Serious procedural complications are taking a significant but unspoken toll on endoscopists, who frequently experience nightmares, physical reactions and feelings of grief in the aftermath.
Writing in a research letter published in the journal Gastroenterology [link here], US gastroenterologists pointed out that ‘second victim syndrome’ – which describes the negative psychological effects of adverse patient events on doctors – had been well documented in surgical specialists, but not explored among endoscopists.
“Notably, second victim syndrome can erode physician confidence and self-efficacy, impacting professional performance due to avoidant behaviours such as more conservative and risk averse approaches in their practice, even against the best interest of the patient,” the clinician-researchers said.
To inform their findings, they surveyed 195 advanced endoscopists (defined as those who performed either endoscopic ultrasound or endoscopic retrograde cholangiopancreatography annually) and advanced endoscopy fellows.
Half of the participants were aged under 40 and two-thirds were male. Experience varied, with a 33% having performed 501 to 1000 endoscopies annually, followed by greater than 1000 endoscopies (29%) and 100 to 500 endoscopies (28%).
Serious adverse events were defined as unexpected events related to the procedures that had resulted in patients having prolonged hospitalisation, disability, permanent damage or life threatening complications or patient death.
Findings showed the most common responses to serious adverse events among the cohort were sadness or grief (75%) or feeling anger or frustration (39%).
Around 31% of participants said they relived the serious adverse event after the fact, while 27% had physical reactions such as sweating, shaking or heart pounding, 24% experienced nervousness and 12% had nightmares.
Helpful coping mechanisms included speaking with colleagues/mentors (53%), exercise (33%), discussion at conferences (17%) and meditation (8%).
Only 5% of participants reported that their institution offered a support program and only 18% felt well prepared by their training program, while there was a small 4% who reported regretting having chosen endoscopy as a profession.
Almost 40% of responders said emotional distress was viewed as a weakness.
Among other findings, gastroenterologists with more years of practice were associated with a higher likelihood of developing anger or frustration after serious adverse events, while endoscopists with less than 1000 procedures completed per year were more likely to develop physical reactions and nightmares.
“Our findings support that newer and younger therapeutic endoscopists are more at risk for second victim syndrome, while higher procedural volume was associated with greater feelings of preparedness to cope with serious adverse events,” the researchers said.
“This is often credited to greater feelings of responsibility and greater concern for potential consequences in those with less experience. However, older endoscopists were more likely to endorse anger and frustration, which we theorise may be related to higher expectations of ones skillset.
The researchers also highlighted the “notable discordance” between the number of endoscopists reporting second victim syndrome and those seeking professional support, which, they said, uncovered a significant opportunity to intervene in the wellbeing of proceduralists. They added that this was also the responsibility of institutions, which needed to play a more active role in supporting doctors.
“Additionally, surgeons criticise the often punitive handling of serious adverse events, and note that the tone and culture in the review process following an serious adverse events dictates reduction or exacerbation of second victim syndrome. Institutions therefore have a moral imperative to promote continued learning and improvement, while simultaneously cultivating a supportive environment.”