Complacency may be the worst stage in ophthalmic surgical grief
A surgeon must take ownership of mistakes and repair them.
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This column is the latest article in the ongoing series “I wish I hadn’t done that.” Past submissions can be read here.
It was the greatest pediatric ophthalmologist I ever met, Dr. Marty Cogen, who taught me about “The Four Stages” of ophthalmic surgical grief.
These apply to surgical screw-ups and represent the psychological states of mind one passes through while coming to grips with the mistake.
Stage 1: Denial. “That did not just happen.”
Stage 2: Conspiracy. “OK, that happened, but no one saw it but me.”
Stage 3: Complacency. “All right, everybody saw that, but I don’t have to do anything about it.”
Stage 4: Resignation. “I have to fix this.”
Of course, a strict and logical transition through all the stages is not necessary. It is common to skip stages or to rehash a miniature cycle (conspiracy to complacency, back to conspiracy, back to complacency) multiple times over in a single operation. But as a general framework, this setup pretty well explains a normal emotional progression through a surgical mishap.
When I first heard about The Four Stages, I thought they sounded funny and felt familiar. I considered them a useful reminder that even the greats undergo struggles and make mistakes. But lately, I have come to appreciate what might be a deeper lesson.
As far as I understand, the “goal” of the original Kübler-Ross stages of grief (denial, anger, bargaining, depression, acceptance) is to get to acceptance. This is true in the sense that, if you do not get to acceptance, you are worse off. Lots of grief counseling seems aimed at helping people get unstuck from one of these intermediate phases and move all the way to acceptance.
When I think about my own worst surgical mistakes, most of them come from a failure to progress beyond stage 3, complacency. Something went wrong, and I knew it was wrong, and I never made the psychological leap into stage 4, the “we can’t just leave it like that” stage. In my experience, the cost of this arrested development has often been a return trip to the operating room or worse (never returning, and so it never gets properly fixed).
Perfect may be the enemy of good. However, regarding your work as “good enough” may be an emotional reaction of the same intellectual respectability as anger or jealousy. Increasingly, I am convinced that complacency, not mistakes per say, are the great enemy. Good surgeons make mistakes, but the great ones fix them, or so my wife tells me anyway.
- For more information:
- Jack S. Parker, MD, PhD, of Parker Cornea, can be reached at jack.parker@gmail.com.
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