Good Surgeons, Bad Outcomes: Dealing with Difficult Situations

By Betty C. Tong, MD, MHS, MS | December 21, 2021

“Primum non nocere” or “first, do no harm” is a fundamental principle of the Hippocratic Oath. As thoracic surgeons, we have a unique opportunity to directly benefit patients through our skills and expertise. 

Regrettably, however, no surgeon can boast a 0% complication rate. Bad outcomes happen to all of us. While it is easy to fall into a cycle of blame and shame after an unexpected event, doing so does not help the patient and family at hand, nor does it help us as surgeons. 

In order to best support the patient and their family, you must understand and manage the problem successfully; this also will help promote your professional growth and development. 

As thoracic surgeons, we have a unique opportunity to directly benefit patients through our skills and expertise. 

Here are a few thoughts on how to deal with a bad outcome:

Own the problem  

I will confess that my first desire is to avoid seeing a patient with a complication after surgery. Out of sight, out of mind? Not so fast. As much as I might want to avoid this patient or family, I owe it to them to face the issue and work to make it right.

Take time to discuss the problem with the patient and family. Explain to them, in a way they can understand, what you think happened that led to the event. DO NOT blame others. Communicate to the patient your “Plan A” and “Plan B,” as well as “Plan C” regarding next steps. They may have seen that Plan A doesn’t always work, so it’s important for them to know that you are being proactive and thinking ahead, while anticipating additional issues. You should also explain that Plan B and/or Plan C are unlikely. 

Sit down at eye level with the patient and family members for your daily conversations. Standing by the door to make a quick escape conveys the idea that you are too busy for them. Always offer to answer questions during your interactions. All of these things help to buffer your relationship with them and restore the trust they have in you as their surgeon.

From a practical standpoint, it also is reasonable to speak with someone from risk management. While potential litigation should not be a matter at the forefront of your mind, having a discussion with an expert in the area at a time close to the event may help you down the road. Understand that these professionals work on your behalf and do not judge your actions or clinical skills.

Balance the ego

Something unanticipated and untoward happened to a patient. Making it right for the patient may involve putting your ego aside and seeking advice from trusted friends and colleagues. These colleagues may have valuable insight regarding management of the patient moving forward. In addition, hearing “I’ve never seen that before” may provide some solace regarding your situation.  

As much as being arrogant or blaming others for the outcome is wrong, losing confidence in yourself isn’t right, either. Trust in your training and your experience to do the right thing moving forward. Again, if this involves bringing in a trusted extra pair of hands, know that you had the good judgment to do so.

Forgive, but don’t forget

Seek opportunities to learn from the situation and prevent similar complications from happening in the future. We are all a product of our education and experiences. One bad outcome has already happened. The real tragedy would be to allow it to happen again to another patient because of your failure to understand or recognize the problem and plan how to avoid it in the future.
In summary, it takes courage and humility to deal with a bad patient outcome. Understand that while we all strive to provide the perfect operation and care, sometimes bad things happen. Put the patient and their family first and try to learn from the situation so that something positive may result.