How do you cope...

[Trauma Surgeon]

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with your complications?

Ok, the only surgeons who do not have any complications are those who never operate. But I have very difficult to cope with my complications. They have not been major ones (only 2, both in colorectal procedures), and as a resident I always have an full fledge attending assisting me, but still it was my operation so it was my bad!

Any word of advice....

thx.

 

[SLUser11]

with your complications?

Ok, the only surgeons who do not have any complications are those who never operate. But I have very difficult to cope with my complications. They have not been major ones (only 2, both in colorectal procedures), and as a resident I always have an full fledge attending assisting me, but still it was my operation so it was my bad!

Any word of advice....

thx.

You will become slightly calloused over time. However, I promise that the burden of complications becomes much heavier once you become the attending.

Honestly, I think that some surgeons cannot handle it, and gravitate toward cases where the complications are fewer or perhaps less severe. Within my own field, some surgeons will concentrate on endoscopy and outpatient anorectal cases, only doing occasional abdominal cases. They make better money, and sleep well at night, so it's hard to blame them.

I have plenty of complications, and what I tell myself is that it's the price of doing business. If I'm going to be in the big leagues, and be doing large complex surgeries on complicated patients, then I'm going to have some bad outcomes. This doesn't stop me from sleeping bad on some nights though. Perhaps I have a mild Delayed Sleep Phase Disorder....

 

[maxheadroom]

You will become slightly calloused over time. However, I promise that the burden of complications becomes much heavier once you become the attending.

All of my friends who were ahead of me said this. And I "knew" it to be true. And then I started practice.

 

[dpmd]

I think emotionally I don't feel any worse about the actual complications now than when I was a resident. It is the worry that my peers will think me incompetent because of them that I deal with more now (although, the complication I have dealt with thus far were not because I actually was incompetent or did something wrong at least as far as I know and how the M+M played out so it has been unjustified worry thus far). However, I think that is something that will get better over time. I think if the complications don't bother you at all, you aren't taking things seriously enough. But the feelings about it shouldn't incapacitate you (unless you really are doing a terrible job).

 

[ESU_MD]

When i have complications, I immediately tell the families/pt ASAP.

I find this helps me cope better since its all transparent. I have colleagues who will downplay stuff and delay disclosure... Like that will make the complication go away.

Fortunately, the vast majority of families understand and accept complications if explained properly AND they think you tried your best. It then makes it easier to move on to the next case and get back on the horse

 

[blue2000]

Here are ways I cope

1) Call the other surgeon in town to ask for "advice." Really I'm looking for a little commiseration, a fresh set of eyes, and maybe a little reassurance that I didn't miss anything huge. It also sets me up for him being emotionally involved to some degree when it goes to M&M.

2) Total transparency with the patient and family. I commit to being as present as they need me to be to get through this. Some of the complications are mild, some are devastating, but they deserve a Dr who is not running away from them in their time of frustration and fear

3) Recommitting myself to the literature. Mostly, I read things I already know. But I try to take the opportunity to ensure my knowledge about the topic is as up to date as possible.

4) My husband is a physician in another field. I can talk about my complications with him, and he has a pretty good radar for when I am merely self-flagellating versus legitimate assessment of an error in judgement or technique.

5) Purposefully engaging with my kids, as a reminder that I have value outside of my profession and that there are people on this earth who love me no matter what.

6) Making sure my physical needs are attending too - eating, running, sleeping all make me feel better about myself and allow me to assess my mistakes with clear eyes.

7) Returning to my faith, and connecting to a world that is bigger than me.

It sounds a little cheesy, but they all keep me balanced. Additionally, I have to remind myself that sometimes I have real saves too. Last week, I did two emergency middle of the night cases -- one on a guy who was redic sick and another on a lady who was doing fine. Guess who had the complication and who got off pressors, extubated, belly closed and is eating? It would be in someways intellectually dishonest to blow off the fact that my actions saved one person while wallowing in the fact that my actions harmed another, but that's my tendency.

 

[45408]

Blue, I don't think that sounds cheesy at all. Refocusing and clearing your head sounds like solid advice. Good to hear from the staff in here.

 

[Fah-Q]

It would be in someways intellectually dishonest to blow off the fact that my actions saved one person while wallowing in the fact that my actions harmed another, but that's my tendency.

I do this ALL the time. I perseverate on the ground-ball-into-the-double-play case and forget the homeruns very quickly. It sure isn't emotionally healthy but that's just the way I'm made.

 

[FulfilledDeer]

. This doesn't stop me from sleeping bad on some nights though. Perhaps I have a mild Delayed Sleep Phase Disorder....

Ah-ha. Ahahaha. Haha. Hmm...

 

[Bostonredsox]

I think this is universal in nealry all medical fields. As surgeons, you guys operate and often feel that something you did, which sometimes is true, is the direct reason of a bad outcome and you feel like you re to blame. Most of the time it is just a bad outcome which everyone includiong the family knew was a possibility. ER docs send TIMI 1's home with 2 sets of normal enzymes and 2 normal ekgs. 5 hours later they come back with a stemi and code/die. I write orders for hot salt in a pt who is comatosed with a Na+ of 102 and the orders get misconstrued/inpappriately titrated and the next sodium is 125. Bad outcomes happen. Sometimes it is our fault, though 9/10 it is not. But as the doctors we always feel like it is our fault and we feel terrible. THIS IS A GOOD THING. It means you are still human. You still have compassion. Families dont care whose fault it is they just seem timmy is dead or paralyzed or w/e. Too often we become as another poster said, 'calloused' and we start to see pts as bodies with a problem we have to fix. I am definitely guily myself of this already as a resident as I am IM/CC and the shear number of pts that die is overwhelming at times. Now we have to distance ourselves at times or the burden of death and bad outcomes can be too great to handle. But in general, most bad outcomes/surgical complications are just as they are described, something that has a small % chance of happening but when it happens it sucks. My advice is make sure you are committed to your field. Keep up with the literature, try and minimize the component of the bad outcome that is an error on your part. Doing everything right in a case can still lead to a bad outcome. Families need to know this up front. "we are going to do this this and this and despite all of that, there is still X % chance dad could not survive the night (my septic shock talk). Simple elective GB cases that post op develop ARDS and die. **** happens. if families know this up front, we are honest with them, we work hard to do our jobs correctly, and are honest with them afterwards about what happens, I have noticed the post-bad outcome talk goes much smoother. And as for yourself, I agree with the other posters, recenter yourself with your religious beliefs. Find your zone/speak with your God(s) and remember, everything happens for a reason. it may not be a reason we fully understand when it happens, but there are powers greater than us who do know why it happened in the way it did. Recenter yourself, take a deep breath and start again tomorrow. The massive amount of good things we do for people is often lost in a few bad outcomes. Dont lose it yourself. Cheers.

 

[Buzz Me]

It's hard. I've had so many patients die (in residency - ICU/trauma rotations, in fellowship - cardiac rotations). Run so many codes, filled out so many death packets, talked to so many patient's families. It never gets easier.

Agreed that total transparency is best though.

 

[Danbo1957]

... remember, everything happens for a reason. it may not be a reason we fully understand when it happens, but there are powers greater than us who do know why it happened in the way it did.

No.

You need to make a copy of your post and show it to your PD, he'll take it from there.

 

[Bostonredsox]

So you have never in your entire career had a bad outcome that neither you nor your collegues could explain in terms of how it happened? You are the first attending I have ever met that can say that. Congrats. You must be a rockstar.

 

[blue2000]

So you have never in your entire career had a bad outcome that neither you nor your collegues could explain in terms of how it happened? You are the first attending I have ever met that can say that. Congrats. You must be a rockstar.

I think this is actually a more existential debate than you are suggesting -- he is merely saying that stuff happens for no reason, and you are saying things happen for reasons we can't understand.

I recently had an otherwise healthy patient who developed a hole in the staple line in the middle of a side to side functional end to end small bowel anastomosis which I had oversewn in a fit of anal-retentiveness. Do I understand why it happened? Honestly, it comes to handwaving and "technical failure of the GIA." But no, I don't understand why it happened. Do I think there is a greater meaning behind why it happened? No. I don't believe some higher power created that hole for reasons I don't understand. I am a religious and spiritual person, but to be frank, I don't think God made that hole. I think crap happens. But this is not a debate I can win, or anyone can. Cause it comes down to faith and beliefs. I use my religion to find personal meaning in my life and a path to deal with the terrible things that happen. But I don't ascribe anastomotic leaks to divine intervention.

 

[Bostonredsox]

I think this is actually a more existential debate than you are suggesting -- he is merely saying that stuff happens for no reason, and you are saying things happen for reasons we can't understand.

I recently had an otherwise healthy patient who developed a hole in the staple line in the middle of a side to side functional end to end small bowel anastomosis which I had oversewn in a fit of anal-retentiveness. Do I understand why it happened? Honestly, it comes to handwaving and "technical failure of the GIA." But no, I don't understand why it happened. Do I think there is a greater meaning behind why it happened? No. I don't believe some higher power created that hole for reasons I don't understand. I am a religious and spiritual person, but to be frank, I don't think God made that hole. I think crap happens. But this is not a debate I can win, or anyone can. Cause it comes down to faith and beliefs. I use my religion to find personal meaning in my life and a path to deal with the terrible things that happen. But I don't ascribe anastomotic leaks to divine intervention.

I was referring to outcomes a little bigger than anatomic leaks....such as deaths, intraop MIs, post op ARDS. things that happen at will even when everything is done right if it just happens to be an unlucky pt. but I agree with your general response.

 

[JayDoc06]

It starts with honest and open discussion PRIOR to any intervention.

I tell every hemorrhoidectomy they are gonna hurt, might have incontinence, etc...; every colectomy they might die, need a permanent stoma, have recurrent cancer in the future, small scars tun into big ones, etc...; lap choles their bile duct might get injured; and on and on.

Not to scare them but to inform them. There are a number of reasons-
1) many patients think surgery is magic and everything will be perfect
2) they are scared and speaking honestly about things that could happen helps them, seems counter-intuitive but I have found that it helps, especially if you are able to say the counter points to the negative- you might leak but 98-99 out of 100 will not
3) when a routine/common complication happens it is much easier for you and patient to accept if half the discussion has already occurred.
4) I always mention that patients can die as a result of any procedure, but also that it is very very uncommon. This will also make some patients who you don't want to operate on/think they don't need an operation realize that maybe this elective procedure isn't quite justified.

When it does happen, full transparency about what happened, why you think it happened and what you are gonna do to fix it is mandatory. Always offer to involve another physician.

My 2 cents.

 

[Pir8DeacDoc]

It starts with honest and open discussion PRIOR to any intervention.

I tell every hemorrhoidectomy they are gonna hurt, might have incontinence, etc...; every colectomy they might die, need a permanent stoma, have recurrent cancer in the future, small scars tun into big ones, etc...; lap choles their bile duct might get injured; and on and on.

Not to scare them but to inform them. There are a number of reasons-
1) many patients think surgery is magic and everything will be perfect
2) they are scared and speaking honestly about things that could happen helps them, seems counter-intuitive but I have found that it helps, especially if you are able to say the counter points to the negative- you might leak but 98-99 out of 100 will not
3) when a routine/common complication happens it is much easier for you and patient to accept if half the discussion has already occurred.
4) I always mention that patients can die as a result of any procedure, but also that it is very very uncommon. This will also make some patients who you don't want to operate on/think they don't need an operation realize that maybe this elective procedure isn't quite justified.

When it does happen, full transparency about what happened, why you think it happened and what you are gonna do to fix it is mandatory. Always offer to involve another physician.

My 2 cents.

Agree with this on all points. I make it clear the risks to people. I work hard to do a great job for people, but if they expect perfection they need to see someone else. I make them an honest attempt to do the best I can for them. I do not have a magic pill that will fix all issues and have 0% chance of complication. People seem to appreciate my honesty.

I also have only been in practice just short of a year. Anything that is not routine (i.e. parotidectomy, thyroidectomy, complicated re-do sinus case, or complicated ear) I will tell people I feel confident to do their surgery but I am not a high volume surgeon for those procedures. I may do 3-4 of those types of cases a year. If they are comfortable with that, fine. If they would rather go to a university hospital then I am happy to make referral. It's been interesting that instead of running to the tertiary hospital, nearly every single one stays with me. Again, I think they appreciate my honesty.

This business is tough. Even simple things are sometimes not. The better the patient understands that the better off things are if something untoward happens.

 

[Chemdocx]

I deal with my complications like most surgeons...booze.

 

[Zedor]

From a nsg attending "I always tell my residents that you didn't put the tumor there. You're doing your best job to remove it. If you make a mistake, learn from it, and move on."

 

[SLUser11]

Today was a tough day full of new and delayed-presentation complications.

I also read a couple nasty patient reviews about me on a doctor ratings website...presumably the same person with 2 screen names. I disagree with their statements, but the statements are permanent, anonymous, and damaging....not much I can do now. It's hard not to take those things personal when you dedicate so much of your time and energy to your profession.

I deal with colorectal cancer on a daily basis, and anorectal complaints are very personal/private, so you can imagine that my patients are often quite emotional.

Complications will certainly happen. Sometimes, they happen in clusters, which is frustrating.

I'm not sure I have great advice on how to cope, because I'm still learning myself. It certainly makes me wish for a few chip shots, but I'm not going to get them, and honestly I think it's probably better that way....

 

[Pir8DeacDoc]

Today was a tough day full of new and delayed-presentation complications.

I also read a couple nasty patient reviews about me on a doctor ratings website...presumably the same person with 2 screen names. I disagree with their statements, but the statements are permanent, anonymous, and damaging....not much I can do now. It's hard not to take those things personal when you dedicate so much of your time and energy to your profession.

I deal with colorectal cancer on a daily basis, and anorectal complaints are very personal/private, so you can imagine that my patients are often quite emotional.

Complications will certainly happen. Sometimes, they happen in clusters, which is frustrating.

I'm not sure I have great advice on how to cope, because I'm still learning myself. It certainly makes me wish for a few chip shots, but I'm not going to get them, and honestly I think it's probably better that way....

Appreciate your honesty and for sharing. It's humbling work sometimes. I hope things pick up for you soon!

 

[survivordo]

Just want to thank all the attendings for the great advice!

Survivor DO

 

[Winged Scapula]

Today was a tough day full of new and delayed-presentation complications.

I also read a couple nasty patient reviews about me on a doctor ratings website...presumably the same person with 2 screen names. I disagree with their statements, but the statements are permanent, anonymous, and damaging....not much I can do now. It's hard not to take those things personal when you dedicate so much of your time and energy to your profession.

I deal with colorectal cancer on a daily basis, and anorectal complaints are very personal/private, so you can imagine that my patients are often quite emotional.

Complications will certainly happen. Sometimes, they happen in clusters, which is frustrating.

I'm not sure I have great advice on how to cope, because I'm still learning myself. It certainly makes me wish for a few chip shots, but I'm not going to get them, and honestly I think it's probably better that way....

I'm sorry to hear that and empathize. It is very disheartening when you first find one especially when its either a distorted view or blatantly wrong.

Some of the physician review sites will let you post a rebuttal and others will also let you remove abusive ones. I think Vitals.com will allow removal of 1 per year at your request.

 

[MediCane2006]

Today was a tough day full of new and delayed-presentation complications.

I also read a couple nasty patient reviews about me on a doctor ratings website...presumably the same person with 2 screen names. I disagree with their statements, but the statements are permanent, anonymous, and damaging....not much I can do now. It's hard not to take those things personal when you dedicate so much of your time and energy to your profession.

I deal with colorectal cancer on a daily basis, and anorectal complaints are very personal/private, so you can imagine that my patients are often quite emotional.

Complications will certainly happen. Sometimes, they happen in clusters, which is frustrating.

I'm not sure I have great advice on how to cope, because I'm still learning myself. It certainly makes me wish for a few chip shots, but I'm not going to get them, and honestly I think it's probably better that way....

I'm sorry. Hang in there.

The day we stop feeling bad about our complications is the day we become the surgeons we don't want to be. It's ok to let it get to you. This is the tradeoff for all those amazing saves and great cases, unfortunately.

A lot of good advice and insight from both the veterans and young attendings in here...

 

[Thanatos]

I deal with my complications like most surgeons...booze.

I was waiting for someone to say it, otherwise I might have a problem.

It certainly makes me wish for a few chip shots, but I'm not going to get them, and honestly I think it's probably better that way....

I just had to highlight this because I do the same exact damn thing....every time I have a bad case or bad week or whatever I wake up the next day and think to myself that we can handle whatever comes.....but god I hope we get some easy ones today. And i'll be damned we never do, not ever

I have an attending who once who told me he had encountered every possible complication....and the only way to prevent the next was to stop operating. I guess thats true but I still feel like **** about some of these things.

Awesome thread with some great contributions from everyone

 

[Buzz Me]

I'm learning more and more that there are no "chip shots" in cardiac surgery. 🙁