Second victim: the doctor after a mistake

The shift ended hours ago, but the resident is still going over the same scene. The abdominal pain that seemed benign, the discharge, the patient returning the next day in a serious condition. She sleeps badly, rereads the chart, avoids the colleague who took over the case and wonders whether she chose the right profession. No one on the team touched on the subject.

NEXO is a daily medical diagnosis game: one clinical case a day, six progressive clues, and ICD-10 proximity feedback across five levels.

This experience has a name. Second victim is the health professional who suffers after an adverse event with the patient, who remains the first victim. This guide explains where the term comes from, what studies show about the impact and recovery, what is known about support programs and how students and residents can prepare.

Key points

• The term second victim was proposed in 2000 to remind us that the doctor who makes a mistake also needs help.
• In a large survey, most doctors reported more anxiety about future errors after an error, and a minority felt supported by the institution.
• Recovery usually follows six predictable phases, from the initial confusion to the moment of moving on.
• Peer support is the most studied intervention, with short-term benefit and still limited evidence for the long term.
• Residents live the same experience as experienced doctors and prefer to talk with colleagues.

What the second victim is

The origin of the term

Albert Wu published an editorial in 2000 whose subtitle sums up the idea: the doctor who makes the error also needs help (Wu, 2000). The text drew attention to a suffering that used to stay hidden, because medical culture treated the error as a personal failure to be overcome in silence.

A definition in evolution

A systematic review that gathered 32 research articles and 9 texts of another nature recorded that Wu described the phenomenon in 2000 and that Scott and colleagues proposed a detailed definition in 2009 (Seys et al., 2013). In the most used definition, the second victim is the professional involved in an unexpected adverse event who feels responsible for the outcome and begins to doubt their own skills.

The term has critics. Some recall that the word victim can sound as if the professional were competing for the patient's place. The use here follows the literature: the patient and the family come first, and recognizing the professional's suffering serves to help them return to providing good care.

What this guide covers

The conversation with the patient after the error and the student's chronic exhaustion have their own guides in this series and appear here only in passing. The focus is what happens to the professional in the hours, weeks and months following an adverse event.

The impact of the error on the doctor

What the surveys show

A survey answered by 3,171 doctors from four specialties in the United States and Canada, with a 64% response rate, examined how errors affected five domains of life and work (Waterman et al., 2007). After an error, 61% reported more anxiety about future errors, 44% loss of confidence, 42% difficulty sleeping and 42% lower satisfaction with work (Waterman et al., 2007).

The stress was not limited to serious errors: a third of the doctors involved only in near misses also reported more stress (Waterman et al., 2007). Only 10% agreed that health institutions supported them adequately (Waterman et al., 2007).

When suffering increases

In the same study, suffering after serious errors was more likely among doctors dissatisfied with the way the error was communicated to the patient (Waterman et al., 2007). The finding connects two themes: a frank and well conducted conversation with the patient seems to help the person who made the error as well.

How many professionals go through this

In the 2013 review, the prevalence of second victims after an adverse event ranged from 10.4% to 43.3% across studies (Seys et al., 2013). The reactions described were emotional, cognitive and behavioral, and coping strategies had an impact on the professionals themselves, on colleagues and on subsequent patients (Seys et al., 2013).

Changes in practice

The same review recorded defensive changes and constructive changes in practice after the event (Seys et al., 2013). Ordering excessive tests out of fear is an example of the first type; revising a protocol or changing how handovers are done is an example of the second. The difference between the two paths depends heavily on the support the professional receives.

The phases of recovery

A predictable course

In a study with interviews of 31 second victims from different professional groups, symptoms did not differ by sex or by profession (Scott et al., 2009). The analysis identified six phases in the natural history of the phenomenon (Scott et al., 2009):

1. Chaos and response to the accident: the event happens, the team treats the patient and the professional is still running on autopilot.
2. Intrusive reflections: the scene comes back several times, with questions like "what if I had done it differently?".
3. Restoring personal integrity: the professional looks for someone trusted and fears how colleagues will see them.
4. The investigation: the formal analyses of the event arrive, with the feeling of being judged.
5. Emotional first aid: the professional seeks support, which is not always there.
6. Moving on: the outcome may be leaving the career, surviving with scars or growing from the experience.

What this changes for those nearby

The authors concluded that the trajectory is largely predictable and that institutions could identify professionals at risk right after the event and offer support to speed up recovery (Scott et al., 2009). Several participants said that taking part in improvement or patient safety advocacy work helped them enjoy their work again (Scott et al., 2009).

Knowing that a sequence exists helps those going through it. The intrusive reflections of the second phase, for example, are expected and tend to fade; recognizing this reduces the feeling of losing control.

The retrospective view

In the reflections phase, the professional tends to judge their own decision with the outcome already known, which makes the error more obvious than it was at the time. This effect has its own guide in this series. For the reasoning, it is worth remembering that the uncertainty at the moment of the decision was real, as discussed in the guide on diagnostic uncertainty.

What helps: peer support

What the reviews say

A 2025 systematic review included 15 studies, mostly of moderate quality, on interventions for second victims (Ong et al., 2025). Peer support programs were the most widely implemented, often organized around Scott's three-tier model, and showed consistent short-term benefit, such as less emotional distress and less isolation (Ong et al., 2025).

The evidence on long-term outcomes, such as resilience, reduced burnout and staying in the job, was mixed and of low certainty (Ong et al., 2025). Structured psychological interventions, such as cognitive behavioral therapy and mindfulness programs, showed more promising long-term results, but are still little studied (Ong et al., 2025).

An example of a program

In an anesthesiology department with three hospitals and six outpatient surgical centers, a voluntary peer support program based on Scott's model was evaluated with questionnaires before and 18 months after implementation (Bursch et al., 2024). After implementation, 62.5% of those who had experienced a serious event said institutional support had improved, and the perception that formal emotional support was available grew (Bursch et al., 2024).

The before-and-after design has limits, and the samples were small. The result shows that it is feasible to set up this support within a department, without proving that it changes long-term outcomes.

The three tiers of support

The three-level model organizes support in layers. At the first level, colleagues and immediate supervisors offer a welcome within the service itself. At the second, trained peers hold structured conversations. At the third, the professional is referred to specialized help, such as psychological care. The idea is that most people recover well with the first two levels, as long as they arrive early.

In medical training

Residents are also second victims

In a survey at a large academic center of gynecology and obstetrics, 58.3% of residents and 55.6% of supervising physicians reported having felt like a second victim after an adverse event (Torbenson et al., 2021). The form of support most desired by both groups was talking with colleagues, and the authors suggest that residency programs offer peer support (Torbenson et al., 2021).

The sample was small, with 12 residents, and the study comes from a single center (Torbenson et al., 2021). The finding is in line with the rest of the literature: those in training live through the same phenomenon, often with less experience to put it in perspective.

What students and residents can do

• Speak early: reach out to a trusted colleague or preceptor in the first days, instead of waiting for the distress to pass on its own.
• Separate fact from judgment: write down what happened, what was known at the time and what only became clear later.
• Turn it into learning: record the gap in your study, as the mistake notebook guide suggests.
• Take care of the basics: sleep, food and breaks. If the distress persists, seek specialized help.

What preceptors and coordinators can do

Those who teach have a decisive role in the first days. Asking "how are you?" before asking "what happened?" changes the tone of the conversation. Case discussions that analyze the system, and not only the individual, help separate the error from the person. A good format for these conversations is in the guide to feedback in clinical cases.

Train before the first error

Talking about the second victim in medical school, before the first serious event, prepares the student to recognize the experience when it comes. A short class with the six-phase sequence and a list of the institution's support contacts already helps. In care simulations, the debriefing moment is a good occasion to talk about error without a patient involved.

Error as information in NEXO

NEXO treats error as information, not as failure. In the case of the day, the diagnosis arrives in up to six clues, and the proximity in ICD-10 across five levels shows how far each guess was from the answer. Guessing close is a useful piece of data for the next hypothesis.

Getting it wrong in a fictional case with a real clinical presentation is different from getting it wrong with a patient, and anyone who has lived through an adverse event needs support from people. The game offers a safe place to practice reasoning and get used to looking at your own error with curiosity. The guide what NEXO is explains the whole match, and the release of modes is on the NEXO economy page.

If you coordinate a medical school, a student league or a residency and want cases for discussions about error, get to know NEXO Closer. Researchers in medical education can propose studies through NEXO Researcher. Physicians who review cases take part through NEXO Curator, and those who create health content on social media can take part through NEXO Creators.

Frequently asked questions

What is a second victim in medicine?

It is the health professional who suffers after an adverse event with a patient, a term proposed by Wu in 2000 (Wu, 2000).

What are the symptoms of the second victim?

Anxiety about future errors, loss of confidence, difficulty sleeping and lower satisfaction with work were the most reported in a large survey (Waterman et al., 2007).

How long does it last?

It varies. Recovery usually goes through six phases, up to the moment of moving on (Scott et al., 2009).

What helps the second victim?

Peer support is the most studied intervention, with short-term benefit (Ong et al., 2025).

Do students and residents go through this too?

Yes. Residents reported the experience in a proportion similar to that of supervising physicians and prefer talking with colleagues (Torbenson et al., 2021).

When to seek specialized help?

When the distress persists, disrupts sleep and work for weeks, or comes with thoughts of giving up on everything. Mental health services at the university or the hospital are the first path.

Checklist for after a mistake

1. Take care of the patient and of immediate safety.
2. Notify the team and follow the service's protocol.
3. Talk to someone you trust in the first days.
4. Write down the facts separating what was known at the time.
5. Take part in the review thinking about the system.
6. Record the learning in your study.
7. Ask for specialized help if the distress persists.

Want to look at a mistake as information? Play the case of the day on NEXO.

References

1. Wu AW. Medical error: the second victim. The doctor who makes the mistake needs help too. BMJ. 2000. https://pubmed.ncbi.nlm.nih.gov/10720336/
2. Seys D, Wu AW, Van Gerven E, Vleugels A, Euwema M, Panella M, et al. Health care professionals as second victims after adverse events: a systematic review. Eval Health Prof. 2013. https://pubmed.ncbi.nlm.nih.gov/22976126/
3. Waterman AD, Garbutt J, Hazel E, Dunagan WC, Levinson W, Fraser VJ, et al. The emotional impact of medical errors on practicing physicians in the United States and Canada. Jt Comm J Qual Patient Saf. 2007. https://pubmed.ncbi.nlm.nih.gov/17724943/
4. Scott SD, Hirschinger LE, Cox KR, McCoig M, Brandt J, Hall LW. The natural history of recovery for the healthcare provider "second victim" after adverse patient events. Qual Saf Health Care. 2009. https://pubmed.ncbi.nlm.nih.gov/19812092/
5. Ong TSK, Goh CN, Tan EKYE, Sivanathan KA, Tang ASP, Tan HK, et al. Second Victim Syndrome Among Healthcare Professionals: A Systematic Review of Interventions and Outcomes. J Healthc Leadersh. 2025. https://pubmed.ncbi.nlm.nih.gov/40485771/
6. Bursch B, Ziv K, Marchese S, Aralis H, Bufford T, Lester P. Department of Anesthesiology Skilled Peer Support Program Outcomes: Second Victim Perceptions. Jt Comm J Qual Patient Saf. 2024. https://pubmed.ncbi.nlm.nih.gov/38556442/
7. Torbenson VE, Riggan KA, Weaver AL, Long ME, Finney RE, Allyse MA, et al. Second Victim Experience among OBGYN Trainees: What Is Their Desired Form of Support? South Med J. 2021. https://pubmed.ncbi.nlm.nih.gov/33787935/