“Waking up the next morning”: surgeons’ emotional reactions to adverse events

Luu S, et al. Waking up the next morning: surgeons’ emotional reactions to adverse events. Med Educ. 2012 Dec;46(12):1179-88. Full-text for Emory users.

Results: Surgeons expressed feeling unique and alone in the depths of their reactions to adverse events and consistently described four phases of response, each containing cognitive and emotive components, following such events. The initial phase (the kick) involved feelings of failure (‘Am I good enough?’) experienced with a significant physiological response. This was shortly followed by a second phase (the fall), during which the surgeon experienced a sense of chaos and assessed the extent of his or her contribution to the event (‘Was it my fault?’). During the third phase (the recovery), the surgeon reflected on the adverse event (‘What can I learn?’) and experienced a sense of ‘moving on’. In the fourth phase (the long-term impact), the surgeon experienced the prolonged and cumulative effects of these reactions on his or her own personal and professional identities. Surgeons also described an effect on their clinical judgement, both for the case in question (minimisation) and future cases (overcompensation).

Conclusions: Surgeons progress through a series of four phases following adverse events that are potentially caused by or directly linked to surgeon error. The framework provided by this study has implications for teaching, surgeon wellness and surgeon error.


El Hechi MW, et al. Design and Impact of a Novel Surgery-Specific Second Victim Peer Support Program. J Am Coll Surg. 2020 Jun;230(6):926-933. Full-text for Emory users.


Biggs S, Waggett HB, Shabbir J. Impact of surgical complications on the operating surgeon. Colorectal Dis. 2020 Sep;22(9):1169-1174. Full-text for Emory users.

“Complications can also have a negative effect on the operating surgeon, contributing to ‘burnout’ with potential further negative consequences for the patient (‘first victim’). Albert Wu coined the phrase ‘second victim’ in 2000 to describe a lack of support for doctors when mistakes happen [4]. A recent large meta-analysis has shown physician burnout to be associated with an increased risk to patient safety, a poorer quality of care due to low professionalism and reduced patient satisfaction [5]. These links were greater in those who were at an earlier stage in their careers.” (Biggs, et al., 2020, p. 1169)


See also:

Han K, et al. The Surgeon as the Second Victim? Results of the Boston Intraoperative Adverse Events Surgeons’ Attitude (BISA) Study. J Am Coll Surg. 2017 Jun;224(6):1048-1056.

Luu S, Leung SO, Moulton CA. When bad things happen to good surgeons: reactions to adverse events. Surg Clin North Am. 2012 Feb;92(1):153-61.

Lillemoe HA, Geevarghese SK. Stopping the Progression of Moral Injury: A Priority During Surgical Training. Ann Surg. 2021 Dec 1;274(6):e643-e645.

Orri M, et al. Being a surgeon–the myth and the reality: a meta-synthesis of surgeons’ perspectives about factors affecting their practice and well-being. Ann Surg. 2014 Nov; 260(5):721-8; discussion 728-9.

Oskrochi Y, et al. Beyond the body: A systematic review of the nonphysical effects of a surgical career. Surgery. 2016 Feb;159(2):650-64.

More PubMed results on the impact of complications on surgeon well-being.

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