to Avoid Becoming the Second Victim with Dr Caraline Wright & Dr Lizzie Sweeting

When something goes wrong, healthcare professionals often tend to feel responsible and develop shame and guilt as a result. In other words, we adopt the position of “rescuer”. But when we don’t handle adverse patient safety incidents well, we can become “second victims” as well.

In this episode, Dr Caraline Wright and Dr Lizzie Sweeting join us to discuss the second victim phenomenon. They explain why patient safety incidents are occupational hazards and how they can affect healthcare providers. Caraline then shares her personal experience of being in the “second victim” role.

Finally, they share tips on how to avoid second victimhood and how to provide support to someone going through it.

Listen to this episode to know more about the second victim phenomenon and how you avoid it!

Here are three reasons why you should listen to the full episode:

1. Understand what the second victim phenomenon is and why it needs addressing.

2. Learn what you can do to avoid becoming a second victim.
3. Discover the importance of workplace support systems in combatting second victimhood.

Episode Highlights

[04:31] What is a Second Victim?

• A second victim is a healthcare provider who becomes traumatised due to an unanticipated adverse patient event, such as a medical error or patient-related injury.

• The term was coined in the healthcare sphere for patient safety incidents. However, it can apply to other industries as well.

[05:33] How Patient Safety Relates to Second Victimhood

• Research shows that up to 50% of healthcare system staff can experience second victimhood as a result of a patient safety incident.

• As a result of being involved in a patient safety incident, someone can experience a spectrum of effects, from acute stress to suicidal ideation.
• The incident itself can also lead to medico-legal consequences. This, in turn, can cause more stress and anxiety for those involved.

[6:59] Determining Second Victimhood

• Second victimhood is specific to being involved in a patient safety incident.

• The feelings you get from a patient safety incident differ from the distress and fatigue associated with normal workplace pressures.
• Many healthcare professionals tend to be perfectionists. So, they feel shame and guilt from patient safety incidents, even if they are unavoidable.

[10:17] Caraline’s Experience with Second Victimhood

• In the first year of her GP training, she started handling a man with a long history of depression and alcoholism.

• He was known to have limited engagement with healthcare professionals, but Caraline built up a relationship with him.
• They got to a point where she felt he could reduce the frequency of his appointments. Shortly after, Caraline learned that her patient committed suicide.
• Though her mentors assured her they would not have done anything differently, she couldn’t shake off feeling guilty and responsible for this patient safety incident.
• Over the next 6-12 months, Caraline struggled with trauma, avoidance, guilt, and anxiety.

[14:47] Post-Second Victimhood

‘Bad things will happen. And we will make mistakes. But it’s finding a way to manage that and not let it impact on your sense of self.’

• While Caraline still feels emotional about what happened, she has realised that it’s part of the job.

‘The world that we’re working in, is getting more complex and busier all the time. So we’re going to make mistakes. And even if we don’t make mistakes, things will go wrong.’

• Since medics desire to help people, they are bound to experience shame and guilt in their profession.
• Following patient safety incidents, healthcare professionals tend to shift to a defensive practice or leave the career altogether.
• Shame from the patient safety incident also hinders them from sharing their experience. As such, we need to reduce the stigma associated with these events.

[21:52] How to React to Patient Safety Incidents

• Healthcare providers need to know that patient safety incidents are occupational hazards.

• When something bad does happen, organisations need to provide quick and appropriate responses tailored to the individual’s needs.
• These can be offering them space to talk with a peer, counselling, or time off work.
• If organisations can cultivate a supportive working environment, healthcare workers may not need individualised help.
• Looking back, Caraline feels this support would have been most helpful to her after the patient safety incident.

‘The thing that’s really helped me has been sharing and hearing other people’s experiences, and also how grateful they are that somebody’s talking about it.’

[28:44] How to Support Second Victims

• Listen with fascination. Just let someone talk and explain, even if you’ve not felt like that yourself.

• To help normalise their experience, let them know that lots of people feel the same way.

‘All you have to do is hear one story that sticks in your head.’

• Know that even if they are not to blame, they are likely to feel responsible. Instead of trying to fix the problem, simply try to empathise.
• Be aware of what second victimhood is and how that might affect your colleagues.

[34:06] Lizzie and Caraline’s Message About Second Victimhood

• Don’t be afraid to share your story, as it can be valuable to others.

‘That ability to connect and talk things through is better than kind of any support or counselling that’s on offer.’

• Having one another to talk things through can be helpful. For Lizzie, it’s all about the relationships at the end of the day.

[35:59] The Impact of COVID-19 on Second Victimhood

• Working remotely has caused us to become removed from one another, as we can’t create connections as well.

• However, with effort, we can still create spaces online.
• Rather than waiting for other people to set up peer networks, we can organise one for ourselves.
• The key is finding your tribe: the people that are really going to get you and you’re going to be able to talk to.

[38:07] Caraline and Lizzie’s Top Three Tips

• Know that second victimhood exists. If something happens, you can offer or seek support.

‘I think it’s often about, you know, the shared experiences and the shared learning that we can take from these things and not being afraid to share.’

• Have a support system.
• Be kind to yourself and your colleagues.

‘We just need to emphasise the importance of those relationships and connectedness amongst all of us.’

About the Guests

Dr Lizzie Sweeting is a GP Trainee who works in the emergency department at Bradford Teaching Hospitals. She is also the co-lead for the managing deterioration workstream of the Patient Safety Collaborative. Lizzie is an alumnus of the Improvement Academy, an organisation composed of improvement scientists, patient safety experts, and clinicians.

You can connect with Lizzie on Twitter.

Dr Caraline Wright is an Airedale General Practice Specialty Training and Health Education England Leadership Fellow. She holds a GP Cert in Medical Education from Lancaster University.

You can reach out to Caraline through Twitter.

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Episode Transcript

Dr Rachel Morris: Have you ever had an experience at work which has stuck with you and been particularly traumatic, even though you cope with lots of stressful stuff on a daily basis? Have you ever found yourself ruminating and going over what happened time and time again and felt like it was all your fault, even if your colleagues have reassured you that you’re not to blame? If so, you may have become a second victim.

In this episode, I’m joined by Dr Caraline Wright and Dr Lizzie Sweeting who are both GP trainees and GP clinical leadership fellows, both who have a particular interest in the second victim syndrome. Listen if you want to know just exactly what we mean by the second victim, and how it’s different from the usual stresses and strains of our jobs, and why it can have such a devastating effect on us, and why often things people say to us can make it worse, not better. Listen if you want to know the most useful way of dealing with it and supporting colleagues when we notice that they are struggling.

Welcome to You Are Not A Frog, the podcast for doctors and other busy professionals who want to beat burnout and work happier. I’m Dr Rachel Morris. I’m a GP, now working as a coach, speaker, and specialist in teaching resilience. Even before the coronavirus crisis, we were facing unprecedented levels of burnout. We have been described as frogs in a pan of slowly boiling water. We hardly notice the extra-long days becoming the norm and have got used to feeling stressed and exhausted.

Let’s face it, frogs generally only have two options: stay in a pan and be boiled alive or jump out of the pan and leave. But you are not a frog. And that’s where this podcast comes in. It is possible to craft your working life so that you can thrive even in difficult circumstances. And if you’re happier at work, you will simply do a better job. In this podcast, I’ll be inviting you inside the minds of friends, colleagues and experts—all who have an interesting take on this. So that together we can take back control and love what we do again.

I’d like to let you know about a webinar we’ve got coming up all about the three crucial conversations you need to have with your team right now to help them deal with their workload and beat the feelings of stress and overwhelm that many people are feeling at the moment. It’s totally free, and it’s particularly for leaders in health and social care. So if you want to build a robust team through difficult times without burning out yourself, then do join us by clicking on the link in the show notes to register.

It’s fantastic to have with me on the podcast today, Dr Lizzie Sweeting. She’s a GP Trainee on the Pennine scheme. She’s also a GP clinical leadership fellow, working currently with the Improvements Academy. Now, this is a team of improvement scientists, frontline clinicians, and patient safety experts, all put together to deliver real and lasting change. Welcome, Lizzie.

Dr Lizzie Sweeting: Thank you very much for having me.

Rachel: It’s also brilliant to have Dr Caraline Wright, who’s a GP Trainee in the Airedale scheme in West Yorkshire, and she’s also a GP clinical leadership fellow working with Health Education England on their future leadership programme. Hi, Caraline.

Dr Caraline Wright: Hey!

Rachel: Caraline originally got in touch with me after… I think we met during a Next Generation GP event that I was speaking at and we have, I think, mentioned a little bit about the second victim during the session. Is that right?

Caraline: Yeah.

Rachel: You’ve got in touch to say, “Actually, I think it’d be really good to do a podcast about this,” and then, having sort of chatted to Caraline and thought, “Actually, yeah. This would be a really, really important thing to talk about because I think it’s something that affects us all to some extent.” I know, Caraline, you’ve got some personal experience of that, haven’t you?

Caraline: Yeah.

Rachel: Then, Lizzie, you’re actually taking the lead on this for some work about the second victim for the Improvement Academy.

Lizzie: Yeah, I’m leading some work on kind of just coaching second victim network and we have a support website called secondvictim.co.uk. So we’re working closely with research teams on how we can best support healthcare professionals who experienced second victim.

Rachel: Great. It’s really great to have you both here to talk about this. I’m just so grateful you got in touch about it. Lizzie, can I start with maybe a definition of what a second victim is? Because I’m not always entirely clear about what we mean by the second victim.

Lizzie: Yeah, so there are various definitions out there but one that we use at the Improvement Academy and in our literature on the website is that a second victim is a healthcare provider who is involved in an unanticipated adverse patient event, whether that be a medical error or patient-related injury. They become victimised in the sense that the providers, the healthcare professionals, are traumatised by that particular event. It’s normally in the sphere of patient safety incidents is when second victim, as it’s often called, comes in play.

Rachel: Is it just healthcare that this happens or can it happen elsewhere?

Lizzie: So it’s been coined in the kind of healthcare sphere, kind of research has been coming out for 20 years, and it’s always been related to healthcare but I would imagine it is applicable to all industries.

Rachel: Yeah. Why did the Improvement Academy think it was really important to do this work?

Lizzie: One of my predecessors, one of the previous clinical leadership fellows, started this work back in 2017, and they had been working with a research group called the Yorkshire Quality And Research Group. They do a lot of research into workforce well-being, workforce engagement in the sphere of patient safety.

One of the colleagues who I work with, Professor Rebecca Lawton, does a lot of work in this sphere and found that it can happen to up to 50% of staff within the healthcare system can experience second victimhood as a result of a patient safety incident. They thought it would be a good idea to bring together all the resources and literature into one place to support staff involved in health care, patient safety.

Rachel: That’s a huge statistic. I was going to ask how much of a problem is this really. 50%. That’s a lot, isn’t it? What sorts of issues does it cause for people?

Lizzie: It can vary from person to person. It’s a spectrum like anything but some people can suffer from acute stress, others can be at the other end of the spectrum suffer from suicidal ideation and even suicide as a result of being involved in a patient safety incident. The incidents themselves can also kind of lead to medico-legal consequences, which then, in turn, can cause more stress and anxiety for those involved.

Rachel: How would I know if I have become a second victim? How would I know what the difference is between second victimhood and just sort of experiencing the stuff that goes along with the job, really?

Lizzie: Yeah and I think that’s a really important question, especially in the time of working with COVID and the increased pressures that all GPs and all healthcare professionals are working.

The second victim is related to patient safety incident; whereas I would say all those other things, though you can feel stressed due to workload issues and all the other things that are going on in the world, but second victim is specific to being involved in a patient safety incident. The feelings that you might get from being involved in that such as shame and guilt might differ from the distress and fatigue associated with normal workplace pressures.

Rachel: Does it always have to have an element of ‘This was my fault, it wouldn’t have happened if I hadn’t done this’?

Lizzie: Well, not necessarily. It might have been an unavoidable patient safety incident and I think what Caraline will go on to talk about later is something that was probably unavoidable. As healthcare professionals, we’re all quite perfectionists, aren’t we? We do things, and we don’t like making mistakes, let alone admitting them so I think there’s a lot of guilt and shame associated with being involved in an incident, even if it was a tiny part to play and nothing could have been changed.

Rachel: Does it always have to have an adverse outcome or can you be a second victim just if someone’s making a complaint, and it’s a bit vexatious and nothing really bad happened?

Lizzie: I think this is a bit contentious. At the moment, my colleagues and I, we’re actually doing a literature review into this. We’re finding that a lot of the papers in the academic world mix those together: whether it’s a complaint, whether it’s a traumatic event such as a cardiac arrest, for example, versus whether it’s something that could have gone wrong due to the error of the healthcare professional. It’s all quite mixed together, and it’s quite muddy water.

Rachel: Yeah. The problem with medicine is nothing’s ever really cut and dried, is it? I guess it’s like life, but I’m sure most people listening to the podcast will be able to put their minds back and think to times when things didn’t go to plan or something really dreadful happened, whether it was their fault, or whether they’re a sort of conglomerate of things that happen.

I can certainly remember some pretty dreadful stuff, actually, when I was working. I knew that happened and maybe things could have been done differently. Maybe they couldn’t but it was very traumatic to watch, and I think even if everything that could have been done was done, you always have that niggling ‘what if.’ ‘What if something different had been done? What if that hadn’t happened or this hadn’t happened?’ It’s quite hard to get your head around, really.

I think this is really helpful to discuss whether we are actually really having second victimhood issues or whether actually there are lots of little incidents that have gone along slightly. I think it’s that spectrum of things that can cause real stress. Caraline, I’d like to come to you because I know you’ve had some real personal experience with this. What happened to you?

Caraline: I was working as an ST1 so the first year of general practice training, but in a local practice. I really enjoyed it. I really liked the practice and the team had really good feedback, and my supervisor was really great. I was seeing a patient in his 30s and recently had a baby. He had a long history of depression and heavy drinking. He’d always had limited engagement with the practice.

He’d see a GP once and then not sign up to the follow-up appointment and then wouldn’t see anyone for sort of six months to a year, but he had multiple visits to see me over a three-month period. I felt that we really built up a relationship. He started self-help and started taking antidepressants, reduced his drinking, which was a massive achievement, and started attending a family support group.

We reached the stage where we both thought that we could reduce the frequency of his appointments. The next would either be his antidepressant review or earlier if he felt that he needed it. A couple of weeks passed, it was a Friday afternoon, which is when I always had a tutorial with my trainers, and neither of us had any appointments booked in. My trainer came into my room and told me that this man that I’ve been seeing had committed suicide, and he’d found out the day before.

He gave me lots of support. He already reviewed the record and discussed with the other partners in the practice. They agreed there was nothing that they would have done differently, so there was no blame or criticism. No one told me that I’d done anything wrong. It was explained to me that there would be a significant event within the practice, and I was encouraged to reflect on my portfolio, which is something that all GP trainees and DPDs do.

He also told the training program directors who were the people that run your GP in your area so that I had other people to talk to if I wanted to. I sat in my room and I felt completely devastated and overwhelmed and really sad for the family, but the thoughts that were going through my head was that I should have been able to do more, that I should have been able to prevent it. I kept asking myself, ‘Would things have been different if it’s in a different GP?’

I thought that I can’t be a doctor. I felt that I was incompetent and actually, even if I wasn’t incompetent, I was too emotional because if this has destroyed me, then maybe I’m just not cut out to be a GP. And I love general practice. Overwhelmingly, I felt that my colleagues, my peers, and my friends and family, would think that I should have been able to do something, that I’m responsible for this man, and that I’m a bad doctor, and an awful person.

I plucked up the courage to ring my mum. She trained as a psychiatric nurse, and she worked in the community for many years. I thought that she would have been through a similar experience, and she told me that she’d never been in the same position, which reinforced my feelings. And I was then too ashamed to share with anyone else. I went home but I didn’t tell my husband or my friends and over the following six to twelve months, I really struggled with the components of second victim: so with traumatisation, avoidance, and guilt.

In terms of traumatisation, I had lots of really intrusive thoughts. I felt like I was re-experiencing the events. I had a lot of vivid dreams, slept very poorly, and I was quite tearful. I felt very anxious and overcautious whenever I saw patients that were low in mood, and I felt a real deep sense of guilt and shame that was really overwhelming at times. Also in relation to other similar situations where somebody jumped in front of a train I was on about six months later, and I felt incredible guilt and responsibility for that.

Then, even after I’d been through the significant event, which actually was quite helpful in my practice, being able to go through and review of history, even being able to understand the contributing factors to the situation, I still felt that I was the responsible practitioner, and that patient put their trust in me, and I should have been able to do something. I still shared my experience and my thoughts and feelings and I’ve been able to gain perspective and it’s become manageable but it’s illustrated how important the issue is and how much we do need to talk about it.

Rachel: I’m just so sorry to hear that you went through that, and it sounds like it’s still quite an emotional thing for you now thinking back on it. How do you feel sort of looking back on all that?

Caraline: I think I do still feel emotional, and I think that as healthcare professionals, we all have some sadness or regret that we carry in our hearts. They’re always certain patients and certain circumstances that hit more of a nerve with you than others but I think now, I sort of realszed that it’s part of the job ,and it’s a privilege of what we do. Bad things will happen and we will make mistakes, but it’s finding a way to manage that and not let it impact on your sense of self. Because that’s what really happened with this that really impacted on how I viewed me. I felt like it was an intrinsic issue with me.

Rachel: That’s really difficult, isn’t it? When it’s part of your identity and part of who you are, and then, presumably, that just exacerbates the shame that people can feel.

Lizzie, is that a fairly typical reaction that people have? What does the literature say about that?

Lizzie: Yes, I think one of my colleagues who has previously worked in an occupational psychologist, well, she describes patient safety incidents for healthcare professionals as an occupational hazard. The world that we’re working in is getting more complex and busier all the time so we’re going to make mistakes, and even if we don’t make mistakes, things will go wrong. I think, especially within medics, as I mentioned before, we’re a certain type of person that goes in, we want to help people.

That’s kind of what we are and I know I’ve listened to a few of your podcasts before and you think about the Drama Triangle. We always want to be the rescuer in a situation with a patient. We never want to be seen as a perpetrator. And I think all the feelings that Caraline has shared there, yeah, I’ve heard her talk before about this, and it’s still emotional listening to her share her story now.

It’s not something that I’ve not heard before. I think we’ve all heard similar stories, whether it’s someone that’s been involved in a different type of incident and had not so much of the intrusive thoughts but still felt that shame and that guilt. I think it’s something that we’re all bound to come across.

Rachel: From the literature, which that I know, Caraline talks about trauma and she talks about avoidance and then sort of the guilt and shame. Out of those, what tends to be the most prominent?

Lizzie: I think the confidence that Caraline has mentioned there. It’s been shown in one paper that following a patient safety incident and involvement in that, the healthcare professionals make the change to defensive practice because they’ve been involved and have been scarred by what’s ever happened in the past. That’s a real common theme that comes out of those that have been involved in patient safety incidents. It can lead to absence, even leaving the career as Caraline described there, and that’s been reported in the literature as well.

Rachel: Yeah, so you’ve got leaving career. You’ve got avoidance practice, which isn’t good for the doctor or the patient because you need to get over investigation, take a lot of time, adds to your stress. You’ve got the general stress of the traumatic thoughts and things so it’s generally really, really bad news, I guess if it’s not sorted and treated.

In a minute, I’m going to ask you, what should we do, first aid for a second victim, but I just wanted to pick up what Caraline’s saying about felt that you couldn’t share it with your friends and your partner. Is that a very common thing that you’ve seen in the literature as well?

Lizzie: I think that shame element, yes, definitely. I think a lot of the work we’re doing at the moment is to try and reduce the stigma associated with being involved in something like this that Caraline and I were discussing earlier about. If you know someone else has been through it, whether that be within your training scheme, within your organisation, within the region, that you have someone to turn to, to just talk, and there’s no judgment there. That’s something that is harder to measure in terms of literature but it’s something that’s recognised as something that can be really supportive.

Rachel: Caraline, looking back on this whole thing, before it happened, would you ever have been able to predict that that was the way you would react?

Caraline: No, I don’t think I could have predicted it would be quite so distressing for me because there have been other experiences that I’ve had, particularly in ANE that have been very distressing but they just didn’t have the same effect on me. I was aware of the concept of second victim, but I always thought it was in relation to errors, and everyone told me that I hadn’t made an error. I just thought that it was because I was a bad doctor.

Rachel: Do you think that we tell ourselves these stories? Even if we literally haven’t done anything wrong, our brains always trying to tell ourselves the stories, ‘It must have been something you did wrong. It must have been a defect in your training or your learning or something wrong with you that this has happened.’

Caraline: Yeah, I definitely took on the responsibility for it, which we do. It’s the same back to that Drama Triangle. We take on a lot of responsibility from our patients, and I just kept thinking that I was responsible for this patient; therefore, I should have been able to do something to prevent what happened.

Rachel: It’s a very difficult thing, isn’t it? Because we’ve just done a series on complaints and mistakes and how to deal with them and there’s a lot of stuff around the shame that we feel and the upset and the defensiveness, even if it’s not our fault. I think the thing I struggle with, ‘What if it is our fault?’ There will be things that happen that are our faults because nobody can run on a 100% success rate.

I was wondering if this whole second victim thing is worse the more personal responsibility we do have if actually, you can directly trace something you did do or you forgot to do to the harm that’s been caused or to the adverse event. Does that make things a lot worse or is there not really much correlate?

Lizzie: I think that there’s work going on in this at the moment. And this research is looking into it and there’s not a lot of literature out there around the whole second victim phenomenon. The first time it was coined in literature was only in 2000, so we’ve made great progress to get to the point where we’re talking about it now, but I think it will only be going forward, that we’re able to kind of get those insights into whether there is a relationship between the severity of the incident and then the severity of the response to it.

Rachel: Then, what seems to help? What helps in this situation? I was interested that Caraline said she couldn’t have predicted it would be, which incident would it would have been, or whatever has been through seeing lots of dreadful stuff in ANE, as you do, and suddenly, there was this one thing. There’s thhis one thing. Given that you can’t predict it, what should you do when it happens?

Lizzie: I think it’s tricky, and we’re working on this at the moment because often, it’s quite piecemeal by organisations and what support they can provide to staff depending, for example, if they’re a trainee, they have the Royal College involved, they have the Education Board. There’s lots of different players, so it’s quite hard to have an approach that suits everyone and is individualistic. But I think it’s about we’ve talked about providing a supportive working environment that if something bad does happen, that staff are encouraged to adapt and are aware that this happens, and this is an occupational hazard.

Then, if something does happen, which as that is probably likely to happen to all of us at some point in our careers is that organisations are able to provide quick and appropriate responses to supporting staff and tailor that to an individual, whether it’s offering them the space to talk with a peer, whether it’s offering them counselling. For some people, it might be a period of time off work, and for others, it might be that they need to stay in work and have something else to concentrate on. I think it’s really hard to pin down but I think it needs to be done on an individual to individual basis.

Rachel: How important do you think is that whole counselling-type professional debrief of the incident?

Lizzie: Some of the work we’re doing at the moment, actually, we’re finding not that important. We’re finding actually that if you get things right in creating a supportive working environment, whether that be having Schwartz rounds where senior leaders talk about when they’ve made a mistake or having that peer support network. We talked about having those relationships between one another, which, I think, COVID has somewhat not helped with, in the fact that we can’t have those personal connections sometimes with staff.

I think if you get that right, then going on, if someone is involved in a patient safety incident, then hopefully, they won’t need the counselling or the more individualised responses. But it’s hard to measure, isn’t it, all these relationships and treatment of staff and culture. It’s a really, really muddy world.

Rachel: Caraline, looking back, what would have been helpful to you?

Caraline: I think the thing that Lizzie was saying about peer support would have been the most helpful because although my trainer and practice were really supportive, I was just too ashamed to tell them what I was thinking and that I was struggling. Every time anybody asked me how I was, I just said I was fine.

Part of that as well was because I felt the thoughts were so distressing, I didn’t really want to think about what was going on. I think if I had somebody who was slightly removed but in the same profession, so through that peer support, just to be able to share my experiences and for them to share theirs as well and to help normalise it and just to let you talk and let you explore your thoughts, a little bit like in coaching, and to sort of really unpick what was going on.

Because the thing that’s really helped me has been sharing and hearing other people’s experiences and also how grateful they are that somebody’s talking about it and that realisation that there are other people who have felt exactly the same.

Rachel: Someone you could have just phoned up and say, ‘This thing has happened. I just need to chat. Can we go for a drink? Can we go for a chat?’ Would you think it would have sort of de-escalated in your mind and process it a bit differently?

Caraline: Yeah, perhaps. And I think that’s probably an individual thing but I think because in this situation, I felt like it was so intrinsic. I wouldn’t have been able to find somebody that was a friend to talk to them about it. But had there been sort of a peer support network through sort of the scenery, that would have been useful to talk to somebody in a similar situation but that’s a little bit removed.

Rachel: Just sort of struck by the fact that at the time, you were in a training practice, you had a trainer who sort of heard about it, checked things, broke the news to you, and hopefully, to the best way possible, he reassured you. You’re able to talk to your TP. All those sorts of things, they were in place.

I’m just conscious that there are other doctors that this happens to a lot who aren’t trainees anymore. They might be consultants, they might be GPs, they might be the senior partner in their practice and sort of they’re running the show and they might just not have that buffer of people. Lizzie, does the second victim thing, does it change with experience? Is there any evidence that you get more used to dealing with it or is it just as bad?

Lizzie: There’s no evidence to support either way with that but I think I was listening to someone talk the other day saying that they had spoken with a consultant who was three months away from retirement and had never had a patient safety incident in their career. They’d been a consultant for nearly 20 years, and then, something happened just as they were kind of looking towards retirement and it hit them just as bad as it hit the junior doctor. It was their first mistake. It’s very individual, isn’t it, how everyone copes with these types of incidents.

Rachel: You may not have that sort of immediate support. You might be the one giving support to other people, then suddenly, you need it and then, it might be even more difficult to ask for help if you’re the person usually who’s helping them. As I can imagine, it would be really, really quite tricky.

Like Caraline says, I think it’s that peer support that’s so lacking sometimes, that being able to just debrief with, either formally or informally, with colleagues who have got your back and who you like and who you trust. I guess that’s the importance of building trust within teams and informal connections within the workplace and things like that.

I’m also interested in how we support other people with this. Caraline, you said you phoned your mum, and her response actually made you feel worse, and I’m sure she obviously didn’t mean that. She was just being honest. She hadn’t ever come across that. What can people do when people do tell them things, that someone can come to you and express what had just happened? What’s the most helpful thing that would have been helpful for you at the time?

Caraline: I think the whole just listening. Anybody who’s had sort of experience of coaching, Nancy Kline’s concept of listening with fascination, just letting them talk, explaining even if you’ve not felt like that yourself and that you know how common it is and you know that lots of people feel that way to help normalise it. Just let people talk, and let people explain how they feel and explore what’s going on for them.

Rachel: There’s nothing really possible that you can actually say that’s going to make it better but actually, that just being there and listening and the empathy can be really helpful.

Caraline: Yeah, because like you said, everyone said to me, ‘Well, it’s not your fault. You’re not to blame.’ As if that sort of makes it okay because I think that we, as healthcare professionals, we want to know what went on, was it my fault? But that doesn’t change that you feel responsible.

Rachel: The feelings often outweigh thinking, don’t they? They trump thinking no matter how irrational they might be.

Lizzie, we talked about the importance of workplace stuff but I’m sort of quite interested in, as individuals, what can we do to prevent this or almost sort of catch ourselves in the moment or flag up, this might be a risk factor, a red flag for a second victim situation? Is there anything that might just flag up to us when it might be one of those situations for either ourselves or our colleagues?

Lizzie: I think it’s tricky. I think just we all need to be aware ourselves of what the second victim is and how that might affect our colleagues differently. So just by raising awareness and talking about these types of feelings and the reactions to being involved in events, as Caraline said.

Not normalising the fact that something has gone wrong but normalising the fact that we’re talking about something like this and that it does happen to us all and I think, as Caraline has shared, being vulnerable and allowing others to see that so that if something does happen to them, they might talk to you about it. You might not be able to help them even by just listening but you might be able to point them in the right direction and say, ‘Oh, actually, have you considered that you might need some extra support other than just talking?’ And just knowing that there is that…

Rachel: I’m just wondering, what should you do if you spot someone? Do you think actually they are really suffering from the second victimhood right now to pointing them to some support? Is there anything else you can do there?

Lizzie: It’s tricky, isn’t it? I don’t know how you would feel. I would feel if someone came up to me and I thought that they commented that they thought I was maybe struggling, that might seem as a bit of a personal attack on me, and I would feel ashamed, and that could just all add up to the whole feeling of second victim. I think it’s a hard one, I think you just got to be really individual but just know that it’s out there.

Rachel: Caraline, what would have helped, when you were sort of in that place where you were withdrawn and not talking to people and whatever, what could someone had done to sort of break in there and support you?

Caraline: I think if somebody had shared a similar experience with me. And I would have been able to identify a little bit within that actually, this is very common, and I’m not the only person that felt like this, which is one of the reasons why I thought it was so important to come on and do this podcast with Lizzie to share all of her learning and knowledge. Because I just think all you have to do is hear one story that sticks in your head.

Rachel: That really strikes me, that what you’re not wanting is someone to come along and say to you, ‘Not your fault. It’s going to be okay. Don’t worry.’ What you wanted was someone’s come along and go, ‘That’s really crap. I’ve been through that as well. We all go through it. It’s an occupational hazard.’ It’s the listening and the empathy rather than just trying to fix it. How long did you think it took you to sort of come out of it and feel like you were recovering?

Caraline: I think I probably had about six months when it really affected me, and then probably sort of another six to twelve months after that when it would raise its head in different circumstances. Then, I finally plucked up the courage to share with the other fellows in the Future Leaders Program because that’s such a supportive, safe environment, and that was really helpful.

All the messages that I got from people really sort of helped put it to bed in a way, not that I don’t still think about it and sometimes, things trigger it. But now, I’m aware of what’s going on and I can stop and think because I have a lot more insight now.

Rachel: I’m sort of quite interested from you, Caraline and Lizzie, with your work. What do you really think people need to know, and what message would you like to get out there about the second victim?

Lizzie: That’s a really good question, Rachel. I think I’m repeating myself, but just knowing that it’s there, and I think being able to share your story, you might see that as being vulnerable but actually, people really value. And that ability to connect and talk things through is better than kind of any support or counselling that’s on offer, just having one on another, talk things through with. I think that’s what strikes with me. It’s all about the relationships at the end of the day.

Rachel: Yeah, but we’re not so good at doing that. I think as professionals, we don’t like to admit when we’ve made mistakes or whatever but personally, when I’ve heard about other people’s journeys and what’s happened to them, it’s just sort of ‘It’s okay. That’s okay. It’s okay.’ It sort of giving you permission not to do shoddy work but to forgive yourself realise that this is an occupational hazard, as we said in another podcast on complaints.

Someone was saying they teach their medical students to say, ‘I am going to make mistakes and some of them will be serious and then maybe a second. And that’s okay because actually, we’re human beings, aren’t we, at the end of the day.’

Caraline, what message would you really like to get out there if you could?

Caraline: Similar to Lizzie, but I think just talk to somebody and if you feel like you’re too ashamed to talk to anybody, that there will be somebody. Everybody has a defence organisation and actually, you don’t have to have made an error to talk to them. They’re there to support you. There’s already always somebody that you can talk to, and it and it will help.

Rachel: In a second, I’m going to ask you for your three top tips just to sort of put this to bed. I just quickly want to touch on COVID because we talked about this fact earlier, that COVID has changed everything, and there are probably lots of different incidents happening during COVID. Lizzie, have you guys seen a change in the sort of second victim stuff that you’re seeing as a result of COVID?

Lizzie: I think not as a result of COVID itself, but I think the fact that we’re all removed from one another, a lot of us are working remotely, you don’t have the time to create those connections with people. I think, as Caraline says though, you can actually create safe spaces online or on Zoom, whether it be on teams, for people to share but you just need to put a bit more into it. I think COVID has a lot of negatives, but it can bring people closer together as well.

Rachel: Reflecting on that, I actually think that sometimes, it’s easier to share things in a sort of Zoom room than it is when you’re face to face. Certainly, with busy professionals who just don’t have the time to be able to jump on an hour over an interacting virtual meeting in an evening. It’s a lot easier than having to travel to find a venue or sit in someone’s front room. You can do it, and it does seem quite a safe space. So I think we probably need to start utilising that a bit more.

I know Caraline mentioned earlier, it would have been great if there was an official peer support network had been set up but actually, that’s something we can do for ourselves. Find out who your mates are around, find out who are people in similar situations, similar times of life, actually form a group that you just meet up either just for drinks, or just to chat, or to just do some case review, or share things that have gone on. I bumped into someone, I think lead managed thrive courses.

It was before COVID, actually and he was there was a GP so I’m just about to go on my yearly weekend with my young practitioners’ group. He said, “We’ve been doing 40 years. It’s brilliant.” He said it was what had kept him going, because there were people that got him that he knew if he had any issue at any point, he would just be able to phone up and have them then.

Sometimes, it’s actually taking that step and doing that for ourselves rather than waiting for it to be set up and people move into new areas and stuff. Sort of, find your tribe, find the people that are really going to get you and you’re going to be able to talk to. We’re very nearly out of time.

Caraline, let’s come to you. What would you be your three top tips for people?

Caraline: I think, firstly would be just to bear second victim in mind, just have it in your head. Say that if something happens and you identify with that yourself or you see it in others, just say that you can be there to offer the support or get that support yourself. Secondly, I would say just like you’ve been saying, have that support network there, whether it’s one person or a group of people, have people that you feel truly safe to share those things with and be there for them as well when they need to do the same. Then thirdly, be kind to yourself and be kind to the colleagues that you work with. We’ll all make mistakes, we’ll have bad things that happen and just be nice to each other. Be nice to yourself.

Rachel: Yeah, be kind, definitely to your colleagues, and even more to yourself. Because that’s what we do, it can be quite atrocious, can we? You’d never speak to your best friend, the way we speak to ourselves. Thank you and what about you, Lizzie?

Dr Lizzie: On a similar theme, really, I think the importance of having a supportive and working environment so those relationships and connections between one another. I think, as Caraline just mentioned, the importance of being kind to one another and ourselves, I think, maybe some of the importance behind that has been lost recently and it’s kind of trotted out is something that we should all be doing but we need to be kind to all of us ourselves, especially in the current climate. Then, I think it’s often about the shared experiences and the shared learning that we can take from these things and not being afraid to share.

Rachel: I think it’s a very brave, courageous thing that you can do that will help so many people. Lizzie, the work that you’re doing, where are you sort of hoping it’s going to end up or lead to?

Lizzie: We have a website at secondvictim.co.uk, which is regularly updated with the literature and kind of real-life case studies of how things work in practice. It’s for individuals that think they might have second victim. It’s for managers that are looking after people that might have been involved in incidents. It does have some stuff stories on there, and then, we’re leading a wider piece of work on just culture, which is a whole other topic in itself but we have a network in Yorkshire and Humber where we bring work from this with the Yorkshire Quality and Safety Research Group that we can share to lots of organisations.

Rachel: What sort of training do you think people need to have in this sort of stuff?

Lizzie: I think training would be the wrong word because I think that would suggest it was like a tick box exercise. Once you’ve done your training, you’re competent and…

Rachel: Boom, right. Send those second victims in. Is there anything more about that, any more?

Lizzie: Yeah, but I think we just need to emphasise the importance of those relationships and connectedness amongst all of us and that’s hard to do.

Rachel: Yeah, yeah and just culture and relationships, topic for a completely separate podcast. In fact, we have just released one on relational abuse in the workplace and we’ve done quite a few about speaking up and it all adds into that, doesn’t it? I think I would just say at the end of this, we’ve been talking about having a supportive working environment, that there are not always things we can do to massively change that but the one thing we can do is be vulnerable ourselves, get to know people on a personal level, just by having coffee, having lunch, chatting away, sharing your own experiences.

If you can start to change that just individual by individual, then, you’re going to start to affect the culture where you work. Everybody, go find your tribe, make sure you’re connecting with people regularly, make sure you’re recognising if you’ve been a second victim in an incident or something that’s gone on and reach out and get the help you need. There are professional organisations out there who can help. There’s practitioner health. There are a lot of counselling and coaching and support out there so please, please don’t go it alone. Do reach out and talk to people.

Thank you, girls, so much for being on the podcast. It’s been fascinating, and just thank you for reaching out and suggesting this as a topic as well.

Caraline: Thank you.

Rachel: I’d love you to come back and share your findings in the future about what’s happening and maybe we should do another one about just culture and more relationships in the workplace. Watch this space. See you soon, thank you.

Caraline: Thank you.

Lizzie: Thank you, thank you.

Rachel: Thanks for listening. If you’ve enjoyed this episode, then please share it with your friends and colleagues. Please subscribe to my You Are Not A Frog email list and subscribe to the podcast and if you have enjoyed it, then please leave me a rating wherever you listen to your podcasts. Keep well, everyone. You’re doing a great job. You got this.

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Check out this You Are Not A Frog episode:

• E86: Gaslighting and Other Ways We’re Abused at Work: What’s Really Going On? with Dr James Costello

Check out the Complaints and How to Survive Them Series!

• E78: Preparing to Fail Well with Drs Sarah Coope, Annalene Weston and Sheila Bloomer
• E80: What to Do When You Make a Mistake with Drs Clare Devlin and John Powell
• E82: Surviving the Process with Drs Jessica Harland, Caroline Walker, and Heidi Mounsey
• E84: Creating a Workplace Where It’s OK to Fail with Prof Susan Fairlie and Dr Jane Sturgess
• E87: What Should I do When I Think a Complaint is Unfair? And Other Questions with Drs Sarah Coope, George Wright, Samantha White, and Andrew Tressider

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