“Collateral damage: the effect of patient complications on the surgeon’s psyche” was a brief but interesting paper that probably went unnoticed by many. Using the results of a survey completed by only 123 of the 403 surgeons who received it, the paper studied the effect of complications on the emotional well-being of surgeons. You could argue that the response rate of 30.5% renders the conclusions suspect. But that’s not the point.

The subject matter hits close to home for any surgeon who cares about his patients and what he does to them.

There are two types of complications—those that happen despite your best efforts, such as a postoperative MI in a seemingly healthy patient or an infection that develops after proper surgical technique and appropriate antibiotic prophylaxis were used.

Then there are the complications that occur because you made a mistake. Examples of this are sepsis due to an anastomotic leak due to your well-intended but erroneous judgment that the patient’s bowel wall would hold the staples or your failure to operate soon enough on a patient with a bowel obstruction.

Of course when any complication occurs, we feel bad for the patient and the family. But the latter type of complication can keep you awake at night, undermine your confidence and your ability to function, and even affect your enjoyment of life in general. Eventually, you get over it and move on, but the next time is no easier. According to the survey, about two-thirds of the surgeons felt it was difficult to deal with the emotional aspect of  complications throughout their careers, and experience did not seem to lessen the impact.

Not everyone is affected in the same way or to the same degree. I once had a surgeon tell me, “I’ve been in practice for 22 years, and I’ve never made a mistake.”

But for us mere mortals, mistakes happen and leave scars. A South African blogger named Bongi said it much better than I in a post he called “The Graveyard.” In it, he describes a case of his with a delayed diagnosis that resulted in a patient’s death. He said every surgeon has a graveyard in the “dark recesses of his mind” where “names engraved on the tombstones” can be recalled.

I have a graveyard. I think most doctors do.

Skeptical Scalpel is a practicing surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For almost 2 years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog has had more than 200,000 page views, and he has over 2900 followers on Twitter.

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