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Surgical ethics are based on several personal characteristics that every surgeon should have, such as authenticity, courage, self-confidence, judgement, intuition, ability, and concentration. Moreover, surgical ethics should be based on Kant’s Categorical Imperative, considering patients and colleagues as goals and not as means.
Surgical practice is also based on certain inalienable principles, such as responsibility, leadership, situational awareness, the ability to make decisions, being a team player, strong communication skills, constant reflection on your own practice, mental training, gentleness in the OR, attention to esthetics, and not overvaluing rushing or simply speed.
An adverse event is any untoward medical occurrence in a patient undergoing an operation or therapy which does not necessarily have a causal link with this treatment. An adverse event can therefore be any unfavorable and unintended sign, symptom, or disease temporally associated with the operation or therapy related with an increased 30-day morbidity and mortality, prolonged postoperative periods or surgical infections such as organ-space SSI, sepsis, pneumonia…
Complications are commonly reported only as figures, but from a humanistic point of view, 1% mortality represents 100 % for the family who lost the patient. Moreover, its prevalence is as high as 10-43%. However, if surgical complications occur, there can be first (the patient), second (the surgeon) and third (the patients treated while the surgical team is still impacted by the earlier adverse events) victims.
When considering the surgeon as a second victim, it is clear that those higher complication rates or the accumulation of several events in a short period of time can deeply affect the surgeon’s well-being. Moreover, several aspects of a surgeon’s common practice, such as communication skills, transparency, can be altered, as fear of litigation can appear.
Quality and safety systems currently focus on reporting data and blaming surgeons rather than solving safety issues. Therefore, when surgical complications occur, emotional management of guilt, anxiety or anger is extremely difficult in this scenario.
Finally, counseling on how to manage complications not only from the clinical point of view, but also offering cognitive and psychological resources and tools, must be guaranteed in any kind of surgical training program.