Poor surgeons

News are running wild in my hospital regarding a surgeon, when performing an operation for ectopic pregnancy, ruptured the aorta accidentally, resulting in a rather disastrous bleed. I have heard various groups of people talking about this over coffee/lunch. With medical students and the surgeons, we generally want to know what happened, how's the patient and how's the surgeon as when things like this occur, it is as traumatic an experience for the surgeon as it is for the patient. Today, in the middle of our little chat, a theatre manager came in and her gossip agenda couldn't be more different. She wanted to know who the surgeon was, whether he or she's usually good or not and who is to blamed - very inflammatory. There was no concern for the wellbeing of the surgeon at all. This just goes to show how little sympathy lay people have for the medical profession and it is up to us to support each other. In this day and age when suing doctor is the norm, we are especially cautious and spend far too much time documenting things, filling in various forms so we are able to defend ourselves. I know it is people's right to complain or sue when they are unsatisfied, but no doctor is ever intentionally negligent. 

Surgeons work extremely hard. Most of them go out of their way to acquire skills. Take my registrar for example: he turned up in theatre this morning after only an hour rest as he has been on-call all night last night just so he could operate in theatre today. He is not alone. I know of many trainees who come in during their free time or stay behind late just for the opportunity to practise and operate. If you want to be good, you have to make this sort of sacrifice especially in surgery.    

Doctors are conscientious. It is generally against our intuition to do things that we are not confident of. When I am asked to do a difficult cannula, I am usually reluctant.  The easy thing to do would be to hand it over to the senior doctor and say 'You do it, it's too difficult and I don't want to stab the patient too many times'. But in fact that is the wrong thing to do. The right thing to do would be to just go for it, and if I fail to try again, and again until I get it. But by then the patient would have had three needle pricks already. However, thanks to this patient, I am more competent of doing cannula. The same with surgery. Reluctant and unsure as the trainee may be, there is no point just watching the same things over and over again. The best way to learn is to get your hands dirty and actually start doing it. But is this fair to the patient? Maybe not at the moment. But if you want you or your children and grandchildren to be treated by the best doctors and surgeons, then the answer is absolutely yes.

Doctors make mistake. In my fourth year, I watched my consultant calmly deal with a bleed from the uterine artery that the registrar accidentally cut. Of course, he had made all the mistakes while he was training already and was therefore confident to deal with anything. In surgery, surgeons generally prefer everything to be well controlled (or boring in the eyes of the medical student). But, a trainee surgeon generally has to do lots and lots of the same operation to achieve this relatively god-like state, which means that the first couple of patients will inevitably suffer as the surgeon hones his surgical skills. The more junior we are, the more supervision we get. The patient is usually not informed if the a trainee is operating instead of the consultant (but it's always documented in the operating notes). Is this ethical? You tell me. I think it is. No surgeon should become consultant until they have encountered and dealt with mistakes. If we tell the patient it would provoke too much unnecessary anxiety and training opportunities for surgeons will decline even further.   

Back to my point of lay people not being very sympathetic to the surgeons. I am really sad to see an eminent surgeon go down this road. I have been to her clinic once. She is an excellent surgeon and no doubt have saved many lives before. Unfortunately because of this adverse incident she is brought to disrepute. Such a waste of a highly trained surgeon. I don't think she deserves this. I hope this post has shed some light from the surgeon's perspective. I'm not saying that surgeons shouldn't take responsibility for the complications from the operations. Every operation carries risk, (and it is unrealistic for the surgeon to list every single one while consenting), so when you the patients agree to an operation, you should have agreed to accept the risks. Surgeons do every operation very carefully and would never have intended to do any harm. And when things go wrong, they don't deserve to be criticized and condemned as if they are some ignorant and incompetent second rated doctor. Have a heart for the poor surgeons.

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