Second Victims: The impact of complications on the lives of surgeons

As surgeons, we really fear complications and sometimes we have to face up to the harsh reality of complications actually occurring. Whether they're a consequence of patient factors, a difficult procedure or an error, complications will invariably happen from time to time. 

While the patient is the first victim of complications, not uncommonly the surgeon may also feel significantly impacted as a consequence. In taking responsibility for a bad surgical outcome, we too may experience varying levels of emotional trauma. The term “second victim” describes the physical and emotional consequences of complications on surgeons and caregivers. And whilst it may seem like the latest hot topic of bloggers wanting to create sensational headlines, it is not some new-fangled, new-age concept. The term was coined all the way back in the 1950s and the trauma is very real. It was then, is now, and if you are yet to experience it personally, chances are it will be in your future at some point. Feelings of shame, isolation, even worthlessness are all too common.

A recent study of obstetricians and gynaecologists across Australia and New Zealand that I was involved in, sheds light on the emotional, physical, and relational impact of surgical complications on gynaecological surgeons. The results are eye-opening and, perhaps most importantly, highlight that if you've struggled with the emotional fallout of a complication, you are not alone.

The Emotional Impact: Guilt, Anxiety, and Self-Doubt

From our survey of 727 OBGYN surgeons, we learned that nearly all surgeons—90%—find complications deeply stressful when the patient outcome is poor. Complications that have severe consequences for patients, or those resulting from an error made by the surgeon, carry an even heavier emotional weight. Feelings of guilt and self-doubt are incredibly common in these scenarios. Surgeons reported being highly self-critical, with 51% admitting to rumination over what went wrong, and almost half (49%) experiencing lingering self-doubt.

We also found that when complications arise, many surgeons experience physical symptoms such as interrupted sleep, with 31% reporting they wake frequently at night, and 26% finding it difficult to return to sleep. This constant mental replay of what happened in the operating room can lead to exhaustion, making the next day even more challenging.

The Physical and Relational Costs

Complications don’t just affect your mental health—they impact your body and your relationships too. Our study revealed that complications often take a physical toll on surgeons, with 89% of respondents noting that complications disrupted their sleep, while 33% experienced gastrointestinal issues, and 32% reported musculoskeletal problems.

Beyond these physical symptoms, complications also impacted surgeons’ relationships. Nearly 20% admitted that their interactions with family and friends changed for the worse - becoming more irritable, withdrawn, or disengaged from loved ones after a difficult case. Relationships with colleagues were also strained, with many reporting feelings of embarrassment (15%) and shame (14%) when complications were discussed at work, particularly in morbidity and mortality (M&M) meetings.

This speaks to a larger issue in our profession. Talking about complications can feel taboo, even though it’s something nearly all of us go through. In fact, while debriefing with colleagues was one of the most effective ways surgeons coped with complications, less than 20% of respondents said they felt supported by their colleagues after a complication occurred.

What Helps: Support and Coping Strategies

Despite the emotional and physical burdens that come with complications, many surgeons do find ways to cope—and our study identified the strategies that worked best. The majority of surgeons (85%) found that debriefing with trusted colleagues helped, while 64% leaned on family and friends for emotional support, and 63% turned to physical exercise as a way to cope with stress.

Interestingly, younger surgeons and those with fewer years of experience reported higher levels of stress and emotional impact compared to more seasoned colleagues. This suggests that the earlier years in our careers may be the most vulnerable, and that additional support may be particularly crucial during this time.

Our study unfortunately also highlighted a troubling pattern: the higher the level of stress a surgeon experienced, the less likely they were to reach out for help. Those who struggled the most, whether with stress, physical health, or sleep, were often the least likely to engage with their peers for support. This suggests a need for more proactive approaches in offering help and creating a culture where it’s okay to talk about these experiences without fear of judgment.

Breaking the Silence: You Are Not Alone

One of the most striking findings from our study was how many surgeons felt that talking about complications remains a taboo topic. Despite the known benefits of debriefing, many surgeons still felt embarrassed or anxious discussing complications, particularly in formal settings like M&M meetings.

We need to change this culture. By fostering a more open, supportive environment, we can encourage surgeons to share their experiences without fear of judgment. You are not alone in your feelings, and it’s essential that we help each other through the emotional difficulties that come with our profession. Talking about complications doesn’t make you any less of a surgeon. It makes you a better, more resilient one.

Moving Forward

The findings from the study are clear: complications affect more than just our patients. They affect us too. From sleepless nights to strained relationships, the impact of complications is far-reaching. Many of your colleagues have been in your shoes, and reaching out for support can make all the difference.

Let’s break the silence and create a culture where it’s okay to talk about complications. By sharing our experiences and supporting each other, we can begin to heal the emotional wounds that come with surgical practice. Together, we can make a difference—for our patients, for our colleagues, and for ourselves.

The Restorative Power of SurgicalPerformance 

Having your own performance data at your fingertips can also really help to put your mind at ease. Being able to measure your own complication rate against an anonymised average derived from thousands of other surgeons’ outcomes for the same procedure, with similar comorbidities and so forth, may help to alleviate the stress of your poor outcome by putting it in the perspective of your wider picture. It may not take away the upset of the particular case, but it will go a long way towards quickly restoring any loss of confidence or self-belief. Which is vital, people need you.