Conflicts: Inevitable?

Patients and their families are human beings. Surgeons, to the surprise of some, are also. As such our interactions, especially during the time after an operation when feelings run high, are subject to potential conflict. Despite the best of intentions, the stress of an illness or need for an operation can interfere with a patient’s/family’s understanding not only of the risks of an operation but even of the possibility that an operation may not succeed in curing a cancer. If the surgeon happens to lack warmth and affability (again, we are human) that can make matters even worse. When things don’t go well, even if all care is appropriate, and a family member or the patient erupts with anger the relationship becomes tense and there is a tendency for the surgeon to get defensive or, even worse, in turn respond angrily. A negative feedback spiral begins as the family gets more frustrated and even accusatory and the surgeon equally frustrated and defensive.

There is no magical answer. Certainly, making every reasonable attempt to be sure patients and families understand the risks and limitations of an operation is an extremely important responsibility of the surgeon. When time allows and office staffing or hospital personnel are available, having a second person review these aspects after the surgeon has left can be very useful. Patients/families may relax a little and the messages begin to sink in. The surgeon should keep as calm as possible when families or patients express anger and appreciate the concern for a loved one. Best to attempt to respond with empathy, not just with a legalistic response such as, “I told you this could happen.” As I said in my previous blog the aphorism of being pessimistic to the family and optimistic with the patient is a useful guide. The patient is energized to recover and the family is prepared for the worst.

Fortunately, this is not a frequent scenario. Even if disappointed, most families and patients understand that complications occur even if an operation was performed appropriately in terms of both indications and surgical technique. Likewise, my experience suggests that most surgeons are competent and compassionate. This means that extreme conflicts are unusual and can be navigated to a reasonable conclusion.