By Mathew Grimbeek — Medico-Legal
When something goes wrong in healthcare, the patient must remain the central concern. That is both ethically and legally correct. Patients and families are entitled to honest communication, appropriate support and a proper explanation of what occurred.
What is less frequently acknowledged is the impact that an adverse event can have on the clinician involved.
The term “second victim” is used to describe healthcare professionals who experience emotional or psychological distress after an unexpected outcome, clinical error or serious patient safety incident. For many practitioners, the event does not end when the immediate clinical crisis has passed. It may be followed by guilt, anxiety, self doubt, fear of disciplinary action, concern about litigation and uncertainty about how to engage with the patient or family.
These responses are not necessarily an indication of weakness or poor professional resilience. They are often the consequence of working in an environment where decisions carry significant consequences and where even competent, careful practitioners may encounter outcomes they did not intend or anticipate.
The medico legal significance of this is often underestimated.
A distressed clinician may become guarded, avoid difficult conversations or communicate in a manner that appears defensive. Documentation may become unusually cautious or retrospective. Colleagues may distance themselves from the practitioner because they are uncertain about what can safely be discussed. The organisation may focus so heavily on investigation and accountability that the human impact of the event is overlooked.
None of this assists the patient.
Patients and families are particularly sensitive to silence after an adverse outcome. When communication becomes delayed, vague or overly formal, they may reasonably conclude that information is being withheld. Distrust grows quickly in that environment. What may initially have been a difficult clinical event can then develop into a complaint, regulatory process or legal dispute because the relationship itself has broken down.
Supporting the practitioner is therefore not inconsistent with accountability. Proper support can improve accountability by enabling clinicians to participate more openly and constructively in the response to an incident. A practitioner who feels psychologically safe is more likely to provide a clear account, engage honestly with the patient and contribute meaningfully to organisational learning.
This is where the principles of just culture become important. A just culture does not excuse negligence, dishonesty or reckless conduct. It distinguishes between human error, system weakness and conduct that genuinely warrants sanction. That distinction matters because healthcare professionals are less likely to report mistakes or near misses when every adverse event is immediately approached as a disciplinary issue.
The absence of support also creates longer term risks. Some clinicians lose confidence, withdraw from complex work or leave practice altogether. Others continue working while experiencing significant anxiety and emotional exhaustion. These consequences affect not only the individual practitioner, but also clinical teams, patient relationships and the broader healthcare system.
Healthcare institutions should therefore have clear processes for supporting practitioners after serious incidents. This may include confidential peer support, appropriate counselling, guidance on communication with patients and families, and fair participation in the review process. Support should not interfere with investigation, nor should it become a means of avoiding responsibility. It should allow the process to take place in a manner that is humane, balanced and more likely to produce meaningful learning.
Patient safety and practitioner wellbeing should not be treated as competing interests. In many cases, they are closely connected. Clinicians who are supported are better able to communicate, reflect and continue practising safely.
When healthcare professionals become the second victims of adverse events, ignoring their experience does not strengthen accountability. It may instead deepen the harm, weaken trust and make future incidents more likely.