Journal · The Retreat Clinic

The part patients do not see

Do doctors lose sleep over a patient’s outcome? Some do, and the research has a name for it. This page covers the second victim effect, why it comes at night, and what the evidence says helps.

5 October 2026 · 4 min read

Dr Ong Jin Khang · MMC 45245 · LCP holder · The Retreat Clinic, Setia Alam

Whenever we think of a patient’s outcome, it can be a sleepless night. That is what I wrote when I was asked what patients do not see about this job, and it is the whole of what I want to say first. The rest of this page is what the research says about nights like that, and what I do about mine.

A hand-drawn sketch of a bedroom at night: a tall window onto a city skyline, a bed with rumpled pillows and a phone on the bedside table

What you see

A consultation. A treatment, if you decide on one. A follow-up date in the diary.

A hand-drawn sketch of a tidy desk by day: an open laptop, a spiral notebook with a pen, a wall calendar above and an empty chair

What you do not see

“patients do not see that it is a sleepless night whenever we think of the patient’s outcome.”

Those are my words, as I wrote them.

A hand-drawn sketch of the same desk at night: a laptop with a dark screen, a desk lamp, a wall clock and the chair pushed back and empty

It has a name

Doctors who lose sleep over a patient’s outcome are not unusual, and the literature has a term for the experience after a patient is harmed: the second victim. The idea comes from a 2000 BMJ article by Albert Wu, who described doctors replaying an event, doubting their competence, and being helped by colleague support, by hearing how others had coped, and by having somewhere to talk about it.

A 2013 review of 32 research articles found that between 10.4% and 43.3% of health professionals were affected in this way after an adverse event, with emotional, thinking and behavioural reactions. A small 2009 interview study of 31 health professionals described six stages, the first of which included intrusive reflections: the same events coming back unasked.

Two honest limits. These studies are about adverse events and errors, and the worry I am describing is wider than that: it can happen when nothing has gone wrong. No study of doctors losing sleep over an aesthetic outcome specifically turned up in the sources reviewed for this page.

A hand-drawn sketch of a bedside table with a round alarm clock and a phone beside a rumpled duvet

Why the night, and not the day

A 2012 study of 719 working adults found that replaying work worries with feeling in them (“affective rumination”) predicted work fatigue, and that poor sleep explained part of the link, while thinking about a problem in order to solve it did not. These were workers in general, not doctors, so it is a pattern, not a verdict on any profession.

A hand-drawn sketch of a made bed beside a tall window with trees outside, a quiet empty room

What the research says helps

The best-supported suggestion is the plainest one: talk to someone who understands, a colleague or a peer. A 2025 systematic review of 15 studies of interventions for second victims found peer support reduced short-term distress and isolation, though the certainty of the evidence was low and the long-term effect unclear. Wu’s 2000 article and the 2009 study point the same way.

How do I cope

I pray hard.

That is my own practice and I am not offering it as advice. For what it is worth, the evidence on faith and wellbeing is mixed in an interesting way. A 2023 review of 40 studies found burnout linked to spiritual health, but not to religion as such, and most of those studies were of poor quality. A 2021 review found that most physicians hold religious beliefs and that finding meaning in the work was protective. So I do not say that prayer protects anyone from anything. I say it is what I do.

A hand-drawn sketch of two hands pressed together in prayer

If you are a patient

It is fair to ask your doctor how you will be followed up after a treatment, and when you should get in touch. That question is fair to ask of any doctor.

A hand-drawn sketch of a city skyline at first light, the sun rising between tall buildings seen through a window

Three questions, answered

Do doctors lose sleep over a patient’s outcome?
Doctors who lose sleep over a patient’s outcome are not unusual, and the literature has a term for the experience after a patient is harmed: the second victim. These studies are about adverse events and errors, and the worry I am describing is wider than that: it can happen when nothing has gone wrong. No study of doctors losing sleep over an aesthetic outcome specifically turned up in the sources reviewed for this page.
What is the second victim effect?
The second victim is the term the literature uses for the experience after a patient is harmed. The idea comes from a 2000 BMJ article by Albert Wu, who described doctors replaying an event, doubting their competence, and being helped by colleague support, by hearing how others had coped, and by having somewhere to talk about it. A 2013 review of 32 research articles found that between 10.4% and 43.3% of health professionals were affected in this way after an adverse event, with emotional, thinking and behavioural reactions.
What helps doctors cope?
The best-supported suggestion is the plainest one: talk to someone who understands, a colleague or a peer. A 2025 systematic review of 15 studies of interventions for second victims found peer support reduced short-term distress and isolation, though the certainty of the evidence was low and the long-term effect unclear.

More about the doctor who wrote this is on his page, the thinking behind the clinic is set out in the approach, and the other pieces are in the journal.

Sources

This page is general information, not medical advice. The studies cited are about adverse events and workplace worry in general, not aesthetic outcomes.