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Table of Contents
COMMENTARY
Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 164-165

Perfectly complicated


Department of Neurosurgery, Wockhardt Hospitals, Mumbai Central; Department of Neurosurgery, Grant Medical College and Sir JJ Groups of Hospitals, Mumbai, Maharashtra, India

Date of Web Publication02-Nov-2021

Correspondence Address:
Dr. Mazda K Turel
Department of Neurosurgery, Wockhardt Hospitals, Mumbai Central, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJNO.IJNO_422_21

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How to cite this article:
Turel MK. Perfectly complicated. Int J Neurooncol 2021;4, Suppl S1:164-5

How to cite this URL:
Turel MK. Perfectly complicated. Int J Neurooncol [serial online] 2021 [cited 2021 Nov 27];4, Suppl S1:164-5. Available from: https://www.Internationaljneurooncology.com/text.asp?2021/4/3/164/329817



”If anything can go wrong, it will.” Murphy said so. Medicine is a trying profession. And contrary to the cliché, it may not be entirely correct to call a doctor's profession, “practice,” given that it is a highly iterative learning process involving other peoples' lives. However proficient you become, you can never predict when your next complication rears its ugly head. We all make mistakes and we all pay a price [Figure 1].
Figure 1: The quest for excellence… demands its price

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There is a difference between a mistake and a complication. A complication most often is an adverse event caused by preexisting factors that are outside the doctor's control. A mistake, however, assumes there was a lapse of quality, control, or judgment by the surgeon. They both tread a fine line. Surgeons who tackle more difficult procedures and physicians who encounter more cryptic diagnostic dilemmas than others will have more obstacles and should not be penalized for dealing with them.

Decision-making under pressure is the key to survival both for the patient and the doctor. These are essential decisions about when to operate and more importantly when NOT to operate. This is an imperfect and an ambiguous science. It takes an average of 10 years and 10,000 hours of tenacious practice to achieve a reasonable amount of skill and judgment to become competent. If you graduate from the bottom half of your class in medical school – which by default 50% of the doctors do, you might want to double that figure.

We are often asked by relatives of patients before a surgical procedure – “Doctor, what are the chances of complications, or of things going wrong?” – to which my natural response is “Don't worry, everything will be alright.” I, then, go on to quote figures of a vocabulary of complications from medical literature, leaving them completely perplexed. But does this offer them the assurance they need? Numbers and percentages do not mean much to most, because when it happens to their kin, it is 100% for them.

In a world where doctors are being sued for malpractice, the average doctor becomes a defensive practitioner. It is interesting to state that Malcolm Gladwell in his book “Blink” says that “people don't file lawsuits because they've been harmed by shoddy medical care. What comes up again and again in malpractice cases is that patients say they were rushed or ignored or treated poorly.”

I am one of the strongest proponents of what I call “The Human Connection” without which, not only medicine, but any other activity in one's life is rendered meaningless. In our world, where we sometimes see up to 100 patients a day in the outpatient department, perform nearly 1000 complex surgeries a year, and fill 10,000 forms in different formats, we are as you might like to think “at our wit's end.” There are, however, no excuses for being unable to say a comforting word to an anxious patient or his family… to let them know that you are willing to acknowledge their state of confusion and bafflement and help them through it, while at the same time doing the best job that you were taught by your mentors to do. We were raised in our community by our wonderful parents, with values that go far beyond medical practice statistics, and what the West is experiencing as a crisis in the ethics of a practice as noble as medicine.

Despite all this, we still stumble and when we falter, some believe that the doctor is rendering his version of “another one bites the dust.” This is not true. We agonize over it. We obsess. Our yesterday takes up most of our today. We keep wondering what we could have done differently. We replay the moment of doom a million times and we do that with the microscope of our mind, which only magnifies it exponentially. Our families have to bear with our silence or anger depending on how we choose to introspect. Sometimes, this struggle becomes our identity.

Therefore, I firmly believe that one can never be above one's profession. No operation is too simple or too small. It is sometimes the elementary surgeries that humble us the most, if we are not mindful. Given the complexity of the human body, there are infinite things that can go wrong even during minor surgery. We must realize that the things we take for granted, someone else is praying for.

Medical literature is fraught with statistics of wrong patients being operated on the wrong side for the wrong diagnosis. Every conference we attend has a symposium on complication avoidance, controversies, and dilemmas. Sometimes, even the good we do is full of mistakes!

The introduction of the surgical safety checklist by the World Health Organization has helped to significantly reduce these lapses. Interestingly, studies of plane crashes in the aviation industry have shown that the occurrence of a disaster is never a single failure but a series of slipups that dovetail into massive catastrophes. This has proven to be so in medicine as well. The trick is in anticipating all the things that could go wrong – foresee it and thus avoid it. This becomes a daily addiction. Just as, after the error has occurred – to go to unbelievable depths of the mind to identify the “root cause” of the failure, so that it may never occur again. As my old friend, Aristotle once said – “We are what we repeatedly do. Excellence, then, is not an act, but a habit.”

Now for some of us, this obsession with perfection, in order to transcend complications and mistakes, makes us difficult people to contend with, in mildly endearing ways! If at a fancy restaurant, a strand of hair is found on the plate, the head chef will be called and the situation equated to leaving behind a sponge in the brain. If your plumber can't fix your leaking tap on a Sunday morning, you compare it to your always managing to regulate his prostate problems, even on a Sunday. If your carpenter can't give you a smooth satin finish, you threaten to leave an ugly scar if the need arises. At some point, everyone will stop to ask, “But Sir, how can you compare these two?” May be you can't, but may be sometimes you have to. It is in this very pursuit that we find ourselves doing better. We thus become victims of the rules we live by. We strive for perfection where excellence will do. Yes, it's perfectly complicated!




    Figures

  [Figure 1]



 

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