Mental Constructs to Avoid Complications

In this episode of BackTable Urology, Dr. Aditya Bagrodia interviews Dr. David Canes from Lahey Medical Center about attitudes, practices, and anecdotes to help resident and attending surgeons to avoid surgical complications.

First, the doctors discuss pre-operative rituals. Both doctors agree that reviewing relevant films and picturing the operation step-by-step is very important. Additionally, they emphasize the importance of putting the patient at ease before the surgery. Dr. Canes leaves sticky notes on patient charts that remind him of small personal details about the patient. He usually mentions these details to the patient the morning before their surgery in order to put them at ease. Dr. Bagrodia prefers to call his patients and reassure them the night before the operation. In the OR, Dr. Canes always takes his time-out meetings seriously and makes sure that everyone is able to introduce themselves. Dr. Bagrodia usually takes a moment of silence to personally reflect on the patient before starting the operation.

Next, they discuss the qualities of successful surgeons who encounter minimal complications. Although Dr. Canes concedes that technical skills are important, he thinks that the surgeon mindset is just as important. He emphasizes the importance of approaching surgical procedures systematically, breaking every big step down into smaller microsteps for precision. For difficult cases, he encourages surgeons to engage the opinion of trainees, PAs, and nurses in the OR. In these situations, he believes that patient outcomes should take precedence over pride and ego. Additionally, he highlights the importance of controlling emotions, heart rate, and respiratory rate during complications in order to think rationally.

Finally, the doctors discuss the benefits of collaboration and co-operating. Dr. Canes encourages surgeons to stop by different ORs in order to learn new techniques.