How Can I Conquer My Fear of Surgical Mistakes?

Sarah Bernstein, MD

Disclosures

July 06, 2009

Question

Recently one of my classmates told me about a mistake he made in the operating room. He had been excited because he was allowed to really help in the surgery and not just do the retracting. However, he hit an artery with an instrument and caused bleeding. Now he has lost his confidence, and this episode has made me wonder how I will deal with complications that I cause in patients. Or worse, what happens if someone dies because of my mistake?

Response from Sarah Bernstein, MD
Resident, Department of Obstetrics and Gynecology,
St. Luke's-Roosevelt Hospital, New York, NY

Your questions are ones I'm sure every surgeon ponders at some point in his or her career. Here's a story that provoked similar questions for me:

A woman is at home recovering from an uncomplicated cesarean section. She lifts her new baby out of the crib and feels a "pop" at her incision site and a gush of fluid. She looks down and is horrified to see a portion of her small bowel protruding from her incision. Luckily, she has some healthcare experience and knows to cover the area with a clean, damp cloth and goes right to the emergency department. Once she arrives at the hospital, she is rushed immediately back into the operating room where her complete wound dehiscence is repaired. Fortunately, there is no injury to the bowel or further postoperative complications. Still, she is frustrated by her rehospitalization. The additional days spent in the hospital are full of physical and emotional pain as she yearns to be with her new baby.

The doctors involved in the case talk extensively about what could have prevented this complication. The intern involved in the case, who was the first assist, is horrified. She had sewn half the fascia and tied many of the knots. What if the complication was due to her lack of experience? Would it have occurred if a more experienced resident had been operating instead? These are questions that students, residents, and attendings struggle with on a regular basis.

Although there is no straightforward answer to these questions, here are some helpful points to consider:

  • Doctors always work as a team in the operating room; therefore, no one person is singled out for being to blame for a bad outcome.

  • Sometimes it is less about the complication itself and more about the reaction of the surgeon. If the surgeon is able to approach the situation calmly and rationally, better outcomes are probable.

  • Every complication can be a learning experience. If viewed in the right way, we can learn ways to prevent a similar recurrence or be better prepared for a similar outcome.

  • One can never know whether a complication was truly preventable.

  • In the United States, it is standard to obtain "informed consent" from a patient before any operative procedure. The purpose is to inform patients that there is a certain level of risk involved in every procedure; by signing the consent, the patient acknowledges that he or she understands this risk. Good communication is the key here!

  • There is no harm in asking for help when you encounter a difficult situation; in fact, you can take comfort in the fact that additional help is almost always available. Even the most experienced surgeons often benefit from a new set of eyes assessing a challenging situation.

  • Surgery is not for everyone! If you are constantly stressed out in the operating room, afraid of making a mistake, and unable to enjoy the process, you will probably not enjoy being a surgeon.

It is actually quite useful to experience a complication as a student, both so you can see whether you can handle the adrenaline rush and so you can observe how the residents and attending respond. As a third-year medical student, it can help determine whether you are interested in a surgical residency. As a fourth-year student shopping for a residency program, these situations allow you to see the faculty and residents at their worst (or perhaps best), which can help you determine whether that particular program is an appropriate fit for you.

Now that I have probably scared you away from ever wanting to be a surgeon... remember that complications occur much less frequently than some people might believe; otherwise, the risks of the surgery would far outweigh the benefits. A wise, well-seasoned surgeon once told me that if you approach each patient with a humble attitude, you can prevent complications. She went on to explain that every time her scalpel glides across skin, even in the most routine of cases, she is an intern again. The moment you have the ego of a chief, the human body likely will humble you again.

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