If I were to bet that the majority of physicians are familiar with that pit in their stomach—that sinking feeling of dread that comes with recognizing things aren’t going well—I’d probably win that bet. Contrary to collective wisdom, Wu (2000) first formalized recognition that doctors involved in critical incidents need help too. Now, twenty-five years later, doctors are still held to a standard that eschews the idea of making mistakes. As long as we put in the requisite effort, we protect ourselves. This dogma is a frequently cited justification for the unrelenting arduous hours demanded of trainees, one of the greater underpaid labor forces in the United States. If you make a mistake, young physicians are implicitly told, it is a result of your inadequate effort, not the expected eventuality of choosing this profession. Since the idea of a second victim was first formalized as a legitimate focus, talks on well-being, wellness programs, and peer support groups have been steadily introduced for clinicians in the medical environment. But much of our environment still operates on an unrealistic zero-tolerance ideology: You should have studied/worked harder.

This is, of course, as alluded to above, partly defensive. If we admit to ourselves that mistakes cannot be avoided by simply working harder, then we have to face a reality that can make work more anxiety-provoking. There are few worse feelings for someone who chose the field of medicine than to recognize that action or inaction led to injury or demise of one’s patient. This comes with waves of debilitating shame; it invades dreams in fretful sleep at night; it overshadows the workday—a reminder, moment to moment, of a most consequential personal failure. It can be very nearly overwhelming. And meantime there is no time off. Disease and illness remain to be identified and treated, anesthetized and operated on. Family must be faced with devastating news. Practices are increasingly understaffed, doctors increasingly asked to take on more responsibility for less or the same compensation. This is a perfect storm for consequential error.

Those powerful feelings can ultimately lead to chronic and debilitating self-doubt and anxiety, ruminating over lab values, obsessively checking vials before drawing up medication, indecision in the operative field. It is unfortunately a mantra of medicine to compartmentalize feelings, never to bring them to the surface to process, the summation of which is extraordinarily unhealthy. This default passive approach is neither sustainable nor the most effective. It speaks to the crisis of burnout, depression, anxiety, and suicide in this population without even invoking a seminal event. But it isn’t hopeless.

The single most important variable in mitigating the sequelae of trauma is to talk about it with caring and informed others. This seems very simple, and yet in practice it isn’t. In fact, it is some of the most difficult work that people do—to sit with and to tolerate difficult feelings. Sometimes this looks like commiserating with colleagues who’ve also been there. Sometimes it involves engagement with formal peer support consisting of knowledgeable and caring colleagues gathered for just this purpose. Sometimes that looks like talking with a therapist well-versed in the world of feelings with solid skills to help you navigate this kind of event in the life of a physician. It helps to know you are not alone, that others share your experiences and feelings, that you are part of a community, not a pariah. It is essential not to isolate. It took me a long time as an anesthesiologist accustomed to a very action-oriented profession to truly understand the importance and efficacy of addressing feelings appropriately.

Wu also described that if we involve ourselves in solutions to systemic problems (why does the vial of an anti-nausea look just like a potent vasopressor, and why are they stored next to each other?), if we remain engaged in the care of patients, if we find others to talk with as described above, we can eventually thrive in medicine after such an event. Wouldn’t it be an amazing thing for this to be a formally taught requirement in medical school and residency training? I recall feeling an underlying dread throughout my training, which I otherwise loved: What if I am involved in a critical patient complication before I even finish? And this does happen. I saw it happen, as have many physicians in training. It can mean the end of a career, or it can be leveraged as an opportunity for all of us to learn. It can serve as a critical turning point for young physicians to recognize that none of us are perfect. It can be used to help us learn how to navigate our errors in order to thrive and continue on this path we chose—to help people safely through some of their most vulnerable periods.

Maire Daugharty is an anesthesiologist who expanded her expertise by earning a master’s degree in clinical mental health counseling, merging her long-standing interest in mental health with her medical background. As a licensed professional counselor, licensed addiction counselor, and licensed marriage and family therapist, she brings a well-rounded perspective to her private practice, where she works with adult individuals and couples on a wide range of concerns. In addition to her counseling practice, she continues to work part-time as an anesthesiologist and has a deep understanding of the unique challenges faced by clinicians in today’s medical landscape. To learn more about her practice, visit Physician Vitality Services.