by Antonio Webb, MD July 8, 2022

We all make mistakes. But what happens when a surgeon does? Find out from Antonio Webb, MD, a San Antonio-based orthopedic surgeon.

Following is a transcript of his remarks (note that errors are possible):

Webb: What happens when a surgeon makes a mistake or has a complication in surgery? In this video today, we are going to talk about that.

What's up, guys? My name is Dr. Antonio Webb. I'm an orthopedic spine surgeon here in San Antonio, Texas. I get a lot of questions from people from all over the world. One of the most common questions or a question that I see quite frequently is, have you ever made a mistake as a doctor or as a surgeon? Then some people, "Have you ever had complications?"

Well, I will tell you this. Any surgeon that tells you that they don't have complications is either 1) they're telling a lie, or 2) they're not doing enough surgery. Surgery has a lot of risks associated with it. You could do everything in your power and might, use your training and your knowledge, go to the top schools, top training, do everything perfectly, and a patient still has a complication.

There are certain conditions like diabetes and certain malabsorption disorders that affects the healing process. Patients who have very severe -- in my case, as a spine surgeon -- stenosis or problems, which is essentially narrowing of the spinal canal. You're doing these really complex surgeries and you're working around really delicate structures like the spinal cord or nerves that are sometimes not very forgiving.

If a patient has a fracture, I can hit their bone, just like this right here with a mallet, just hit it, that patient will do fine. If I do the same thing in a patient to their spinal cord, especially in the cervical spine, you can paralyze them. That's the reason why spine surgery is a very stressful career field. It has a lot of responsibility. The risks are really high, but I knew that going into it and I decided to take the leap of faith and to take those risks.

We have discussions with patients about it in surgery, before surgery, and after. Hopefully their condition, their level of impairment or pain, loss of function, is severely impacted to a point where they are willing to take those risks.

Well, complications do happen in surgery. Mistakes do happen. I have seen it over and over again throughout my training. That's why they call it practicing medicine. In order to get good at something, be really efficient, and to have that skill set, you have to do more reps. In training, they can only show us and teach us so much. But once you get out into practice, you do a surgery, let's say you do it 50 times or 100 times or 200 times, there is going to be some mistakes along the way.

You may have one or 20 good surgeries and one patient has a complication from a nerve injury. Or they have a bleed or an infection or a leakage. The most important thing is how you respond to those complications, how you manage them. That to me is the sign of a great surgeon. Also, the fact that a surgeon knows when to operate and when not to operate.

I think a surgeon is a great surgeon when he is able to do those two things, know when to operate and know when not to operate, as well as know how to handle and manage the complications that you may come across. You will. You're going to have them in your career if you want to be a surgeon. If you want to be a doctor, you're going to have complications. It's all about how you handle them.

Yes, of course, we get complications. We get infections, drainage, and hardware irritation. The screw may pull out of the bone and you have to take your patient back to surgery. Patients with continued pain, you have to know how to manage those complications and this comes with experience.

A person that tells you, "Oh, I don't get any complications. I will never get one," that's a lie. They are not operating enough and they told a lie. We get complications as surgeons, things that can go wrong. Mistakes are made. Sometimes it's not our fault as surgeons. It's just working in certain type of environments that are high risk. Unfortunately, that's what we do as spine surgeons and as orthopedic surgeons.

Thinking back to, let's say a mistake that I made, as I mentioned, repetition, going through the reps. Going throughout my training, I have seen and really have appreciated the fact that my comfort level with surgery, doing surgeries on my own, and my skill set has increased dramatically. The complication rate goes down.

There are some studies out that look at the complication rates when you first come out of training may be up here. As you go through your career, it goes down. At the end of your career, it goes back up again.

One mistake that I have made -- a patient with very severe stenosis, or narrowing of their spinal canal, as I was taking the pressure off of the end of the spinal cord, the spinal canal, I had a tear in the what's called the dura, which is the outer covering of the spinal canal. Inside of the spinal canal are nerve roots and there is spinal fluid. It's like a balloon with a lot of nerves in it.

What happens is if the patient has very severe stenosis and it's stuck down to the dura, you're taking the pressure off of it, you're using instruments to bite it very carefully, then there is a tear in it, your spinal fluid leaks out. That's one recent mistake that I have made, and I have learned to effectively decompress a patient's spine and their canal with less dural tears. As I mentioned, as you come out of training, you're doing these surgeries by yourself. You saw your mentors do it, but you're doing it by yourself. As you go through your career, you get better, more efficient, and less complications.

What we do for that is we identify the tear. We find it. We have to make a larger incision, or widening your decompression, take more bone so that you can see and actually put a suture in. That's what we do. It's a very small suture. You have to usually wear loupes to actually see it. It's very small. Then you suture it together, put a patch over it, some surgical glue, and then you check it to make sure there is no leak. We call that a watertight seal. That's one complication or mistake that I have made.

As a surgeon, you analyze your mistakes. You think about them. What could I have done differently? What can I do to improve and better myself in the future? That's what makes a good surgeon.

Watching the NBA series where Jimmy Butler decided to take a three-pointer at the end of the game, tried to win the game, and he missed. That was a mistake. He should have drove in, tried to take it up, and get fouled. But as a leader, as someone who is a professional athlete, they make mistakes too.

These things happen and fortunately they don't happen a lot, but you have to be mindful. There is litigation that can happen. There are lawsuits and people will become injured. That's just the risks that we take as physicians.

I just wanted to make a video about this. I get this question a lot. For the future students out there, doctors, you're going to get them. It's going to happen. Most importantly is how you manage and how you react to it. Not only in that type of environment, but how are you reacting? Are you yelling? Are you screaming? Are you freaking out? "Oh my God! Oh my God!" Well, you don't want to do that. Keep your composure. You've seen this before. You can do it. Repair it. Tell the patient about it. Be honest and be upright. Say, "Hey, we had a dural tear. I was able to repair it. It doesn't affect your outcome in any way. You're going to do great. We're going to get you through this."

This is Dr. Webb, thank you for watching. We'll see you next time.

Antonio Webb, MD, is a spine surgeon located in San Antonio, Texas. You can learn more on his website or YouTube channel.

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