Ep. 198 Thriving despite having complications- New Attending Week Replay
Summary
The meeting was day three of a launch week focused on complications in surgery, presented by a surgeon who is also an author, podcast host, and certified coach. The presenter emphasized that complications are inevitable in surgical practice and provided guidance on how to manage them effectively.
The presenter began by outlining the main topics to be covered: understanding what a complication is, perfectionist thinking, asking for help, the prolonged stress cycle, self-compassion, managing negative emotions, shame resilience, confidence and self-confidence, and peer review assessment.
The presenter defined a complication as a failure to achieve a stated outcome, specifically a perfect procedure where nothing goes wrong. They addressed perfectionist thinking as a double-edged sword - while striving for perfection is admirable, it can lead to fear, overwork, and burnout. The presenter recommended shifting perspective from focusing on the gap between achievement and perfection to celebrating the best effort given with available knowledge and resources.
The prolonged stress cycle was discussed as a significant issue for surgeons, where continuous stress without recovery leads to cognitive impairment, decreased empathy, irritability, anxiety, depression, and potentially self-harm. The presenter offered strategies to interrupt this cycle, including deep breathing, music, exercise, mindset work, and community support.
For managing complications during surgery, the presenter advised checking one's pulse, taking deep breaths, stepping back to think, asking for help, and considering the next best step. They emphasized the importance of clear communication with partners about expectations when asking for help.
After a complication, the presenter stressed the importance of naming emotions, practicing self-compassion, and using shame resilience strategies: reaching out to trusted sources, talking kindly to oneself, and owning the story to control the narrative. They highlighted that patients primarily want to know what happened, that the surgeon did their best, that they won't be abandoned, and that learning occurred from the experience.
The presenter also discussed peer review processes, advising surgeons to control the narrative in medical charts, respond non-defensively to inquiries, and seek legal counsel if necessary. They emphasized the importance of measuring outcomes and knowing one's numbers to build confidence.
The session concluded with advice on debriefing with teams and communicating with patients' families after complications, emphasizing the need to address emotional concerns before providing technical details.
Chapters
Introduction to Complications in Surgery β 00:00:00
The presenter welcomed attendees to day three of launch week, focusing on complications in surgery. They acknowledged that while complications may seem like a heavy topic, it's important because all surgeons will experience them. The presenter introduced themselves as a surgeon, author, podcast host, and certified coach, emphasizing that complications are "near and dear to their heart." They outlined the main topics to be covered: what a complication is, perfectionist thinking, asking for help, the prolonged stress cycle, self-compassion, managing negative emotions, shame resilience, confidence and self-confidence, and peer review assessment.
Understanding Complications and Perfectionist Thinking β 00:01:46
The presenter began by addressing two common statements about surgical complications: "The only surgeon who doesn't have complications is the one who doesn't operate" and "Every surgeon carries within himself a small cemetery where from time to time he goes to pray." They defined a complication as a failure to achieve a stated outcome - specifically, a perfect procedure. The presenter discussed perfectionist thinking as a double-edged sword, explaining that while striving for perfection seems admirable, it can lead to fear, overwork, and burnout. They recommended shifting perspective from focusing on the gap between achievement and perfection (e.g., achieving 95% vs. 100%) to celebrating the best effort given with available knowledge and resources.
The Prolonged Stress Cycle β 00:07:17
The presenter explained how surgeons often experience prolonged stress cycles without recovery, especially when dealing with complications, hostile work environments, or difficult patients. They emphasized that surgical jobs are inherently difficult, stating "Our jobs are hard. Not everyone can do it." When stress continues without relief, it can lead to rumination, hypervigilance, isolation, impaired cognitive function, decreased empathy, irritability, anxiety, depression, and potentially self-harm. The presenter recommended strategies to interrupt this cycle, including deep breathing (especially exhaling), music, exercise, mindset work through neuroplasticity, and community support.
Managing Complications During Surgery β 00:11:25
For handling complications during surgery, the presenter advised: checking one's pulse first, taking deep breaths to interrupt the stress cycle, stepping back to think about what you know, asking for help, and considering the next best step. They used the analogy of viewing a maze from above versus being inside it to illustrate the importance of perspective. The presenter emphasized that how a surgeon responds during a complication influences everyone in the operating room, as they are all experiencing stress and looking to the surgeon for leadership.
Asking for Help and Managing Expectations β 00:13:51
The presenter discussed the importance of clear communication when asking for help, emphasizing understanding both your expectations and your partner's expectations. They shared examples of misunderstandings, such as a junior surgeon expecting a senior partner to scrub in during a complication while the senior partner was hesitant to appear to be taking over. The presenter advised explicitly stating what you need: "If you're the person in the operation and you want them to scrub in, just say, 'Hey, I really need you, can you scrub in?'" They also addressed "want mismatches" where partners have different expectations and recommended finding alternative sources of help if necessary.
After the Complication: Managing Emotions β 00:18:51
The presenter emphasized the importance of naming emotions after a complication occurs, describing it as learning a new language of emotional intelligence. They discussed "emotional alchemy" - the ability to transform one emotion into another, particularly distinguishing between guilt ("I feel bad that this event happened") and shame ("I feel bad because there's something wrong with me"). The presenter introduced BrenΓ© Brown's shame resilience framework: reaching out to trusted sources, talking kindly to oneself (self-compassion), and owning the story to control the ending. They explained self-compassion as "feeling a negative emotion and wrapping it up in love and respect for yourself."
Communicating with Patients After Complications β 00:24:51
The presenter shared insights about what patients want after complications: to know what happened while they were asleep, to know the surgeon did their best, to feel they won't be abandoned, and to know the surgeon learned from the experience. They emphasized the importance of giving complications purpose and using them as learning opportunities. The presenter advised being present with patients, acknowledging the reality of what happened, and providing certainty and stability during a confusing time.
Peer Review and Professional Consequences β 00:27:12
The presenter discussed peer review processes, acknowledging that surgeons have reason to be concerned but emphasizing that the goal should be quality improvement and patient safety. They advised controlling the narrative in medical charts by clearly documenting decision-making processes. The presenter outlined possible peer review outcomes: no action (sometimes even congratulations for handling difficult situations well), education/questioning, remediation requirements, or more serious consequences like privilege restrictions or National Data Bank reporting. They advised not signing anything without careful consideration and possibly consulting a lawyer if serious concerns arise.
Building Confidence Despite Complications β 00:33:48
The presenter distinguished between confidence ("I know I can do it because I've already done it") and self-confidence (the ability to take chances, stretch oneself, and manage failure). They recommended breaking down complex procedures into components, recognizing that surgeons typically know 95% of what they need to do, with only 5% requiring special focus. The presenter emphasized the importance of measuring outcomes and knowing one's numbers (complication rates, case volumes, etc.) to build confidence and counter drama with facts: "Information is the best solution when you have drama. Math always settles down drama."
Debriefing with Teams and Families β 00:41:54
In response to audience questions, the presenter discussed the importance of debriefing with both teams and patients' families after complications. For families, they advised leading with emotional reassurance before providing technical details: "First, I know things took a little longer, but everything is okay." For team debriefs, they recommended acknowledging everyone's efforts, discussing what went well and what could have gone better, and identifying next steps. The presenter also endorsed proactively reporting complications to administrators rather than waiting to be discovered: "Don't give into that kind of suffering... You're going to decrease the amount of suffering that you're going to have by doing that."
Action Items
The presenter recommended shifting perspective from focusing on the gap between achievement and perfection to celebrating the best effort given with available knowledge and resources. β 00:05:54
The presenter advised interrupting the stress cycle through deep breathing (especially exhaling), music, exercise, mindset work, and community support. β 00:09:51
The presenter suggested discussing expectations with partners before complications occur to establish when and how to call for help. β 00:14:47
The presenter recommended explicitly stating needs when asking for help: "If you're the person in the operation and you want them to scrub in, just say, 'Hey, I really need you, can you scrub in?'" β 00:15:59
The presenter advised practicing shame resilience by reaching out to trusted sources, talking kindly to oneself, and owning the story to control the ending. β 00:21:54
The presenter suggested controlling the narrative in medical charts by clearly documenting decision-making processes. β 00:28:01
The presenter recommended not signing anything without careful consideration and possibly consulting a lawyer if serious concerns arise during peer review. β 00:32:14
The presenter advised measuring personal outcomes and knowing one's numbers (complication rates, case volumes, etc.) to build confidence. β 00:36:37
The presenter suggested debriefing with teams after complications using a simple assessment: three things that went well, three things that could have gone better, and next steps. β 00:45:24
The presenter recommended proactively reporting complications to administrators rather than waiting to be discovered. β 00:48:38
