Surgical errors or complications
Accidents change many things in those involved. Surgical accidents lead to loss of trust and endangers life. In recent times, I had seen a few errors from very close quarters. As a surgical gastroenterologist, it falls on me to solve problems created by other surgeons and solve them without adding anything to it. I have now taken some time to reflect upon this - and I am sharing these thoughts with you.
What happens from the patients perspective?
I read an article in the Daily mail dated November 10 about a special investigation against a senior surgeon whom the newspaper reported to have botched up more than 1000 breast surgeries. Being a surgeon, this is a little hard to digest. 1000 surgeries of one particular type is a magic number for a surgeon. It is a number you would reach only if you have given your life to it. But reading through the article revealed that the patient died of the disease and not the surgery. The surgeon had told the family that surgery would be a waste for the advanced disease. No I am not passing any judgment on this issue. What is clear is that patient's perspective and the surgeon's perspective are a lot different.
Operating on the wrong side, the wrong patient or doing a wrong operation is not what I am talking about. The public perspective that these errors are common is actually wrong. They are extremely rare. In India, patients are known to the surgeon pretty well before the surgery is undertaken and in most situations, the surgeon actually greets the patient as he or she enters the operating room. In India, repeated checks are done by the doctors because there is no system to check this and the surgeons do most of this work. What I am about to talk are errors in each surgical procedure.
I would talk about my own self. I recently operated on a 50 year old man with periampullary cancer for which I did a Whipple's operation. While suturing the pancreas to the small intestine, the needle went through a blood vessel in the posterior aspect of the pancreas and I had to deal with a torrential bleed. It took 30 minutes for me to dissect and control the bleed. The whole rhythm of the operation was disturbed. When we finished the operation, I was exhausted, but felt sorry. The procedure had taken an extra 2 hours to finish.
These near misses are common events in surgery, especially in major surgery.
All surgeons (barring a few) primarily operate to make patients better. Though money is involved, the primary driver is the passion to make people well. It is very rare for a specialist surgeon to do a procedure entirely for the sake of money, because the knowledge of the complications and consequences of the procedures are too well known.
While I was writing this post, I happened to witness a problem in a major liver surgery. During removal of the liver, it was noticed that the portal perfusion was slow and the porto sytemic bypass had to be changed to a shunt. The Clamp was placed on the inferior vena cava and lo, the whole operative field was filled with blood. The field could not be made dry. Three senior surgeons were called and ultimately, the rent was located in the kidney veins and one of the kidneys had to come out. The patient recovered well. The surgeon explained what had happened and the family was understanding.
I still hold the surgeon in high regard in that he could face the family about the error and admit it. It requires a lot of courage.
Surgical treatments are not simple. Some of them last more than 12 hours. Each step of the procedure has to executed to perfection and there are several aspects of the treatment over which the surgeon has no control. But despite our training, we are still human and we are prone to errors. Though surgery is evolved around this priciple, we have never made it 100 % safe. There will always be a risk for complication and it is worse if the disease or the patient is a complex one.
One appeal that I would tell anyone who would care to listen is that you empathise with your surgeon. If the judgment regarding the treatment is correct, you will be on the way to normalcy at the end of treatment. It is the onus of the surgeon to judge correctly what is required for treatment and also whether he or his team can handle the treatment protocols effectively. But all these treatments have inherent complications which cannot be completely eliminated.
If the public shuns a surgeon on complications which he has no control over, the next surgeon may not be willing to offer a treatment at all. That could be a disaster.
Everything has a risk. The patient should decide whether he can do it.
My father taught me this - Every chasm in life can be crossed - it is reasonable to do it, especially if sweet life lies on the other side.
What happens from the patients perspective?
I read an article in the Daily mail dated November 10 about a special investigation against a senior surgeon whom the newspaper reported to have botched up more than 1000 breast surgeries. Being a surgeon, this is a little hard to digest. 1000 surgeries of one particular type is a magic number for a surgeon. It is a number you would reach only if you have given your life to it. But reading through the article revealed that the patient died of the disease and not the surgery. The surgeon had told the family that surgery would be a waste for the advanced disease. No I am not passing any judgment on this issue. What is clear is that patient's perspective and the surgeon's perspective are a lot different.
Operating on the wrong side, the wrong patient or doing a wrong operation is not what I am talking about. The public perspective that these errors are common is actually wrong. They are extremely rare. In India, patients are known to the surgeon pretty well before the surgery is undertaken and in most situations, the surgeon actually greets the patient as he or she enters the operating room. In India, repeated checks are done by the doctors because there is no system to check this and the surgeons do most of this work. What I am about to talk are errors in each surgical procedure.
I would talk about my own self. I recently operated on a 50 year old man with periampullary cancer for which I did a Whipple's operation. While suturing the pancreas to the small intestine, the needle went through a blood vessel in the posterior aspect of the pancreas and I had to deal with a torrential bleed. It took 30 minutes for me to dissect and control the bleed. The whole rhythm of the operation was disturbed. When we finished the operation, I was exhausted, but felt sorry. The procedure had taken an extra 2 hours to finish.
These near misses are common events in surgery, especially in major surgery.
All surgeons (barring a few) primarily operate to make patients better. Though money is involved, the primary driver is the passion to make people well. It is very rare for a specialist surgeon to do a procedure entirely for the sake of money, because the knowledge of the complications and consequences of the procedures are too well known.
While I was writing this post, I happened to witness a problem in a major liver surgery. During removal of the liver, it was noticed that the portal perfusion was slow and the porto sytemic bypass had to be changed to a shunt. The Clamp was placed on the inferior vena cava and lo, the whole operative field was filled with blood. The field could not be made dry. Three senior surgeons were called and ultimately, the rent was located in the kidney veins and one of the kidneys had to come out. The patient recovered well. The surgeon explained what had happened and the family was understanding.
I still hold the surgeon in high regard in that he could face the family about the error and admit it. It requires a lot of courage.
Surgical treatments are not simple. Some of them last more than 12 hours. Each step of the procedure has to executed to perfection and there are several aspects of the treatment over which the surgeon has no control. But despite our training, we are still human and we are prone to errors. Though surgery is evolved around this priciple, we have never made it 100 % safe. There will always be a risk for complication and it is worse if the disease or the patient is a complex one.
One appeal that I would tell anyone who would care to listen is that you empathise with your surgeon. If the judgment regarding the treatment is correct, you will be on the way to normalcy at the end of treatment. It is the onus of the surgeon to judge correctly what is required for treatment and also whether he or his team can handle the treatment protocols effectively. But all these treatments have inherent complications which cannot be completely eliminated.
If the public shuns a surgeon on complications which he has no control over, the next surgeon may not be willing to offer a treatment at all. That could be a disaster.
Everything has a risk. The patient should decide whether he can do it.
My father taught me this - Every chasm in life can be crossed - it is reasonable to do it, especially if sweet life lies on the other side.
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