North-African doctors as second victims of medical errors

Abstract Introduction. Physicians involved in medical errors (MEs) can experience loss of self-esteem and negative psychological experiences. They are called “second victims” of the ME. Aims. To i) describe the profile, the types and the severity of MEs, and ii) explore the psychological impact on “second victims” to better understand how they cope. Methods. It was a cross sectional retrospective study conducted from March to August 2018. All physicians working at Farhat Hached and Sahloul university hospitals were asked to complete a questionnaire about their possible MEs. The impact of MEs was evaluated using the Impact of Event Scale-Revised (IES-R) (scoring, 0-88) (subscales ranges; intrusion, (0-32); avoidance, (0-32); hyperarousal, (0-24)). The diagnosis of post-traumatic stress disorder (PTSD) was made when the total IES-R score exceeded 33. The coping strategies were evaluated using Ways of Coping Checklist Revised (WCC-R) scale (scoring, problem-focused, (10-40); emotion focused, (9-36); seeking social support, (8-32)). Results. Among 393 responders, 268 (68.2%) reported MEs. Wrong diagnosis (40.5%), faulty treatment (34.6%), preventive errors (13.5%) and faulty communication (6.4%) were the main frequent types of MEs. The most common related causes of MEs were inexperience (47.3%) and job overload (40.2%). The physicians’ median(range) score of the IES-R was 19(0-69). According to the IES-R score, the most frequent psychological impacts were median(range): intrusion, 7(0-28) and avoidance symptoms, 7(0-24). PTSD symptoms affected 23.5% of physicians. Female sex and serious MEs were identified as predictors of PTSD. On the WCC-R check list, coping was balanced between the three coping strategies median(range), problem focused, 28.5(10-40); emotion-focused, 24(9-36) and seeking social support 21(8-32). Conclusion. There is a relatively high impact of ME within these North-African university hospital physicians. Coping was balanced within different three strategies as reported worldwide. Physicians adopted more likely constructive changes than defensive ones.