04/08/2025
Are All complications the fault of the surgeon ?
Yesterday I was at Hyderabad for a Gynae conference predominantly on complications in Obstetrics & Gynaecology. The prestigious Oration was delivered by an illustrious personality who is Chairman and founder of a Hospital Chain which has trained thousands of laproscopy surgeons across India and the world. During his oration he opened his address with a statement that “All complications are fault of the surgeon” and reiterated this a few times during his oration. It raised my hackles , distressed me, upset me very much but the traditions of respect given to the “oration” prevented me from raising the issue there and then with him. Mostly however I was disappointed that a senior medical doctor, a teacher, an entrepreneur and a person who many of us would normally look up to and aspire to emulate held such a view.
All surgeons train long and hard to attain surgical skills and take it as a personal failure if they have a complication. They are known to undergo "second victim syndrome" whereby the event effects them psychologically and has a deleterious effect on their professional confidence and skills. A complication is just that “a complication”, it happens and mostly we do not know why. Ability to tackle the complication maybe directly related to surgeon experience, but the occurrence of a complication during surgery, intervention, procedure or even during medical treatment is definitely not always due the surgeon / doctor ‘s fault or related to a surgeon's experience.
As he mentioned in his oration it is important for surgeons to recognize tissues and how they feel. The only time I caused a perforation in my 65000 odd UGIE procedures was during a stricture dilatation being done second time by me after an interval of 12 years in the same patient and let me tell you the procedure and the feel of the stricture was soft, dilatation was done without any undue force or pressure and I could never imagine a perforation in that particular patient till it became evident 24 hours later. As it turned out she was on dialysis. So to answer the orator, I would not kiss every hand which felt like my wife’s hand with blind faith in my abilities to recognize the “touch and feel”.
If the surgeon is incompetent and causes a complication which another average surgeon would not have caused then the fault lies with those who have trained him and sold him a defective product while certifying that he was now as “Master of Surgery”. No I have not made any error. I meant it when I said that we are today selling medical education and if someone should be held accountable for the consequences of the substandard training it is the mushrooming medical education shops and the agencies which endorse them as being prim and proper for imparting medical education and training (NMC).
Even a vascular injury which may be trochar induced is an accident and though the accident may cause a patient her life it is not always actionable negligence. Multiple factors play a role, the lax abdominal wall, the previous surgical scar, the mesh placed for past umbilical hernia surgery, poor quality of instruments and even aneurysmal dilatation of artery. Instead of blaming and shaming the surgeon by calling all complications his fault we need to look deeper into how to prevent complications from happening. The live surgical demonstrations is one way but then the courts and the National Medical Commission have found another way to destroy medical education by placing restrictions on live workshops.
There are people in the medical field who are at the pinnacle of their careers having achieved name, fame and wealth beyond what can be dreamed of by others. In the absence of genuine leadership from our organizations such hugely successful personalities act as surrogate leaders in the profession. If they make such statements, then we cannot blame the judges, the society, and the press for blaming us whenever something goes wrong. I was disappointed when members of select committee entrusted with the matter by Supreme Court had endorsed the lack of need for a central Act for prevention of violence against Doctors. But I was positively devastated to hear this doyen in field of laproscopy say that “Complications are always a surgeon’s fault”.
Compare us with advocates where the Supreme Court says “Advocates should not be penalised for minor mistakes” and that “Profession of advocate is sui generis and hence should not be within purview of CPA” . If complications are our fault then every complication should be penalised, any treatment needed of the complication should be done free of cost, and every patient who comes to hospital should walk out to live happily ever after. We need to all follow a no compromise stance in matter of selective accountability of Doctors in our country. I will continue to defend any surgeon who faces a complication during surgery even if God himself says that "Complications are all due to fault of the surgeon".
Dr Neeraj Nagpal
Managing Trustee,Medicos Legal Action Group (MLAG)
Ex President IMA Chandigarh
Director Hope Gastrointestinal Diagnostic Clinic,
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Medicos Legal Action Group is a non-profit trust registered at Chandigarh by a group of allopathic doctors from all over the country who wish to legally engage the Govt of India regarding its various policies concerning medical profession, training, working conditions. MBBS doctors today are threate...
