Right response to complications.(Guest Editorial)

Complications are ubiquitous in procedural medicine. They happen to all physicians. But I've come to understand that most doctors are poorly equipped, at an individual level, to handle the psychological effects of severe complications.

The effects of complications can be devastating for the doctors involved, and they may even substantially inhibit a physician's future success. Despite this, medicine does a poor job of acknowledging the deeper effects of complications. Medical training must change so that it emphasizes and teaches practical ways for clinicians to deal with these issues, including how to approach patients and families affected by complications. Such training would help physicians do a better job, as well as maintain their own mental health.

Currently, most doctors receive little or no training on dealing with the personal sequelae of complications or on handling the severe stress that these situations can cause. Traditionally in medicine, the personal response that physicians have to complications has been learned, not taught--and that is part of the problem. Many physicians have told me that the complications they experienced early in their careers had changed their practice and altered their conduct and attitude in a negative way.

Early in my career a patient of mine had a severe complication. I was performing a procedure aimed at resolving chronic pelvic pain associated with a vascular malformation. During the procedure the patient had a massive pulmonary embolism and died. It was a wrenching experience. In my mind I replayed over and over the decisions that led to this tragic outcome. For weeks, I felt remorse, self-doubt, and recrimination. The experience made me sharply aware of the negative personal and professional dynamics that a complication can trigger.

When I related my experience to other doctors, almost all said that they had dealt with similar episodes in an almost identical manner, and all strongly agreed that they were in no way prepared to handle the event in a healthy way.

Common responses by clinicians to complications include confusion, anger, repression or denial, and self-doubt. Blame is placed on others or on the patient, the incident is not discussed with other physicians, the patient is avoided, and the doctor involved enters a period of ...