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Introduction

Residents will hear many different surgical aphorisms throughout their training. Some of the most common include quips like “Surgery is a contact sport,” “Don’t mess with the pancreas,” and “A fool with a tool is still a fool.” While sayings such as these harbor important truths, perhaps the most honest is the expression that states, “The only way to avoid complications is to avoid operating.” Put more bluntly, complications are an inevitable part of our careers as surgeons. And though the effects may range from uncomfortable to life-altering for both patients and providers, facing complications is an integral part of our education and growth.

Throughout both literature and common lexicon, the concepts of complications and medical errors are often conflated. For the broader medical community, a complication or adverse event may be defined as a known and unavoidable risk of medical care, while a medical error describes an avoidable commission or omission which may have negative consequences. However, as surgeons, what we commonly refer to as complications—instances like anastomotic leaks, postoperative hemorrhage, and wound infections—encompass both the above definitions. Thus, we more commonly separate complications into disease related (unavoidable) and provider related (avoidable). Yet, as all who have attended an M&M conference can attest, these distinctions are rarely cut and dried, as most complications can be attributed to a combination of patient-, provider-, and system-based factors.

While it is crucial to review and discuss these contributing factors, what is arguably more important is the way in which we react to complications. When we make mistakes, or patients have bad outcomes, it is important to remember that our responsibility is first and foremost to our patients. As an intern placing a subclavian line in the ICU, I dropped a lung. I shamefully gathered the supplies to place a left chest tube, expecting my supervising chief to take over. However, he dismissed my suggestion, telling me, “This is your patient, your complication, and you are going to take care of what needs to be done.” I will never forget that lesson in patient ownership. However, our duty to our patients does not end with performing an indicated procedure or intervention, but also includes having an honest conversation to disclose the error that occurred and discuss a plan forward. As trainees, we do not often receive formal instruction on error disclosure, which can make this process more stressful. The simplest approach is to honestly explain to patients and their families what happened, how it happened, and the future implications for the patient’s health while genuinely expressing remorse and offering a sincere apology. Like most skills we acquire during our training, these conversations are something that require practice and should be experiences we lean in to as learners.

Although often less obvious, complications can also deeply affect caregivers, especially surgical trainees, who may be the “second victims” in these circumstances. The guilt we feel for the harm we have caused our patients, as well as fears regarding loss of reputation and possible litigation, can increase symptoms of burnout, depression, and PTSD. As such, it is imperative that we develop coping strategies which will allow us to face and overcome complications. Sometimes, this may mean unpacking a challenging case with coresidents and/or attendings you trust to help put the event in perspective and identify opportunities for improvement moving forward. This may also mean talking openly with your patient and their families to help you find closure. It is important to allow yourself to process the emotions that come from a challenging patient outcome, be it through conversations with colleagues, friends, and family, or even professional help.

Ultimately, we must accept the truth that we, as humans and surgical trainees, are imperfect and prone to mistakes. We can and should do our best to prevent and mitigate them, but we cannot expect to avoid them completely. Instead, we must remember to lean into discomfort and learn every day.

Pearls

  • We, as humans and surgical trainees, are imperfect and prone to mistakes.

  • The most important part in disclosure of a medical error is your apology.

  • We grow by leaning into discomfort and learning every day.