Coping with the emotional trauma associated with surgical complications

Many years ago Rene Leriche wrote: “Every surgeon carries within himself a small cemetery, where from time to time he goes to pray – a place of bitterness and regret, where he must look for an explanation for his failures”.

Complications, which can occasionally be fatal, are part and parcel of surgery, but emotional resilience is required on the part of the surgeon, who needs considerable fortitude to avoid becoming the “second victim”.

Different individuals have different ways of dealing with very personal fallout that accompanies the creation of a severe complication. Sometimes sharing the experience, and the strategies required to deal with it, rather than bottling it all up, can be very beneficial.

This blog is an opportunity to do just that! Please do add your own encounters with surgical complications and any other comments on such matters to this blog.

Comments (10) Add yours ↓
  1. Christian Brown Urologist

    Completely agree. The ‘de-brief’ with colleagues and some times loved ones can be very therapeutic. I am part of a group set up when we were all hunting for SpR numbers. 15 years later we still meet twice a year and share experiences of all types including complications. Explaining to others what happened and most importantly how is was managed both clinically and non clinically can be very cathartic, and I learn a lot from others experiences as well.

    Complications can be lonely but they need not be, share them, everybody gets them.

    January 18, 2018 Reply
  2. Rob Gray Urologist

    One strategy I have observed from some of my mentors is that of “owning your complications”. One temptation, and something I have seen a few times in my training is for a surgeon to try to distance themselves physically and emotionally from a complication, it seems to me that this is often counter productive, leaving both surgeon and patient unhappy and isolated/abandoned.

    A better strategy I have witnessed seems to be where a surgeon embraces their complication, they communicate freely and regularly with the patient and continue to develop their rapport in the spirit of trying to get through the complication together (not always possible where there is a break down of trust). They talk freely at conferences, multidisciplinary team and morbidity meetings and enlist the help and support of colleagues whilst always ensuring the patient has a reliable point of access and contact.

    Though initially often seemingly uncomfortable, I am sure it results in catharsis and happier patients and surgeons in the end.

    January 19, 2018 Reply
  3. Philip Cornford Consultant Urologist

    I was once told “ There are bold surgeons and old surgeons but no old bold surgeons”. Although I don’t believe that to be completely true it does reflect the consequences of not dealing with the emotional fallout of trying your best to do what you believe to be the right thing only to watch a patient suffer. Good surgeons care for patients it is part of why they try but honest reflection in a supportive environment is important if we are to avoid previous experience adversity affecting future decision making

    January 19, 2018 Reply
  4. Gordon Muir Consultant Urologist

    A key factor is being honest with patients about expectations. No intervention is without risk, and even the best surgeon’s make mistakes and have bad outcomes. Setting realistic expectations and admitting errors or poor results will be understood by the vast majority of patients, all of whom will have made some well-intentioned mistakes in their lives. This may not affect the physical outcome but will usually allow both doctor and patient to feel they are still working together with the same goal.

    January 19, 2018 Reply
  5. Roland Morley Urologist

    Duty of Candour now dictates that we must be honest with patients when complications occur and inform them in a timely manner. many medico-legal situations occur because of failure to inform in a timely and appropriate fashion. Do it properly and may of these headaches can be avoid. It’s all down to communication.

    Then , don’t keep it to yourself but share with your colleagues so all can learn, and then , when appropriate share the result with the patient so that they are informed at all times

    January 20, 2018 Reply
  6. Ben Challacombe Consultant urologist

    The only surgeon who doesn’t have any complications is one who doesn’t operate. So of course as Roland says we need to do things as well as possible and stick to procedures that we do in high volume whilst auditing our work and outcomes.
    However sometimes complications occur when things seem to have gone as well as possible at the time of the operation. eg the post operative bleed or lymph leak after radical prostatectomy, urinary sepsis after ureteroscopy or anastomosic breakdown in a comorbid patient after cystectomy can occur after the most perfectly performed procedures.
    There is certainly potential for the second victim here as many surgeons take these things to heart and will ruminate over what happened for weeks. I can still remember every aspect of 4 cases over the last 5 years that have had bad outcomes and remember all the lessons learnt.
    I’m a member of the same club of colleagues as Christian which is an invaluable resource for discussion of complications at our 6 monthly meetings and on our WhatsApp group. I also discuss these issues with my surgical wife and medical parents which really helps when these things occur.
    Genuine no blame culture at work and support from amazing colleagues at Guy’s also key.

    January 21, 2018 Reply
  7. John Boyd Retired urologist

    Difficult to add to these reassuring and sensible approaches. Perhaps to add that patients’ relatives and loved ones need to be included in the open approach and need to be part of the story. They are easily forgotten. Also if the worst happens and the patient dies then these are the survivors who have to live with you and themselves.

    January 24, 2018 Reply
  8. K Sritharan Consultant Vascular Surgeon

    Every procedure has a list of potential complications and I was once told, ‘if you’ve never had a complication, then you simply haven’t done enough operations.’ I agree with much which has been said about the need for good communication with the patient, setting realistic expectations and early discussion of complications with the patient, if they do arise. That ability for personal reflection, if a complication does occur, also requires a degree emotional intelligence – empathy and self-awareness and this sometimes needs to be nurtured.

    I remember my first, devastating complication and how awful I felt for the patient and their family and the emotional toll it had on me…….thankfully, I did have supportive colleagues to debrief with and rather than ruminating on the case on my own I was was able to openly reflect – I think this is a key step in not only learning from any complication, but also for developing emotional resilience.

    January 28, 2018 Reply
  9. Tom Stonier Core Surgical Trainee

    It seems pertinent to mention Dr Hadiza Bawa-Garba who was given a suspended 2-year prison sentence for manslaughter and has subsequently been struck off after a boy with sepsis died. In this tragic case it cannot be denied she made mistakes; yet further investigation found she was doing the job of two registrars and covering an extra ward. Not to mention this was her first shift back from 13 months of maternity leave with no induction.

    What’s more troubling (in the context of this blog) is that her personal reflections on the event in her logbook were used against her in court. This has sent a wave of fear to the next generation of junior doctors that honesty over their mistakes could end their career.

    In a complex system such as surgery/healthcare human error is inevitable – it is the learning from the mistake that is crucial. As is frequently mentioned this is done well in the airline industry where crashes are now only 1 per 8.3 million take-offs thanks to an open no-blame culture with expert reviews of black box data which are then available to all pilots.

    Yet the Journal of Patient Safety reports 400,000 avoidable deaths in the US alone; as Matthew Syed says in his excellent book, Black Box Thinking, ‘the equivalent of 9/11 every few days’. If we transition to a world where each of these failures is taken as human error punishable by law and not the systems failure that it (almost universally) is – these numbers will only get worse.

    January 28, 2018 Reply
  10. Culley Carson Professor of Urology

    The issue of facing one’s complications is a complex one. After residency, I found the issue of morbidity one of the hardest to accept. Conferences to report, discuss and learn from complications is one of the most important conferences for both academic and non academic programs. Indeed, a place to objectively look at problems and “morbidity and mortality” is the best way to learn from and avoid complications in the future. The thought that any surgeon can escape complications is just fantasy. As was mentioned if a surgeon says that he/she has no complications has not done enough cases. Complications as we all know can be a result of surgical missteps, patient issues, team issues or even systemic healthcare system issues. It is best to vet these complications, assign a possible reason and look for a future solution.

    Only if these discussions are truly peer discussions can this be done effectively. If the plaintiff’s bar has access to these discussions, there will be no more communication or learning.

    February 2, 2018 Reply

Your Comment

All comments are moderated. Trends in Urology & Men’s Health reserves the right not to publish material we deem inappropriate.

Web design and marketing agency Leamington Spa