How many mistakes have I made? How many people have I harmed? Hopefully not as many as I have helped, at the end of one’s career the thank you cards should outnumber the complaints.
I have undoubtedly caused harm, I can think of some of them now and those are just the ones I remember. What about all the people I’ve harmed and not known about?
The woman who I sent for a CT scan in error, entering the patient details from the preceding patient. The operations that I did that would have been done better by someone more experienced. The pelvic abscess from a bad lap washout. The massive incisional hernia that resulted from an abdomen I made a shambles of closing…shit there’s loads of them.
There are probably plenty I don’t know about, the wound infections, hernias, anastomotic leaks even deaths. (Jeremy Hunt take note, junior doctor bodge ups that would not have happened if a consultant did them, maybe. I hope you do read this you lanky shit)
The question that interests me now is how the hell do you start letting trainees do the operating and decision making and not freak out? I cannot imagine it, walking out of theatre and leaving a trainee to do the anastomosis!
I need to become a good trainer; having been obsessed with being a good trainee I now need to figure out how to teach people. Knowing how to do something doesn’t mean that you can teach it. I have had the benefit of some amazing trainers and emulating them is undoubtedly the way forward.
I’m sure I will manage to train someone and trust them and feel happy to leave them to do the operation, but will I be happy to deal with the complication? I remember seeing a consultant blame his trainee for a bilateral hernia that recurred on one side “that’s the one my registrar did” he told the patient. The patient looked at him like he was a twat, as did I.
Letting someone do it in your name means taking the blame when it goes wrong. How do you cope with that? I can barely cope when something goes wrong that I have done never mind taking the rap for my trainee. It looks like I am going to be a terrible boss, who senior trainees will hate because I don’t let them do anything.
Where are we meant to learn this? The GMC that licence my practice insist that the care of my patients my first concern, which of course it is. Nowhere in the Duties of a Doctor am I obliged to teach or train: but I am really and if I don’t I won’t get a registrar and I can’t easily do the operation without skilled assistance.
How do I face a patient with a complication that I didn’t directly cause but was done in my name? Apologising is obviously in order and I do this without hesitation or reservation and so far haven’t been sued for admitting that a mistake has been made. People are very understanding, famously the family of a massive error have never sued as the surgeon was so open from the outset; I take my lead from him and haemorrhage regret and apologies for every ileus and leak that I come across. Sorry doesn’t mean you’re guilty or negligent.
How do I face my registrar and be kind and pleasant when they have fucked something up? I have caused my fair share of problems and I have been on the receiving end of some spectacular bollockings but overall mostly lovely bosses who have soothed my troubled conscience. I will try and be good and fair and take the pain. I’ve plenty of practice of doing this sort of thing as a parent, but I love my children more than my future trainees.
There are so many things to worry about above and beyond the actual operating and none of it is in any book or written down anywhere.