Complications are shared experiences

As a surgeon, when complications happen, I tend to take them very personally. I see these technical or clinical errors as damning evaluations of my own effort, work, and worth. I think all surgeons have this mentality to some extent—the belief that their value and ability as a physician is tied to their patients’ outcomes.

This belief, of course, is foolish because clinical outcomes are dependent on many factors outside of the surgeon’s control, such as patient follow-up, comorbidities, and so on. However, as “captains of the ship,” surgeons inherently believe that the outcomes are in our control. When the outcomes go wrong, the effects on our self-worth can be devastating.

After my first complication, I found myself in a semi-depressive state, wondering whether I was cut out to be a surgeon. As one of my patients showed me, however, this was borne out of an error in how I viewed the surgeon-patient relationship.

I received my education after inadvertently ligating the common bile duct on a patient. The patient remained in the hospital for months, and for the first few days after the complication, I became a mute, walking the halls in a zombie-like daze of regret and self-anger.

My attending paged me a few days later and asked me to meet him in the patient’s room. As I entered with my head held low, not wanting to make eye contact with the patient whom I had injured, the patient put his hand on my shoulder and told me, “Doc, you’re my surgeon. We can’t take this on together if you’ve already given up.”

We talked for about 15 minutes that day—the patient, my attending, and I. We talked about the patient’s kids, about the championship football game of his son that he would miss while in the hospital, and about how the patient needed to quit smoking. A small amount of time was devoted to explaining what the next steps in his care would be, the challenges ahead, and what each of us needed to do. Sitting there, huddled together, it felt like a discussion on a team bus headed for a big game. Teammates talking about our personal lives, but also focused on what needed to be done to achieve a positive outcome.

When mistakes occur, retreating into seclusion and self-blame are common reactions. For surgeons, this reaction is borne of the theory that they are ultimately in control of the patient’s care and outcomes. However, we are not.

Surgeons have a complex relationship with their patients, one marked by the common goal of a positive outcome. When successes happen, we should celebrate together. And when failures occur, we should grieve and rebound together as well. This is a unique method of dealing with errors as surgeons that we all should embrace.

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