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Complications Are Inevitable

By Caitlin Symonette, MSc, MD, FRCSC

With high operative caseloads, bad outcomes/complications are inevitable. This is a humbling reality of being a surgeon. I find this especially true at my early stage of career. Also like most surgeons, I am a type A personality. I like to be in control and strive for perfection. I find that when I have a bad outcome, my initial reaction is stress and disappointment. My professional performance feels fragile and my confidence temporarily wavers. Then, I tend to perseverate over the case- review the case and imaging, return to literature, seek the opinion of senior colleagues, and spend some wakeless nights reflecting on my decisions, approach, and actions. Bottom line- I am extremely hard on myself when I have encountered a bad outcome. My personal approach is emotionally exhausting.

When I was in my training, one of my mentors advised if you have a bad outcome do not shy away from that patient but offer to connect with them more regularly. This is an approach that I have embraced. I strive to be open and honest with my patients and have strong communication with them. I have also accepted that bad outcomes can be the result of different factors related to my own actions/decisions, patient expectations, patient participation and compliance with their care, constraints of our health care system, and challenging clinical situations. I cannot have control over all of these but work to identify and mitigate negative consequences where I am able.

Bad outcomes are powerful experiences and have shaped me as a surgeon. I am constantly working on my emotional response to be more productive and less destructive. Creating a plan for the patient and reframing my emotional response to focus on the opportunity to grow, learn and improve has helped. I have become more resilient. I look forward to reflecting on how my perspectives on this topic evolve as my career unfolds.

Caitlin Symonette, MSc, MD, FRCSC
London, ON

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