Bonnie Gregory, MD | Liana Tedesco, MD
September 21, 2023
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Across surgical subspecialties, there are many adages about complications, including: “the only way to avoid complications is to not operate” and “the only surgeons without complications are the ones who don’t operate and the ones that aren’t telling the truth,” which serve as a reminder that complications are an inevitable, unavoidable part of being a surgeon. However, this knowledge does little to make dealing with complications as a trainee or an attending surgeon any easier.
Even the thought of complications can bring up a myriad of emotions for surgeons at any stage of their career as so much of how we view ourselves and our success lies in the success of our patients and our surgical outcomes. We want the best for our patients, who have given us their trust in allowing us to operate on them, and often take complications personally, even when we may not be at fault.
Of course, we first look to promptly address any complications to mitigate the effect on our patients. We must reflect on the cases to consider technical errors, lapses in judgment, and systemic factors that could have contributed to the negative outcome. As surgeons, given the inevitably of complications, we have many formal procedures and policies in place for doing just this. The morbidity and mortality conference, “M&M”, serves as a forum to identify, classify, and discuss complications in a confidential space. In addition, many health systems have formal reporting structures in the form of quality improvement committees to understand why complications occur and how to prevent them in future.
However, these formal structures fail to address the “second victim” of complications, the surgeon. From the day we take the Hippocratic Oath in medical school, we take on a tremendous responsibility for our patients and their outcomes. When those outcomes are less than we would have hoped or when complications happen, we often bear the burden of this in isolation and take full responsibility regardless of the cause. This is particularly true early in practice, as we continue to learn and grow as surgeons and can experience more or different complications than we may have seen our mentors tackle throughout training.
So how can we or should we deal with the inevitable negative outcomes of our patients? The initial step is prompt identification and intervention, as well as swift, accurate, humble and frank discussion with the patient/family. One of the best pieces of advice we’ve received is to “lean in” to complications, do not run away! But then we must look to our own care as well to limit the negative effects complications can have on our mental and physical health. Although complications will always make us lose sleep, we must take care to not allow them to overtake our sleeping and waking hours, impeding our ability to care for ourselves and our patients. Ultimately, a surgeon must not put themselves on an island when dealing with complications. Many hospital systems have specific mental health resources for trainees and physicians, which may be helpful during these difficult times. Surgery is a team sport – lean on colleagues for support and guidance. There is a good chance they have dealt with something similar.
Tips:
- Reflection, both on your own and with trusted peers and mentors about the case.
- Self-care, we can’t forget the basics: sleep, eating well, physical exercise, spending time with loved ones, and even taking some time off if necessary
- Seeking help, professional and otherwise, if anxiety, insomnia, or critical decision making is impeded
- Trusting in your skills and your training
- Know that we are all human and make mistakes. Your value as a person and surgeon is not defined by complications.
References:
- Siddaiah-Subramanya M, To H, Haigh C. The psychosocial impact of surgical complications on the operating surgeon: A scoping review [published correction appears in Ann Med Surg (Lond). 2021 Jul 24;68:102585]. Ann Med Surg (Lond). 2021;67:102530. Published 2021 Jul 3. doi:10.1016/j.amsu.2021.102530
- Helo S, Moulton CE. Complications: acknowledging, managing, and coping with human error. Transl Androl Urol. 2017;6(4):773-782. doi:10.21037/tau.2017.06.28
- J. Bunni. Complications – A surgeon’s perspective and humanities’ methods for personally dealing with them: The “4 R’s”. International Journal of Surgery, Volume 41, 2017, Pages 134-135, ISSN 1743-9191,
DISCLOSURES: Dr. Gregory This individual reported nothing to disclose. Dr. Tedesco This individual reported nothing to disclose.
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