"Living on the Edge": The Role of Critical Incidents on the Development of "Secondary Resilience" in Physicians

This qualitative, phenomenological case-study focuses on physician-reported experiences related to caring for refugees, in order to investigate what experiential factors contribute to effective therapeutic relationships. Findings and medical literature show that caring for refugees can have adverse psychological and physiological repercussions for physicians. Extensive exposure to trauma narratives and vivid examples of human suffering can lead to burnout, vicarious trauma, and/or secondary traumatic stress – affecting physicians’ ability to care for patients effectively. Nonetheless, emerging psychological literature indicates that, over time, providers may be able to develop vicarious resilience by mirroring the resiliency of their patients. This notion is based on theory that chronic exposure to patient suffering can bolster social advocacy and altruistic behavior in providers. Supplementing this theory, the data shows that providers can develop “secondary resilience” after a single exposure to a critical incident, that evaluation of critical incidents is the link between secondary traumatic stress/vicarious trauma and secondary and/or vicarious resilience, and that secondary/vicarious resilience can coexist with vicarious trauma or secondary traumatic stress, allowing physicians to continue caring even as they witness suffering and suffer with their patients.