Medical Anecdotal Report
Index Title: DMCRUZ’S MAR [15-06]
MAR Title: To err is human: Redefining the attitude towards surgical complications
Date Of Medical Observation: June 2015
Tag: Understanding the implication of surgical complications as a first year resident on training
Category: Professional/Ethical – Reinforcement
It was half-an-hour past three in the afternoon when our team was already preparing ourselves for the after rounds at the wards when suddenly a foul smelling scent filled the Emergency Room (ER). Not for long, a familiar face greeted us at our table. A 13-year-old female who was previously admitted and operated on our institution due to acute gangrenous appendicitis who came back for follow up at the ER and complained of abdominal pain. Upon thorough history and complete physical examination, we had noted that the pungent smell that we were smelling were from the patient’s purulent discharge. Exactly a week from the day of her operation, the patient admittedly confirmed that they were not doing any form of wound care at home and the patient was not able to take a bath, not even once, since the day that they were sent home. As a consequence, the patient had been constantly febrile and tachycardic and with noted abdominal distention and wound dehiscence. While rendering wound care at that time at the ER, I was beginning to question myself and cannot help myself but to contemplate that what if one of my post-op patients also developed such complications?
(Physical, Professional/Ethical, Psychosocial)
(Discovery, Stimulus, Reinforcement)
“To err is human”, probably this is would be the famous line that most of us often used to defend our shortcomings. Even in the field of Surgery, errors or mistakes are all too frequent if we were not careful enough. We all commit mistakes, but the only difference is what we do after we have made this mistake and how we see this mistake – is it a learning experience or a failure? Whenever complications occur on our post-operative patients, the involved physician struggle with its aftermath. While most of the attention typically, and appropriately, focuses on disclosing what could be possibly went wrong and addressing the concerns of the patient, the emotions triggered on the surgeon when these complications occurs are often overlooked. All too often, surgeons deal with these emotions in isolation. As a first year resident in training, such kind of post-operative event would be of high impact not only emotionally, but would greatly define our character as to what kind of a surgeon we will be in the future. More important than the harm that it will cause to our reputation as a resident on training in this department, would be the anxiety about the future operations, thinking that these untoward incident may happen again. Overall, we tend to lose confidence not only on this particular procedure alone but to ourselves as a surgeon. Doubt and these self-perceived errors can be associated with reduced quality of our everyday work at the wards; it might probably increase the feeling of burnout, self-pity and worse, depression. According to Dennis J. Boyle, MD, a physician – risk manager for a medical liability company: “It’s important to understand the needs and the coping habits of a physician after the occurrence of such complications, namely, the opportunity to talk to someone, reaffirmation of one’s competence, validation of the decision-making process and skills, and lastly the reassurance of their self-worth”. To promote emotional healing thereafter, as a first year surgery resident on training, I need to adapt different coping mechanisms to learn the most out of this mistake and move forward. The needs to recognize, forgive, repent, and finally, imbibe the lessons that I should learned from such experience should be emphasized. As a student of this prestigious department, I should learn to realize that holding on to these past failures can actually hold me back from reaching my full potential as a surgeon and I should never forget to look back from this learning experience because this would just deprives me the opportunity to carry out the crucial exercise of understanding what went wrong to the procedure and improve on them. And would serve as a constant reminder for all of us to practice extra care in handling our patients because it is their lives that are at stake.
ROJoson’s Notes (17feb13):
Writing such a Medical Anecdotal Report is also a way of coping with the stress of having complications. One reflects and one makes a resolution on what to do if there is a surgical complication.