"How do you regain confidence after a surgical complication and prevent the experience from keeping you up at night?"
Brandon D. Ayres, MD
As physicians, we like to make a positive impact on our patients’ lives. That positive impact may be on their mental health or their physical health, and, for the most part, we’re good at making people better. I think there is an even more special relationship when someone allows you to perform surgery on them. Patients are entrusting in our skills to fix and heal them. But every surgeon has cases that do not go as planned or encounters a poor outcome independent of surgical skill (such as endophthalmitis). It’s these times—when our intention is good but the outcome is poor—that the patient-physician relationship is most strained.
I can recall several surgical procedures I have performed that eventually led to loss of vision or even loss of the eye. In my opinion, the discussion with the patient and their family starts as soon as the procedure is completed. It is important for the patient to know that an unusual event was encountered during the surgery and that it may affect the length of their recovery or possibly the quality of their vision as they recover. The patient should also know that you are on their side and will do everything possible to help them recover and maximize their vision. Recognizing that a surgical case was more complex than average is not an admission of guilt or error; not taking proper care of the patient postoperatively is an error. Staying connected to the patient and their family and helping them orchestrate additional referrals or surgical procedures is helpful for maintaining the patient-physician relationship.
There is no question that a surgical complication is most traumatic for the patient, but it can also be quite traumatic for the surgeon. There have been days when I’ve left the OR swearing that I'd never return, as I thought I may be doing more harm than good by performing surgery. On these more challenging days, it is important to have a short-term memory. You want to quickly forget the nerves and the jitters and the feeling that you don’t belong in the OR. At the same time, it is important to learn from each complication encountered, as this will make you a better surgeon. Get back in the OR as quickly as you can to show yourself that one complication does not mean you’re not a skilled surgeon.
I still encounter nights when I have difficulty sleeping before a complicated case. I constantly review the case in my mind, running through all of the potential complications and how they may be managed. I think about how the way in which I perform that surgery will affect that patient for the rest of their life. I don’t think this nervous restlessness means I’m not confident in my surgical abilities; rather, it means that I care about my patients and want them to have the best outcome.
In short, complications will happen. Don’t abandon your patients when you encounter a complication; bring them closer. Do your best to move past the self-doubt and allow the negative experience to make you a better surgeon. Try to forget about the specific event and hold onto the useful information that will serve you in the future.