Share Your Complication
Submit a video showing how you handled a complication, and you could get to present at AAO 2016 in Chicago.
Everyone has had complications in surgery, some more gut-wrenching than others. And as a young ophthalmologist, you’re at a significantly higher risk of making surgical errors than your more senior colleagues.
At first thought, it might seem prudent to hide or minimize these mishaps. But as three established ophthalmologists demonstrate through their own experiences, openly acknowledging and sharing mistakes will make you and your colleagues better surgeons and better healers.
Sharing Forges Lifelong Learning
“If we don’t share our collective experiences and reach out to others for improvement, we’ll make the same mistakes again and again,” said YO Committee member Janice Law, MD. “And we’ll eventually be left feeling like there’s no solution the next time around — our patients deserve better.”
After every procedure at the Vanderbilt Eye Institute, Dr. Law sits down with her surgical fellow and has an open discussion about anything that went wrong and what could’ve gone better — even something as simple, yet critical, as the insertion of trocars or wound closures.
“There’s always more than one way to perform surgery,” she said. “So being open-minded and honest helps us become better lifelong learners and stay true to our patients. It also establishes a positive work culture in your practice that says, ‘Yes, mistakes happen, so let’s learn from them together.’”
Sharing Is a Part of the Surgical Tradition
“Sharing our mistakes is a long-standing aspect of our profession,” said Thomas A. Oetting, MS, MD, the director of the ophthalmology residency program at the University of Iowa. “And multimedia websites like YouTube, Facebook and the Academy’s Ophthalmic News and Education (ONE®) Network are really helping to expand on this tradition.”
Dr. Oetting knows the importance of these resources first hand. In 2007, Amar Agarwal, MS, FRCS, FRCOphth, and his colleagues published an innovative “glued” technique for posterior chamber IOL fixation in eyes with absent or insufficient capsular support. This method involves making two partial-thickness scleral flaps 180 degrees apart followed by a sclerotomy and the use of an anterior chamber maintainer.
Dr. Oetting’s first attempt a few years later didn’t go as planned. He decided to forgo the maintainer and soon found himself in trouble. So he posted the video of his complications on Facebook and asked his peers for advice. “I had several experienced surgeons reach out to me reminding me to use the maintainer,” he said. “On my next case, I used it and I've never gone back — it was a testament to transparency.”
Sharing Helps Ophthalmologists Become Better Healers
“It’s these very mistakes that make us better humans and better healers,” said William C. Lloyd III, MD, FACS, a career military surgeon and moderator of the Academy’s AAO 2016 YO Program. “We’re coded for error, but we keep trying. Otherwise, we could never get anything positive accomplished.”
Dr. Lloyd found this out for himself in residency. A severely diabetic blind woman was in need of an enucleation — a relatively low-risk procedure for a first-year resident looking to get some practice in the OR. However, the 45-minute procedure became a six-hour ordeal. The patient would not stop bleeding. Unbeknownst to Dr. Lloyd, she had been undergoing routine hemodialysis but had her most recent appointment postponed until after the surgery, per anesthesiology.
This delay in dialysis caused the blood to become highly uremic, which poisoned her platelets and led to the profuse hemorrhaging. In effect, the clean preoperative blood work that Dr. Lloyd obtained did not reflect the patient’s actual intraoperative values. After multiple platelet transfusions, he got the woman through a scary situation.
For Dr. Lloyd, many positive things came from that mistake. For one, it helped solidify his belief that ophthalmologists are truly healers. “In our surgery, the patients are often wide awake,” he said. “And by maintaining openness, honesty and transparency — especially when the unexpected occurs — we can build very deep relationships with patients, which is one of the most rewarding aspects of practicing medicine.”
After sharing this experience with peers, he published a paper on the topic as a second-year resident. He soon became an evangelist for the perioperative management of patients on hemodialysis and presented his work at the Academy’s annual meeting.
Now’s Your Turn to Share
How do you manage surgical complications? In the 2016 YO video competition, “When Vit Hits the Fan,” you can submit a case of your own and show your peers how you handled it. The top three winners will be awarded prizes and have the opportunity to present their video during the YO Program at AAO 2016 in Chicago. Submissions must be received by Sept. 1.
“This is your moment to shine,” said Dr. Lloyd, “and show us all how, after a mistake, you dust yourself off and get back up!”
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About the author: Mike Mott is a former assistant editor for EyeNet Magazine and contributing writer for YO Info.