The American Journal of Surgery published an article "The effects of Stress on Surgical Performance"
Firstly, Why is it bad?-
Stress effects cognitive processes including memory, recall of knowledge and attention. We are talking about high stress, so stress generally associated with physical responses – pounding heart, sweaty, physical tension, shaky etc.
How this plays out is an inability to think clearly, you doubt decisions, and you have distractive thoughts e.g. this is going to affect my reputation etc. These thoughts increase your cortisol production and stress response which can lead to a cycle of despair. Additionally, you might not be able to think straight in terms of when to ask for an assistant or a more experienced surgeon if available.
What they found is that experienced surgeons are able to do the following.
STOP by GAINING TIME to recover from the stress e.g. put pressure on the bleeding. They use this time to regain self-control, assess the situation, make a decision and prepare for the next stage.
They avoid over-focusing on the task, so they can break the cycle of anxiety and think clearly about what they need – is it another assistant?, retraction?, alternative suture?, increased exposure? etc.
Experienced surgeons were also better at hiding their stress from the team, as this creates stress in the team which leads to their cognitive function decline. They do communicate clearly with the team however. E.g. ‘Can I have everyone listening to me’ or "can I have everyone concentrating for a minute as I’m encountering difficulty’
I think you will find if you focus on these techniques, you actually will know what to do – Don’t start thinking ‘‘oh no the client isn’t going to like the long incision' - this will create stress.
If you experience a complication during a spey, explain to the client why you had difficulty. "I had difficulty as there was a lot of fat....I had difficulty because I was trying to keep my incision short but the suspensory ligament was tight" (etc). Explain that you therefore made the safest decision to get some better exposure.
Comments