After a Bad Outcome

The six stages (Scott et al.)

1. Chaos & accident response. The event itself; you're running the code.
2. Intrusive reflections. Replaying the event, what-ifs, sleep disturbance.
3. Restoring personal integrity. Seeking reassurance, talking to trusted colleagues.
4. Enduring the inquisition. M&M, peer review, possible legal process.
5. Obtaining emotional first aid. Professional or peer-support engagement.
6. Moving on. Three outcomes: dropping out, surviving, or thriving. Support predicts which.

What helps, what doesn't

Helps:

• Trained peer support within the first 24–72 hours.
• Clear separation of the learning conversation (M&M) from the emotional one.
• Time protected from clinical work to process — negotiated, not assumed.
• Factual clarity on the root cause to avoid indefinite self-blame.
• Therapist consultation for persistent symptoms beyond 2 weeks.

Doesn't help:

• Returning to the same case type the next day because that's “the right thing.”
• Isolated rumination.
• Alcohol as coping.
• Discussing details with unprotected parties (social media, non-privileged colleagues).

Programs you can access

• forYOU (Missouri): The prototype second-victim program. Many US institutions modeled theirs on it.
• RISE (Johns Hopkins): Resilience In Stressful Events, 24/7 peer responders.
• Hospital peer-support programs: Most academic centers now have these; check your GME or CMO office.
• AANA Peer Assistance: 1-800-654-5167, also serves second-victim needs.
• Physician Support Line: 1-888-409-0141.

Legal & documentation

Emotional-support conversations through a recognized peer-support program are generally privileged in most states. Text messages to friends and social media posts are not. Before you process out loud, know which channels are protected. Your risk-management team can walk you through this — and should.

When to step back

Self-assessment questions, 24 hours after an event:

• Am I sleeping >4 hours?
• Can I focus for a full case without intrusive thoughts?
• Am I eating?
• Do I trust my hands today?

If the answer to any is no, request time off. This is a clinical-safety decision, not a weakness.