What Happens to the Physician After an Adverse Event
Patients are harmed first, but clinicians carry the aftermath too. Recognizing the second victim experience and responding well can protect both the person and the care that follows.
You find out on a Tuesday afternoon. A result you reviewed was more significant than you realized, and a patient was harmed. The formal review starts, the disclosure conversation is scheduled, and your clinic continues as usual. By evening you have replayed the decision dozens of times. You are not sleeping. You wonder whether you should be practicing at all.
This experience has a name in the patient safety literature. Clinicians involved in an adverse event, especially one involving error, are sometimes described as second victims. Some find the term uncomfortable because the patient and family are always the ones most harmed. Whatever you call it, the reaction is common, it is human, and it deserves a deliberate response.
What it tends to look like
Reactions vary, but physicians often describe intrusive replaying of the event, guilt and shame, fear of judgment from colleagues, anxiety about the next similar case, and a loss of confidence that makes routine decisions feel heavy. Some people practice more defensively for a while. Others withdraw from colleagues just when connection would help most.
The worst time to be alone with a mistake is the week after you make it.
If it happens to you
- Tell someone you trust, early. A peer who has been through something similar is often the most helpful listener.
- Ask whether your organization has a peer support program. Many do, and conversations with trained peers are typically kept separate from the formal review.
- Participate honestly in the review and in disclosure. Transparency with the patient and family is the right thing to do, and many physicians find it part of their own recovery.
- Protect the basics for a few weeks. Sleep, food, and time away from the chart matter more than usual.
- If distress persists, if you are unable to function, or if you have thoughts of harming yourself, reach out to a mental health professional or crisis resource right away. You deserve the same care you would want for a colleague.
If it happens to a colleague
You do not need special training to help. Check in within a day or two. Say something simple, such as that you heard about the case and wanted to see how they are doing. Listen more than you advise. Avoid the reflex to reassure that it was not their fault, which can feel dismissive, and avoid second guessing the clinical details in the hallway. Offer practical help with coverage if it is possible.
Leaders have an outsized role. A chair who calls, makes clear that the review is about learning, and connects the physician to support sends a message the whole department hears. A culture where clinicians can talk about harm without being isolated is also one where problems get reported sooner, which is ultimately better for patients.
Dr. Okafor is a general internist and contributing editor who writes about primary care redesign and the economics of the exam room.
This article is for professional education and does not replace clinical judgment. Treatment decisions should be based on the individual patient and current guidelines.
