A New Strategy
By Mitchell Pet, MD
When I participate in achieving a bad surgical outcome, it seems like the sensible thing to do is acknowledge it, learn from it, salvage it as best I can, and then move on to help someone else. I like to think that I am reasonably good at acknowledging and learning from my failures, and I’m slowly getting better at fixing what can be fixed. Moving on though, is hard. Even when I have no surgical treatment left to offer, I have found it tough to walk away. I think that the reason I have trouble with this is that in the back of my mind, I know that while I would like to move on from this unfavorable outcome, the patient is stuck living with it. How is it fair that I could permanently vacate from this situation, while my patient may be left with permanent physical consequences? This incongruity has at times left me with churning thoughts and insomnia.
The only strategy I have found to help mitigate my troubles moving on from bad outcomes has been to give up the idea of moving on. Rather than attempt to have a final reckoning with the patient and close the book on the experience, I have accepted that these issues remain open indefinitely. Even when I have little left to give clinically, I offer to have these patients with my worst outcomes back into the office every so often for an update on their situation. Sometimes they get better with time, sometimes they don’t. Sometimes they find another place to get care, sometimes they just keep coming back to talk.
Either way, I find that keeping the door open to further conversations allows me to feel like I am participating in the process of living with a poor outcome. Importantly, even though I haven’t moved on, this strategy has allowed me the psychic relief of putting it down for a while. In this scenario, the outcome is still acknowledged as an active issue, but I am able to turn my attention to other things while letting this issue rest temporarily. I think the approach offers me peace because I know I haven’t dissociated from my bad outcome, and that I will at some point revisit it and share in bearing a little bit of the burden it has created.