There are just some cases that hit too close to home, they replied, "Like when you're in a unit where someone bleeds to death in front of you, that could be upsetting," Wu says.
He likens the scenario to that of a train operator who, as many do, sees his train running over someone on the track. "The operator just sits there; it's not his fault; he shouldn't feel badly that someone got mangled."
But he does.
Bob Wachter, MD, director of the division of Hospital medicine at UCSF and a friend of Wu's, says he "loves the concept of a structured program for second victims, and the evidence is strong that they work."
But he says they're tough to do because so many people need to be trained to make sure someone is available every shift in case an intervention is requested. "It's also resource-intensive, so it tends to fall to the bottom of the deck."
But Wu says the business case is easy to make, in part because a burned out second victim is expensive, typically costing between $100,000 to $200,000 to replace.
Besides, Wu suggests that hospitals have an ethical obligation to start these programs when they strongly encourage their doctors to report their mistakes to their supervisors, as well as the patients and their families.
"That's likely going to make the doctors feel even worse about themselves. And you're really being irresponsible if there's not an organized system of support."