Tebala Giovanni D
Consultant Colorectal and Emergency Surgeon, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Headley Way, Headington, Oxford OX3 9DU, United Kingdom.
Med Hypotheses. 2020 Nov;144:110006. doi: 10.1016/j.mehy.2020.110006. Epub 2020 Jun 19.
The surgeon has been recognised as the "second victim" of a surgical complication and the long term psychological impact of a surgical adverse event has been demonstrated. However, the immediate and early psychological response to a surgical complication has not been properly investigated. In this manuscript we analyse a well-known historical case of a surgical complication and discuss the early reaction of the surgeon. Sir Anthony Eden, UK Prime Minister in the '50s, underwent a cholecystectomy for gallstones, but the operation complicated with a biliary fistula causing jaundice and sepsis. The reaction of the surgeon followed a precise three-stage pattern that can be identified in almost every case of surgical complication. Initially he denied the complication, with a simplistic attitude, but subsequently he felt overwhelmed by the environmental pressure and gave up. The early psychological response of a surgeon to a surgical complication usually follows the three phases of "denial", "desperation" and "action or get-away". In the denial phase the surgeon tries to reassure him or herself by diminishing the real burden of the complication and to demonstrate self-confidence. After few days, when it is evident that the complication is more severe than expected, the surgeon changes completely his or her attitude and becomes more and more depressed and anxious. The reaction to phase 2 will determine the subsequent phase 3, where the surgeon would choose between a positive and proactive attitude or getting-away, thus disengaging from the complicated patient. Acknowledging these three phases would help team leaders and colleagues to recognise the need for a supportive, friendly and blame-free environment and to act timely to help the surgeon to overcome the negative impact on his or her personality and career.
外科医生已被视为手术并发症的“第二受害者”，并且手术不良事件的长期心理影响已得到证实。然而，对外科手术并发症的即时和早期心理反应尚未得到妥善研究。在本手稿中，我们分析了一个著名的手术并发症历史案例，并讨论了外科医生的早期反应。20世纪50年代的英国首相安东尼·艾登爵士因胆结石接受了胆囊切除术，但手术并发胆瘘，导致黄疸和败血症。外科医生的反应遵循了一种精确的三阶段模式，几乎在每一例手术并发症中都能识别出来。最初，他以一种简单化的态度否认并发症，但随后他被环境压力压垮并放弃了。外科医生对手术并发症的早期心理反应通常遵循“否认”“绝望”和“行动或逃避”三个阶段。在否认阶段，外科医生试图通过减轻并发症的实际负担来安慰自己，并表现出自信。几天后，当并发症明显比预期严重时，外科医生会完全改变态度，变得越来越沮丧和焦虑。对第二阶段的反应将决定随后的第三阶段，在这个阶段，外科医生会在积极主动的态度和逃避之间做出选择，从而脱离复杂的患者。认识到这三个阶段将有助于团队领导和同事认识到需要一个支持性、友好且无指责的环境，并及时采取行动帮助外科医生克服对其个人和职业的负面影响。
