How Surgeons and Surgical Leaders Manage Complications, Medical Errors, Malpractice, and Second Victim Syndrome.

Complications are inevitable for practicing surgeons, and when you lead surgeons, negative outcomes and consequences will result from some of their professional work. The implications of the undesired, unintended, or unexpected changes to a child's health due to surgical intervention can be either transient or permanent, ranging from minor to major, devastating, or even deadly adverse events. Just as surgeons strive to maximize their surgical knowledge and expertise before performing an operation, surgeons and their teams need to practice and learn how to improve their non-technical leadership and team performance skills. When an error occurs, surgeons and their teams need to resolve the complication as best as possible with their expertise, knowledge, and consultation(s) as needed. Leaders of surgeons and institutions need to support the patients, their families (first victims) and the surgeons and their care-giving teams (second victims) when a complication occurs. After a medical error, healthcare professionals should for their and the patient-parent(s) well-being: (1) acknowledge the error and its consequences; (2) take responsibility for the error; (3) express regret that the error occurred; (4) solve the problem as best as feasible with professional colleagues; and (5) strive to learn from this error and prevent such or related complication(s) from occurring to other patients in the future. There are partial and total apology (I'm sorry") laws in 38 states protecting expressions of sympathy (partial) and admissions of fault (total) from admissibility in court. Institutional CANDOR/CANDOUR requirements do exist respectively in the US and UK. Malpractice or negligence litigation is a real risk when complications occur but interestingly occurs most often when patients and their families feel abandoned and deceived. Ultimately, all involved need to heal and this includes the surgeons who experience second victim syndrome. Providing individual and institutional support is imperative and essential for patients, their families, and the health care professionals involved in a serious surgical complication or medical error. Only then can we all cope and continue on as our best selves.