OPINIONS

Everything’s my fault: How a surgeon says I’m sorry

Monday, November 11, 2013

by Dr Lara Devgan

When I started my surgical internship, my chief resident told me some magic words: Whenever something bad happens, stay calm and say: “I assume full responsibility. It won’t happen again.”

Dr Lara Devgan

Dr Lara Devgan

As a young surgeon at the bottom of the totem pole, those words were my mantra for the times when someone’s head was go in to roll. In those nascent days of my surgical career, I was just trying to stay in everyone’s good graces. Surgery is a traditional, hierarchical field, and acting defensive or blaming someone else — whether it is justified or not — is a rookie mistake.

In the beginning, I used the “responsibility mantra” mainly to put out fires. Late one night, a transplant surgeon pulled me into the supply room to scold me. A kidney transplant patient’s blood tests were missing, he barked. Where were they? I thought about telling him the full story: I ordered the blood tests, the phlebotomist drew the blood and sent it to the lab, and somehow the test tube went missing. I thought about saying I was sorry.

Instead, I took a deep breath and said: “I assume full responsibility. It won’t happen again.” His anger was temporarily extinguished. Then I drew the patient’s blood myself, hand-delivered the test tube to the lab, and waited for the results to get printed before I ventured back to the wards.

This same scenario repeated itself over and over in my first few months as a junior surgeon. A patient would accidentally eat a snack before getting wheeled to the operating room, and the case would get cancelled. A chest X-ray I ordered wouldn’t get done. The results of a wound culture wouldn’t show up in the computer records. The hospital is an imperfect place, and there are holes in the system. Over and over again, I would assume full responsibility for things that on some level had nothing to do with me. I didn’t want to incur the fiery wrath of the senior surgeons.

Over time, though, a funny thing happened. After repeating the responsibility mantra so many times, I internalized it. I really believed it. When something went wrong with one of my patients — whether it was his fault, my fault, or someone else’s — it was always my responsibility. When a person trusts you with his life, the buck stops with you.

Thousands of people are needed to make a modern hospital run, but if you are the physician in charge of someone’s care, you are accountable for all of those people. You are the one who needs to notice when a blood test is lost or when a patient doesn’t understand his pre-operative instructions. You are the one who must follow up on the scans and cultures to make sure they are complete. You are the one who needs to verify all aspects of your patients’ care.

The truth is that in surgery, bad things can happen. A patient can have an allergic reaction to an antibiotic; a doctor can fail to diagnose a cancer until it has already spread; a surgeon can injure a blood vessel during an operation. Physicians make mistakes, and patients get sick or die because of what we do or don’t do. It is this unadorned reality of the profession that makes the responsibility mantra so important.

Accountability is at the core of what it means to be a surgeon, and it is the reason why we have “morbidity and mortality” conferences. M&M, as it is more affectionately known, is a confidential group-wide analysis of complications and medical errors that occurs in nearly every hospital Department of Surgery in the world. If a patient has a problem, his surgeon stands before his peers and explains what happened: This is what went wrong. This is why. And this is what we can all do to make sure this never happens again.

The airline industry has a similar approach to analysing plane crashes — the black box is taken apart, crew members are interviewed, and experts convene. It is not enough to apologize for an error. In order to really be responsible for our mistakes, no matter the industry or profession, we must own up to them and be personally committed to preventing them in the future.

Now that I am an attending surgeon, I teach younger doctors the same mantra I learned so many years ago. What starts as a catch phrase somehow becomes a sense of maturity that molds them into compassionate surgeons. By teaching trainees the script to become accountable leaders, we give them the structure, the behaviours, and the words to grow into professionals who understand the gravity of their jobs.

I recently attended an M&M in which surgeons, young and old, presented their complications. A surgeon who was just a few years into clinical practice discussed a surgery that he cancelled at the very last minute because the patient’s blood pressure was too high.

“It’s your responsibility to know the blood pressure in advance,” a senior surgeon called out from the back of the room.

“Of course,” the young surgeon said, with complete sincerity. “Everything is my responsibility.”

Dr Lara Devgan is a US-based plastic and reconstructive surgeon and can be reached on the self-titled site, www.laradevganmd.com. This article first appeared in KevinMD and has been republished here with permission from Dr Devgan.

Categories: OPINIONS

Tags: , , ,

  More from OPINIONS

Opinion: Hapless Doctors, Insensitive Judiciary

Dr Soham D Bhaduri

Opinion: Designate me a ‘Public Servant’

Dr Neeraj Nagpal

Deaths that will not count

Dr Neeraj Nagpal

The enduring conundrum of euthanasia

Dr Ashoka Jahnavi Prasad

Opinion: Are doctors like commodities to be monitored with RFID tags?

Prof Dr D R Nakipuria

Opinion: What are we congratulating?

Dr Neeraj Nagpal

8 Comments »

Comment by Dr vivek Chhimpa
2013-11-12 04:21:46

Thanks for this beautiful article Dr Lara.

 
Comment by Dr Vijay Kumar
2013-11-12 08:02:02

beautiful article by b’ful lady…. the responsiblity mantra works

 
Comment by sandeep bhagwat
2013-11-12 11:29:40

I do not agree with you madam.

It is easier to speak “everything is my own responsibility”. But when a doctor internalizes it, he or she becomes tremendously stressed, blames himself for no fault of his or her. The shortcomings of medical technology, morbidity, complications of a medical condition are not anyone’s responsibility. If a doctor is burdened with these things the stress would cause more errors and omissions.

Modern health care is a team work. Team is responsible for the job. It is team leader’s responsibility to ensure smooth operation of services. Team leader is not the treating physician or surgeon because he does not have any control over services of other departments, or even the nursing staff. Team leader is the person running the hospital. I remember one of my professors had a placard behind his chair on which it was boldly written “i treat, he cures.” And this is true to the word. We are the professionals who apply known scientific knowledge for the well being of a person. Nothing more nothing less. Outcome of treatment is not in our hands.

If this attitude is kept in mind. A doctor would be able to work more efficiently, with less stress and better patient care.

 
Comment by Dr S Hariharan
2013-11-12 18:47:30

To stay calm by self,this mantra is good.This attitude is more of a selfish nature.Dr Lara’s role, when she learnt the mantra,was of a juniour doctor.But if the operating surgeon falters in some area and after the damage is done,if he says the mantra to calm himself,it will not be accepted by a court of law for pardoning him;instead he will be punished.
But in general,accepting Dr Lara’s mantra will definitely make one better not to commit gross errors for the second time because the mantra concludes with “I will not repeat it again.”

 
Comment by Kalyan
2013-11-13 09:31:33

The statement works in an utopian world where everyone understands others problems and forgive each other in case of a mistake. It also works sometimes when you are a trainee because the secret is concealed among the doctors. But when this statement is uttered by a consultant in a M&M conference the results can be disastrous sometimes because M&M conferences became a game of one-upmanship rather than sources of learning nowadays. And definitely this is a forbidden statement to utter with the patients or their attendants because of the prowling lawyers lurking behind them waiting for their opportunity.

 
Comment by DR.manisha agrawal
2013-11-14 11:43:26

congrats lara for this approach. captain of the ship, or a football team is fully responsible for his team success of failure.

 
Comment by Dr Pradeep Arora
2013-11-18 20:23:33

This mentality of self- reproach and self pity is out of whack with changing trends , . It was alright in past when doctor patient relation was paternalistic . It was then a reciprocal sentiment to the unwavering trust , the patients reposed in their docs, Now in these times of rank accusativeness and litigations, resulting in windfall compensations , it would be naive to encourage the culture of putting vicarious responsibility on surgeons for any lapse in care.Senior surgeons should desist from making a scapegoat of their juniors for every wrong. It is demoralizing for the green horns and lowers their self esteem unduly. . Contriteness eventually becomes their second habit. What more today’s’ consumer alias patient can ask for. The sacrificial lamb is trained to happily put his neck on chopping block with an exaggerated sense of virtuosity.

 
Comment by priyanka
2013-12-06 04:33:38

Absolutly right…Not everytime the same statement can be applicable & it may even create legal issue…

 
Name (required)
E-mail (required - never shown publicly)
URI
Your Comment (smaller size | larger size)
You may use <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong> in your comment.