“Battlefield first aid” after a colleague has a bad case as the cornerstone of peer-to-peer support in vascular surgery was the feature of the recent Jesse E. Thompson, MD, Distinguished Guest Lecture at the 2025 Southern Association for Vascular Surgery (SAVS) annual meeting in St. Thomas, the U.S. Virgin Islands (Jan. 22–25).
John Eidt, MD, the chief of vascular surgery at Baylor, Scott & White Heart and Vascular Hospital in Dallas and a former SAVS president, asked attendees to consider what they do in response to an adverse outcome during the course of their clinical care; how they treat their colleagues after they have a bad case; whether they have sought professional counseling after an adverse surgical event; and how they teach trainees to deal with these adverse events.
“We all have patients who have left an indelible mark on us,” Eidt told those gathered at SAVS 2025. “The asymptomatic carotid that has a stroke in the recovery room. The routine EVAR that goes bad. The claudicant that winds up with an amputation.”
He highlighted the importance of peer support and not suffering in silence. “In vascular surgery, our actions and inactions have immediate consequences,” he said. “There is no delay like a recurrent hernia. There is no shifting blame. Our memories may be vivid and precise and filled with details like patients’ middle names, and children’s faces and spouses’ occupations. Sometimes we can see the operations like it was yesterday, but, in other cases, we just see fragments, those that haunt our memories and invade our dreams, though we never fully forget.”
Eidt raised the specter of the “second victim” concept, which describes the doctor who makes a mistake and needs help too. Under this definition, he described how in the absence of mechanisms for healing, physicians find dysfunctional ways to protect themselves. They respond to their own mistakes with anger, projection of blame and may act defensively or callously, and blame or scold the patient or other members of the healthcare team, Eidt said. “Distress escalates in the face of a malpractice suit. In the long run, some physicians are deeply wounded.” They may lose their nerve, burn out, or seek solace in alcohol or drugs, he added.
“I think that’s an unfortunately accurate picture of how sometimes we do respond to these situations.”
But “second victim” is an ill-fitting term in this arena, Eidt continued. “Victim” most commonly refers to those who experience devastating loss at the hands of others, he pointed out. “Placing both clinicians and patients in this category after medical error seems erroneous given the degree of intentionality and violent harm that the word victim connotes,” Eidt said. “It’s not really a good illustration of how we all experience these events.”
The potential consequences from bad outcomes for physicians are well reported: for instance, the literature documents that more than 90% of surgeons reported an emotional impact from adverse surgical outcomes. These included anger, anxiety, guilt, shame— “all the stuff you know you’ve felt after a bad case,” Eidt said. “It can mess up your sleep, how you’re thinking, even how you relax. And it can change practice patterns if you stop doing evidence-based medicine and start doing anecdote-based medicine.”
Women and minorities might carry added burdens, he considered. “It’s bad enough for a White guy, but if you have extra scrutiny, it may even be harder.”
In light of all of this, the question becomes how surgeons deal with the reality of facing up to bad outcomes, Eidt continued. “The most common way surgeons want to deal with these things is to talk to each other. We have a lot of evidence that adverse clinical events have a significant bad impact on you, but we tend not to seek professional help. We know the reasons why: there is so much stigma, all kinds of negative connotations.”
What surgeons do like is peer-to-peer support, he said. “It’s got to be confidential, available 24/7. They are almost inevitably, though, not point of care.” Surgeons also prefer something longitudinal, as well as thoughtful critique, with questions like, “What would you have done? How can I do better?” Eidt added.
There are four tiers of peer support, with “self ” peer support, hospital-level structured support and professional counseling among them. But it is the second tier where the greatest value might be yielded, Eidt argued: that is, battlefield first aid. At the base of this approach, he said, is “reaching out to each other, listening, offering support, providing acceptance, offering trust, confidentiality, providing a safe space, normalizing talking about feelings.”
There are also don’ts, he pointed out. That means don’t isolate, pry, place blame, try to fix it, minimize it or give false reassurance, Eidt reasoned. “What we tend to do is pretend it didn’t happen. Everyone knows it went south, but no one is talking about it, and that creates more paranoia.”
