How Do Neurosurgeons Cope With Complications? Results of a Nationwide Survey.

Abstract

Complications are an unfortunate but ubiquitous part of neurosurgery, affecting both patient outcomes and surgeons' well-being. No study exists which has defined the impact that these complications have on neurosurgeons' emotional well-being or sought to define the various ways they choose to cope with them. We surveyed 142 members of the Congress of Neurological Surgeons about the impact that complications have on them. Most respondents had complications that resulted in the death of a patient (58.4%) and even more had complications that resulted in short-term or long-term harm (80.3% and 79.6%, respectively). Complications had a significant (55.6%) or profound (38.0%) impact on emotional well-being. The most common defense mechanisms used were humor (64.1%) and intellectualization (68.3%). On subgroup analysis, junior neurosurgeons were more likely to use a greater number of both adaptive and maladaptive coping mechanisms than were senior neurosurgeons (parameter estimate [standard error] = -0.31 [0.14], P = .02 and parameter estimate [standard error] = -0.37 [0.14], P = .01, respectively). Academic neurosurgeons were more likely to question their clinical abilities than were private (OR 2.68, 95% CI 1.21-5.96). Neurosurgeons with maladaptive coping mechanisms were 5.84 times more likely to consider leaving the profession (95% CI 2.34-1.60) and 3.08 times more likely to limit their practice in the short term (95% CI 1.35-6.99). When assessing years of practice, type of practice, or sex, there was no difference in contemplation of leaving the field, self-doubt, propensity to admit fault, or number and type of coping mechanisms. Complications have a major impact on the well-being of neurosurgeons, who use a variety of mechanisms to cope with them. Neurosurgeons with maladaptive coping mechanisms are more likely to question their career choice, consider leaving the field, and modify their practice after experiencing a complication.