How do we as surgeons deal with our mistakes?

This blog was first published on KevinMD entitled “How do surgeons deal with their mistakes” and is re-published here as well. 

As surgeons we are privileged to have our hands work inside someone’s body with the intention of alleviating suffering, removing sources of pain, excising diseased organs, fixing this or that, ultimately to improve someone’s quality of life, prolong it or at times even save it.

Yet we also know that people can suffer complications from surgery, that in some cases are fatal, and where our good intentions seemingly backfire. Patient deaths and complications can be related to the quality of the body that the patient brings to the operating table, as well as technical factors that occur during an operation and errors of judgment or decision-making by the surgeon. The only way to totally avoid complications is to not operate – not a viable option for most surgeons or for the patients seeking help and where surgery is the mainstay of treatment!

Our intention is always to help, to care, to heal and never to harm patients – but how do we stay healthy when our healing intentions turn into actions that harm? We are all human, we are all fallible and we all make mistakes – but the price of our mistakes can be another person’s quality of life and even life itself.

People can and do die when we make mistakes.

How do we deal with these mistakes – both personally and professionally?

How do we make sense of them in the privacy of our own hearts and minds?

Do we internalise them and go on a feast of self-reproach, recrimination and judgment, punishing ourselves with our harsh words and thoughts, the long list of:

“I could have done this”

“I should have done that”

“What if I had or hadn’t done this or that?”

“How could you be so stupid?”

“What were you thinking?”

“You should have known that”

“You should have done better”

“You’re not good enough”

“Another surgeon would have done this or not done that”… and on and on the endless tirade can go. I know them all well.

Do we externalise them, deny we had anything to do with them and instead seek to blame anyone and everything outside of ourselves – the assistant, the scrub nurse, the suture material, the stapling gun, the blood transfusion, the instruments, the theatre temperature, the anaesthetic, the junior doctor, the nurse, the anaesthetist – you get the picture? Anything to not feel we may have had a part to play in someone’s surgical complication, or even his or her demise?

Do we bury them, suppress them and numb them with alcohol? A favourite drug of choice for many medical professionals (and one that I chose myself for many years)  – unless of course its grip takes hold and we spiral into the shameful cesspit of addiction – overflowing with the pain and hurts we have perceived but have had no idea how to address.

How many dead or harmed patients are swimming in the whirlpool minds of doctors who are addicted, and whose intentions were to help and heal; not maim, harm or kill?

Alcohol is just one such tool, but I could have used other drugs, food, sex, work, porn, exercise, gambling, over-achieving and on and on are the many forms and ways that we use to distract ourselves from feeling what is really going on inside ourselves, from feeling those things we don’t want to feel.

How we treat ourselves when such situations occur is reflected in how the system treats us. It is little wonder then that this translates into a culture of medicine that is equally harsh, punishing and blaming – even if it professes not to be! The professional bodies put their reputation over and above the humanity of the people they are in charge of teaching and regulating. They set curriculums devoid of care for the people they are supposedly training to care for others, and then wonder why there is a lack of compassion in the profession, when it has been absent from the culture of how the regulating bodies treat their subjects, how doctors treat doctors, how senior doctors treat junior doctors and how all grades of doctor treat medical students. And so the cycle continues.

Ask yourself this – has self-critique, judgment, reproach, recrimination, bashing, punishment ever worked?

Has it ever made you feel better about yourself or the situation?

Has it enhanced your level of acceptance of yourself or of the events that occurred?

If the answer is no – is it possible then that there is another way? A way that brings understanding, acceptance and healing to all concerned? A way whose voice is gentle, caring and loving, that understands there is a bigger picture to everything in life, that even though we may not know or be able to fully comprehend all the details, that ultimately there is an order, there is a reason for why things happen the way they do. A way where we can take a step back and begin to observe and have compassion for ourselves (and others) rather than judge, bash, and criticise ourselves (or anyone else).

For it is only when we start to nurture a more caring and compassionate way with ourselves that we will then grow, develop and nurture a culture of medicine that is equally so for all.  

We are all responsible for our choices and actions in any moment, but what if there are a host of seen and unseen factors that are influencing those choices and actions?

What if in any moment we are all doing the best we can, given our upbringing, our experiences, our culture, our religion, our education, our training, our relationships, our ideals and beliefs, our past hurts and traumas and so on?

And what if in the next moment we can always choose to be more caring, considerate, kind, compassionate and loving towards ourselves? In doing so, it then becomes a natural consequence that we will bring those same qualities to our patients and everyone else.

Why not give it a go and see what happens?

 As surgeons we do not intentionally kill or harm patients – but patients can die or their lives can be affected as a consequence of a complication of surgery that may be related to technical factors or errors of judgment or management by the surgeon. It goes with the territory; it’s part of the job, as any honest surgeon will tell you.

But what if there is much more to it, what if it’s not as simple and straightforward as we like to believe? What if there are other unseen factors at play that mean, although we are always responsible for doing the best we can to care for the patient in every way, we are not ultimately responsible for the trajectory of another’s life, including their death?

Staying healthy when I make mistakes – when my healing intentions are betrayed by technical complications or errors that may cause harm or even death ­– has required me to no longer deny, bury or suppress what I am feeling, but to feel it all and to understand that there is always a bigger picture than the one I see with my eyes, and that bigger picture has love and only love as its calling card for all.


1 Comment

  • Reply
    Michael Goodhart
    17th September 2018 at 4:22 am

    I love what you have shared here Eunice about how self-bashing after making a mistake has never truly helped anything, and that when we drop back and feel the bigger picture, there may be all kinds of life lessons and opportunities for growth or deeper reasons for things that happened, even if they may appear to be tragic on one level. This blog also helped me appreciate how at least I have for the most part taken responsibility for my mistakes (even if I have gone the distance in self-criticism and beating myself up over and over for them!) and have always felt there to be a reason for everything happening in my life that could help me and others evolve in some way. This approach brings so much more purpose to life than the alternative view that life’s tragedies, mistakes, or other occurences are all random events with no meaning whatsoever.

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