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The Role of Compassion after an Adverse Event in a Hospital

Wilbrink, Alexander LU (2026) FLMU16 20262
Division of Risk Management and Societal Safety
Abstract
When a physician is involved in an adverse event, two things happen at once. A patient or family is
harmed. And so, in a different way, is the physician. This thesis asks what enables or prevents compassion
in the physician’s primary reaction, and whether that compassion shapes the trajectory towards
reconciliation. Eight semi-structured interviews were conducted with medical specialists in Dutch
hospitals each with direct experience of a serious adverse event. The data were analysed using Max van
Manen’s hermeneutic phenomenological approach, attending to lived experience rather than causal
explanation. Four themes structure the findings. The first is lived impact: an existential rupture marked by
shame, counterfactual thinking,... (More)
When a physician is involved in an adverse event, two things happen at once. A patient or family is
harmed. And so, in a different way, is the physician. This thesis asks what enables or prevents compassion
in the physician’s primary reaction, and whether that compassion shapes the trajectory towards
reconciliation. Eight semi-structured interviews were conducted with medical specialists in Dutch
hospitals each with direct experience of a serious adverse event. The data were analysed using Max van
Manen’s hermeneutic phenomenological approach, attending to lived experience rather than causal
explanation. Four themes structure the findings. The first is lived impact: an existential rupture marked by
shame, counterfactual thinking, and eroded professional confidence. The second is the first reaction: a
composite of action and numbing, dominated by the reflex to explain rather than acknowledge. The third
— the central theme — examines compassion’s presence and absence. Three distinct mechanisms of
failure emerge: compassion fatigue, arising from structural exhaustion; compassion distress, the acute state
in which the physician’s own suffering leaves no space for the other’s pain; and the defensive reflex, a
trained product of a professional culture that treats failure as inadmissible. These are distinct problems
requiring distinct responses. The fourth theme maps outcomes. Reconciliation occurred where someone
stayed with the patient’s suffering rather than simply accounted for the event. Such procedural responses
consistently closed the relational space in which repair might have grown. The central finding is that
compassion is not a character trait. It is a condition-dependent state. The physician involved in an adverse
event is herself a second victim, and her capacity for compassionate communication is directly impaired by
her own unresolved distress. The second victim experience is co-produced by the surrounding system:
where colleagues and institutions respond with recognition, recovery becomes possible; where they
respond with silence or judgment, it stalls. Five recommendations follow: an independent contact person
for affected families; never entering a disclosure conversation alone; timely peer support for second
victims; replacing counterfactual critique with local rationality inquiry; and measuring/addressing adverse
event response by relational repair, not only legal outcome. (Less)
Please use this url to cite or link to this publication:
author
Wilbrink, Alexander LU
supervisor
organization
alternative title
What is the influence of compassion in the primary reaction after an adverse event, and could its presence or absence be a factor for the success or failure of reconciliation in a hospital setting?
course
FLMU16 20262
year
type
H1 - Master's Degree (One Year)
subject
keywords
Compassion, Second Victim, Adverse Event, Reconciliation, Hermeneutic Phenomenology, Medical Specialist, Open Disclosure, Compassion Fatigue, Compassion Distress, Patient Safety, FLMU06
language
English
id
9250632
date added to LUP
2026-09-09 14:44:28
date last changed
2026-09-09 14:44:28
@misc{9250632,
  abstract     = {{When a physician is involved in an adverse event, two things happen at once. A patient or family is
harmed. And so, in a different way, is the physician. This thesis asks what enables or prevents compassion
in the physician’s primary reaction, and whether that compassion shapes the trajectory towards
reconciliation. Eight semi-structured interviews were conducted with medical specialists in Dutch
hospitals each with direct experience of a serious adverse event. The data were analysed using Max van
Manen’s hermeneutic phenomenological approach, attending to lived experience rather than causal
explanation. Four themes structure the findings. The first is lived impact: an existential rupture marked by
shame, counterfactual thinking, and eroded professional confidence. The second is the first reaction: a
composite of action and numbing, dominated by the reflex to explain rather than acknowledge. The third
— the central theme — examines compassion’s presence and absence. Three distinct mechanisms of
failure emerge: compassion fatigue, arising from structural exhaustion; compassion distress, the acute state
in which the physician’s own suffering leaves no space for the other’s pain; and the defensive reflex, a
trained product of a professional culture that treats failure as inadmissible. These are distinct problems
requiring distinct responses. The fourth theme maps outcomes. Reconciliation occurred where someone
stayed with the patient’s suffering rather than simply accounted for the event. Such procedural responses
consistently closed the relational space in which repair might have grown. The central finding is that
compassion is not a character trait. It is a condition-dependent state. The physician involved in an adverse
event is herself a second victim, and her capacity for compassionate communication is directly impaired by
her own unresolved distress. The second victim experience is co-produced by the surrounding system:
where colleagues and institutions respond with recognition, recovery becomes possible; where they
respond with silence or judgment, it stalls. Five recommendations follow: an independent contact person
for affected families; never entering a disclosure conversation alone; timely peer support for second
victims; replacing counterfactual critique with local rationality inquiry; and measuring/addressing adverse
event response by relational repair, not only legal outcome.}},
  author       = {{Wilbrink, Alexander}},
  language     = {{eng}},
  note         = {{Student Paper}},
  title        = {{The Role of Compassion after an Adverse Event in a Hospital}},
  year         = {{2026}},
}