We are all surgeons, doing different surgeries every day, and complications are inevitable. It is worthwhile to think about how to deal with complications, how to correctly understand the complications that have occurred, and how to summarize the experience of complications.
In December 2013, the European Colorectal Conference was held in St. Gallen, Switzerland, with the theme of “Complications in colorectal surgery and their management”. There is an old Chinese saying that “family shame must not be disclosed”. In China, our approach to complications is significantly different from that of foreign clinicians, and we really rarely get together to discuss complications, especially our own complications. We are all surgeons, doing different surgeries every day, and complications are inevitable. How to treat complications, how to properly understand the complications that have occurred, and how to summarize the experience brought by complications are indeed worthy of deep thought.
Many complications of colorectal cancer surgery
Common complications of colorectal cancer surgery include intraoperative complications, such as intraoperative bleeding, peripheral organ injury, serious complications are presacral bleeding, ureteral injury of urinary system, bladder injury, uterine adnexal and vaginal injury, etc. Recent postoperative complications include postoperative anastomotic leak, anastomotic obstruction, anastomotic stricture, postoperative intestinal obstruction, bleeding from the anastomosis, stoma-related complications, rectovaginal leak, rectal bladder leak, and urinary leak after ureteral injury; neurological injury caused by rectal surgery, including postoperative limb dysfunction in the relevant region, sexual dysfunction and urinary dysfunction; postoperative pulmonary embolism, lower limb vascular of thrombosis in the lower extremities; the long-term complications also include the recurrence of tumor anastomosis.
In fact, surgery for rectal cancer sometimes requires multidisciplinary cooperation, such as urology, obstetrics and gynecology, orthopedics, etc.
Surgeons should have a positive attitude towards complications
Undoubtedly, every surgeon wants his surgery to be flawless, however, as long as surgery is performed, complications will occur. However, due to the special and irreproducible nature of medicine, the attitude towards complications is very important.
First, face them positively and objectively confront the complications that occur in the spirit of doing things first.
Second, assess the adverse consequences of the complications, take strong measures, and if necessary, ask for multidisciplinary consultation so that the patient can turn back in a good direction as soon as possible.
Many complications cause serious consequences because the surgeon is not timely, the word “fear” is in the forefront, want to put things to rest, minor issues, the results delayed the best treatment time, causing serious consequences for patients. In addition, the current medical environment, we are facing increasing tension between doctors and patients, individual unscrupulous media malicious hype, so that doctors dare not out of complications, dare not face complications. It should be seen that most surgeons possess a high degree of responsibility, hard work and dedication.
Third, organize a careful analysis of the causes and learn from them. If it is due to system deficiencies, revise the existing rules and regulations.
Fourth, after fully assessing the condition and the overall development of complications, actively and sincerely communicate with the patient and family.
Sincere and proactive doctor-patient communication
Sincere and effective proactive communication is very important
Surgeons should not avoid the occurrence and existence of complications, and strive to take the initiative.
Effective communication must be based on a “sincere” attitude, therefore, doctors must be sincere, put themselves in the position of the patient and be realistic; before communicating, they should fully understand the occurrence of complications, the probability of occurrence, countermeasures, and the possible causes and future regression of complications. It is recommended that senior physicians communicate with patients and families.
A good environment with responsible family members is usually an important part of good communication
Communication should be done in a quiet setting with one responsible family member, and usually should not be done with multiple family members, as too many family members can make communication difficult due to different emotional types. The patient’s legally authorized, preoperative informed consent filling family member or the patient himself should usually be approached.
Adequate explanation and communication of the patient’s condition and listening to the patient’s family
Adequate explanation and communication of the patient’s condition, including the cause, current status, and possible consequences of the patient’s complications, and the proposed series of measures to be taken, should be fully explained. At the same time, there should be sufficient time for family members to ask questions. The doctor should answer carefully and give detailed explanations for relevant technical issues to gain the understanding of the patient and family members.
Invite the staff of the hospital’s doctor-patient coordination department to be present if necessary
Complications have the potential for doctor-patient disputes, and staff from the doctor-patient coordination department, or even lawyers, should be invited to be present when major complications occur to assist in effective communication. Some important medical-legal documents related to complications should be signed on this occasion, also to keep relevant evidence for future doctor-patient dispute handling.