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Background <p>Medical errors cause significant psychological distress among healthcare professionals, known as “second victim syndrome” (SVS). Although SVS is universal, it is likely modulated by organizational and cultural contexts. Therefore, we aimed to address the following question: Do cultural and legal differences between Japan and the United States (US) influence emotional distress and coping behaviors among healthcare professionals following medical errors?</p> Methods <p>This cross-sectional, web-based survey included healthcare professionals at 14 Japanese hospitals, and used validated clinical scenarios identical to a prior US study. To enable rigorous comparison, 1:1 propensity score matching was performed based on specialty, profession, and years of clinical experience.</p> Results <p>A total of 542 Japanese healthcare professionals responded (response rate: 40.0%). After matching, 185 pairs (<i>n</i> = 370) were analyzed. A “psychological burden paradox” emerged: despite reporting lower actual involvement in severe medical errors than US counterparts (11.9% vs. 73.0%, <i>P</i> &lt; .001), Japanese professionals experienced more intense distress. Following a severe error, Japanese professionals reported a higher prevalence of guilt (94.6% vs. 61.6%), anxiety (84.9% vs. 55.7%), and fear of litigation (76.2% vs. 42.2%) (all <i>P</i> &lt; .001). Furthermore, Japanese respondents were more than three times as likely to consider leaving their profession (30.8% vs. 8.6%, <i>P</i> &lt; .001). Despite perceiving greater institutional support (83.8% vs. 70.6%, <i>P</i> = .012), Japanese providers were more likely to “just move on” (34.1% vs. 11.4%, <i>P</i> &lt; .001) and less likely to discuss the event with colleagues (48.6% vs. 61.1%, <i>P</i> = .027).</p> Conclusion <p>Significant cultural disparities exist in SVS symptoms and coping behaviors. Japanese healthcare professionals experience disproportionately intense psychological distress despite less frequent error exposure, likely driven by cultural norms, emphasizing shame and a legal framework that criminalizes medical errors, leading to a “culture of silence.” Support systems in Japan must be tailored to address these unique structural and legal barriers.</p>

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The impact of medical errors on healthcare professionals: a cross-sectional propensity score-matched comparison of second victim syndrome between Japan and the United States

  • 期刊论文

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  • 发表日期：

    2026年7月31日

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  • Yudai Takatani,
  • Taro Minami,
  • Genta Kato,
  • Gerardo P. Carino,
  • Shigeru Ohtsuru

摘要

Background

Medical errors cause significant psychological distress among healthcare professionals, known as “second victim syndrome” (SVS). Although SVS is universal, it is likely modulated by organizational and cultural contexts. Therefore, we aimed to address the following question: Do cultural and legal differences between Japan and the United States (US) influence emotional distress and coping behaviors among healthcare professionals following medical errors?

Methods

This cross-sectional, web-based survey included healthcare professionals at 14 Japanese hospitals, and used validated clinical scenarios identical to a prior US study. To enable rigorous comparison, 1:1 propensity score matching was performed based on specialty, profession, and years of clinical experience.

Results

A total of 542 Japanese healthcare professionals responded (response rate: 40.0%). After matching, 185 pairs (n = 370) were analyzed. A “psychological burden paradox” emerged: despite reporting lower actual involvement in severe medical errors than US counterparts (11.9% vs. 73.0%, P < .001), Japanese professionals experienced more intense distress. Following a severe error, Japanese professionals reported a higher prevalence of guilt (94.6% vs. 61.6%), anxiety (84.9% vs. 55.7%), and fear of litigation (76.2% vs. 42.2%) (all P < .001). Furthermore, Japanese respondents were more than three times as likely to consider leaving their profession (30.8% vs. 8.6%, P < .001). Despite perceiving greater institutional support (83.8% vs. 70.6%, P = .012), Japanese providers were more likely to “just move on” (34.1% vs. 11.4%, P < .001) and less likely to discuss the event with colleagues (48.6% vs. 61.1%, P = .027).

Conclusion

Significant cultural disparities exist in SVS symptoms and coping behaviors. Japanese healthcare professionals experience disproportionately intense psychological distress despite less frequent error exposure, likely driven by cultural norms, emphasizing shame and a legal framework that criminalizes medical errors, leading to a “culture of silence.” Support systems in Japan must be tailored to address these unique structural and legal barriers.