President's Perspective October 2016

Sean T. Grambary, DPM, FACFAS

Complications Happen
“Failure is never fatal, but failure to change can and might be.”—John Wooden, Basketball Coach
Sean T. Grambart, DPM, FACFAS
ACFAS President

As I sat down to write this Perspective and was thinking back on the last several years, I had the NFL game of the week on in the background, and I came to the realization that surgeons and athletes are similar people. When you listen to professional athletes speak, especially retired ones, they can recall the devastating losses more than the wins. Those losses can still linger, and some athletes refuse to talk about a really ad defeat even years later. I think surgeons have the same mentality. It can be hard for us to remember the specifics of a successful outcome or the name of a patient who had great result, but at times, we can easily remember the specifics of a patient who had either a devastating complication or a poor surgical outcome.

As I reflected, I was reminded of another quote from Coach Wooden, “Failure is never fatal, but failure to change can and might be.” Everyone hates to see a poor outcome or complication, but each issue is a chance to learn from that failed procedure and to possibly change what you do as a surgeon. Skill changes come when surgical techniques can be refined and instrumentation advances. But, one change that took the most time for me to improve upon was my interactions with patients when these complications or poor outcomes occurred.

We are, by nature, people pleasers. Our desire to help people is one of the biggest reasons why most of us went into medicine; it’s why discussing poor outcomes or complications can be difficult. We want our patients to be happy and satisfied with their outcome, and when we see “that” particular patient who experienced a poor outcome on the schedule, it can ruin your whole day.

To help, I decided to change my mindset. First, I needed to accept the realization that I can’t satisfy every patient. As surgeons, we all have a goal of a zero-complication rate and a successful outcome every time, but in this day and age of patient satisfaction scores, we know 100 percent isn’t possible to achieve. In fact, many hospital systems offer incentives for 80 percent or greater satisfaction scores. Think about it—if you do 500 cases per year and have a 90 percent satisfaction score, there are still 50 patients who are not satisfied with their results. As people-pleasing surgeons, this is a hard reality to accept as a fact of practicing medicine.

Second, I needed to come to terms with the fact that complications will happen. I’m always surprised when new patients come to me for a second opinion after surgery and tell me their previous surgeon said he or she never has surgical complications. Complications happen to all of us. A surgeon friend once shared with me that he tells every patient, “No matter what procedure you do and no matter how many times you have one it, everyone heals on a bell-shaped curve.” Sixty-eight percent of patients will heal as expected, 14 percent will heal a little quicker and 2 percent will heal extremely quickly. He also tells them that the exact opposite can happen; 14 percent will heal slower and may have expected complications, and 2 percent of patients will have poor surgical outcomes. I’ve been sharing this exact phrase with my patients to help us know and remember what to expect from each case.

Remember, failures will happen. When you have a poor outcome, take the time to learn from the situation. You may need to change your technique or how you deal with your patients. Also, be honest with your patients; they want to be reassured you can help them and won’t leave them on their own. And as much as we’d like to forget, take it from a former athlete who can still recall every heart-breaking loss—I know we can’t always forget the heart-breaking surgical outcomes either.

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