26th March 2012

Complications in surgery

I have been reading Atul Gawande again, surgeon & philosopher. He reflects on complications and also on how surgeons become better – areas that interest me too.
Complications can occur because of lack of knowledge and the uncertainty or unpredictability that accompanies this. Rhinoplasty carries perhaps more unpredictability than many operations. The gap between what we know and what we aim for will always be present. Human beings are highly complex both in anatomy and healing. As we strive to get better results with surgery and learn more the knowledge gap moves with us throwing up new questions. Unpredictability persists all be it different and therefore so does the risk of a complication. We always need pioneers but pioneers may face greater uncertainty and so require courage. Complications also relate to errors. The more complex a procedure therefore the greater the potential for error. This the expert surgeon with more difficult cases or higher expectations has to deal with too. Their difficulties though may be balanced by their greater experience over other surgeon’s areas of uncertainty and may be associated with increased chances of a superior result.
Pioneers must be responsible and must audit & analyse their results. It is said by Atul that as we all learn more and improve the average improves. So if we are average and everyone improves then we stay average. However the best seem to pull away more. I think this may be because the best want to get better the most and so think and reflect more. This increases understanding and so decreases uncertainty and perhaps complications. However the only way to have no complications is not to operate!
As my valued friend and expert rhinoplasty surgeon Rollin Daniel says we “practice” medicine meaning we don’t have all the answers and continue to learn, sometimes the hard way for our entire professional lives. We must learn from every experience and be awake to them.
David Fincher the acclaimed film producer in a press relese modestly states that he “—— makes films, not everyone will like them —— but it won’t be for want of trying to do my best”.