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The Mentors | Sept/Oct '15

When Bad Things Happen to Good Doctors

These days, for me, the most difficult part of being an eye surgeon is managing the ever-increasing expectations of my patients. When you add to that the fact that we all can’t be perfect surgeons every time we operate, it’s inevitable that we will, on occasion, be dealing with patients who are upset and disappointed in the results of their surgeries. As the attending physician, our initial response to these patients is critical to defusing a potentially disastrous situation. Conflict resolution, if done properly, can avoid escalation toward litigation and often can strengthen the bond between the patient and doctor. A few simple steps taken early can go a long way toward achieving a successful resolution in even the most serious of complications.


A patient experiencing an unexpected complication needs to be able to express his or her fears, disappointment, and concerns and know that he or she is being heard. As the patient’s doctor, we need to be able to compartmentalize any fear, anxiety, and stress we may be feeling and focus on what the patient is saying, making sure he or she is able to get everything he or she needs to say said. Showing empathy for the patient’s symptoms and indicating that you are equally unhappy with the situation and that the two of you are in this together tells the patient that you are there for him or her and that he or she is not alone with this problem.


The next step is to explain to the best of your ability what the situation is and allow the patient to ask whatever questions he or she may have. Some may disagree, but if I made a mistake, I tell the patient flat out and let the chips fall where they may. If you don’t have all the answers yet, tell the patient so and say that you will look for whatever information you need to sort this all out. Then discuss what the potential courses of action are. There should always be more than one so as not to appear to be dictating to the patient what needs to be done. It’s also critical to come to any decisions together. The patient needs to be an active participant in the decision-making process. This also helps to create the necessary bond between doctor and patient that needs to be present for a peaceful resolution.


Finally, I make sure these patients have easy access to my office and me. Again, this requires compartmentalization of the feeling to want to avoid a difficult situation. I see these patients regularly (missed appointments are a bad sign) and give them all the time they need for their appointment. The staff also needs to know early that these patients are to be treated carefully. It is very easy for one staff oversight to undo all the good will you’ve worked hard to create.


Fortunately, complications are a rarity in our field. Sometimes bad outcomes occur, and patients can be left with a poor result. If handled properly, however, most patients will be accepting of the situation. Some of my strongest advocates are patients who’ve experienced significant problems with their surgeries. Their praise is undeserved to be sure but certainly very much appreciated.