Department of Medicine, University of California, San Francisco, San Francisco, California, USA
Department of Medicine, University of California, San Francisco, San Francisco, California, USA.
BMJ Qual Saf. 2019 Jul;28(7):564-573. doi: 10.1136/bmjqs-2018-008372. Epub 2019 Feb 4.
The second victim effect is defined as emotional distress experienced by providers involved in mistakes. This study characterises events contributing to the second victim effect among a diverse sample of physician mothers, describes the impact on both provider and patient and seeks to determine the association between experiencing a mistake and burnout.
In this mixed-methods study, an anonymous, cross-sectional survey was posted to an online network of over 65 000 physician mothers on 17 June 2016. Self-reported involvement in a mistake provided opportunity to describe the error and impact on both provider and patient. Free-text responses were qualitatively coded to identify error types. Hypothesising that making a mistake contributes to burnout, self-reported burnout was examined using a single question. We used logistic regression to estimate the association between involvement in a mistake and burnout, adjusting for practice years, setting and specialty.
5782 members completed the survey for an estimated response rate of 16.5% based on 34956 active users during the survey period. 2859 respondents reported involvement in a mistake (49%), which was associated with higher reported burnout (p<0.0001). 56% of those reporting a mistake provided descriptions. Qualitative analysis revealed that self-reported treatment errors were more common and diagnostic errors were most often reported to result in greater patient harm. Of those involved in a mistake, 82% reported feelings of guilt; 2.2% reported reducing clinical workload, taking leave or leaving the profession.
Physician mothers involved in errors experience negative outcomes and may be at increased risk for burnout. Additional research should focus on strategies to mitigate burnout associated with the second victim effect, particularly among women physicians and those with family responsibilities.
第二受害者效应是指涉及错误的提供者所经历的情绪困扰。本研究描绘了在一个多样化的医生母亲样本中导致第二受害者效应的事件，描述了对提供者和患者的影响，并试图确定在经历错误与倦怠之间的关联。
在这项混合方法研究中，于 2016 年 6 月 17 日向一个拥有超过 65000 名医生母亲的在线网络发布了一项匿名、横断面调查。自我报告的错误涉及提供了描述错误和对提供者和患者的影响的机会。自由文本回复被定性编码以识别错误类型。假设犯错误会导致倦怠，使用一个问题来检查自我报告的倦怠。我们使用逻辑回归来估计参与错误与倦怠之间的关联，调整了实践年限、环境和专业。
5782 名成员完成了调查，根据调查期间 34956 名活跃用户的估计，回复率为 16.5%。2859 名受访者报告了错误参与（49%），这与更高的报告倦怠相关（p<0.0001）。56%的报告错误的人提供了描述。定性分析显示，自我报告的治疗错误更为常见，诊断错误通常导致更大的患者伤害。在涉及错误的人中，82%的人感到内疚；2.2%的人报告减少临床工作量、休假或离开职业。
涉及错误的医生母亲会经历负面后果，并且可能面临更高的倦怠风险。进一步的研究应关注减轻与第二受害者效应相关的倦怠的策略，特别是针对女性医生和有家庭责任的医生。
