This is one of my rare articles that I have to admit almost writes itself after a difficult week.
As a gynaecology surgeon, I spend much of my professional life operating on women, including those with cancer. Many of these procedures are complex, long, and mentally draining, while some are routine, standard procedures that I have done for over two decades. And if I am honest, after years of doing this work, it is easy to begin believing that experience alone protects you from complications.
Recently, one of my patients had an operative complication. Thankfully, it was not serious, it was recognised quickly, managed appropriately, and she is expected to make a full recovery. But even when the outcome is good, complications shake surgeons deeply. As they should.
One of the paradoxical things about medicine is that of course confidence is necessary. Patients want their surgeon to be calm, decisive, and assured. In the operating theatre, hesitation can be harmful. But there is a very fine line between confidence and invincibility.
Surgeons are human beings performing extraordinarily technical work under pressure, often for many hours at a time. We train ourselves to function during stress, fatigue, uncertainty, and emotion. Over time, experience can become a double-edged sword. Experience improves judgment, but even I might begin to quietly convince myself that complications happen to “other people.” Until they happen to me.
The truth is that complications are an unavoidable part of surgery. Even in the best hands, with perfect preparation and flawless technique, the human body is unpredictable. Scientific data consistently shows that complications occur across all specialties and at all levels of expertise.
What many patients may not realise is how deeply complications affect doctors emotionally. There is a concept in medicine called the “second victim” phenomenon. The patient is, of course, the first and most important victim of any adverse event. But healthcare professionals involved often experience guilt, shame, anxiety, insomnia, self-doubt, and even symptoms similar to post-traumatic stress.
Surgeons rarely talk openly about this. There is an unspoken expectation that surgeons should be resilient at all times. We are trained to move quickly to the next patient, the next clinic, the next operation. But after a complication, many surgeons replay every step repeatedly in their minds: What could I have done differently? Did I miss something? Was I distracted? Was I too confident? Even when colleagues reassure you that complications occur in the best practices, it still hurts.
I remember early in my training hearing senior surgeons speak about how complications will happen the more you operate, but how you deal with them is even more crucial. One lesson that becomes increasingly important with experience is the value of auditing your own practice.
Surgical audit is not about self-punishment; it is about self-awareness. Looking carefully at your complication rates, outcomes, infection rates, readmissions, and surgical trends helps surgeons identify patterns they may otherwise miss. In many hospitals, risk management meetings and multidisciplinary discussions allow doctors to review difficult cases together in a structured and supportive way. Morbidity and mortality meetings, for example, exist not to shame doctors, but to learn collectively. These conversations can be uncomfortable, but they are essential for safer patient care.
Evidence consistently shows that healthcare systems which encourage open discussion, reflection, and learning from complications tend to improve outcomes over time. No surgeon, no matter how experienced, should practise in isolation. Sometimes a colleague’s perspective can reveal blind spots, reassure you appropriately, or simply remind you that medicine is a team profession and not an individual performance.
One of the most important things we can do after complications is react honestly rather than defensively. Humility, it turns out, is also a safety tool. My recent experience also reminded me how important communication is with patients. Patients do not expect perfection nearly as much as doctors think they do. What they value is honesty, transparency, compassion, and accountability. Difficult conversations are never easy but avoiding them erodes trust far more than the complication itself.
Ironically, the surgeons who worry the most after complications are often the safest surgeons. Anxiety can become destructive if it overwhelms you, but a healthy respect for risk keeps us careful. It reminds us to pause, to double-check, and to never underestimate even “routine” operations. The operating room has a way of humbling everyone eventually. No amount of experience grants immunity from human limitation. Perhaps the greatest danger in surgery is not fear, but overconfidence.
So, this week, I found myself reflecting less on technical skill and more on ego. The quiet ego that whispers, “You have done this hundreds of times.” The ego that can make anyone, not just surgeons, less attentive, less cautious, less open to possibility.
And that is the hidden value of difficult moments. They force us to remain teachable. My patient will recover fully, and I am profoundly grateful for that. But I suspect I will carry the lessons from this for a very long time. Not as a mark of failure, but as an important reminder that good surgeons are not the ones who believe complications will never happen to them but the ones who never forget that they can.
