RANZCOG complications survey
I am an Obstetrician and Gynaecologist in a small country town in NSW.
When I set up my practice 2 years ago, I had trained with exceptional people and was introduced to a less emotional but more rational approach to surgical complications, which I have not been exposed to previously. While I applied these principles in my practice and work, I still found myself constantly worrying about surgical adverse events. I was wondering how many of my colleagues are worrying in silence, solitude and unlike me do not have access to professional friendship groups.
Together with Andreas Obermair, a colleague from QLD and the founder of SurgicalPerformance Audit we created an online survey. Initially we were concerned that only a small number of RANZCOG Fellows and trainees would respond. These days it is not very attractive to discuss complications and failure and put it out there in the open. We were concerned we could look stupid, dark and negative.
Nevertheless, we approached RANZCOG and they were very supportive of the project outline. The first email was sent to RANZCOG members on 13 FEB 2013. Andreas and I were overwhelmed because only a few of hours later we counted more than 200 responses. In total we received more than 600 responses, comments from 133 participants and 257 colleagues left their email addresses so that we could informe them about the outcomes of this research.
As a first step we inform you about the qualitative outcomes. In due course Andreas and I will put a proper manuscript together and submit it to our journal, the ANZJOG. We will notify you again when that paper gets published
In brief, the distribution of responses was consistent with the number of RANZCOG members in the Australian states and in New Zealand. Most responses (72%) were received from metropolitan areas. Forty per cent of respondents work in both, public and private practice and 62% practice both, Obstetrics and Gynaecology. Here are some excerpts from the comments that participants left to share with us.
Some comments outright triggered a WOW response
“Complications are the biggest issue for me, I am constantly thinking of an “exit” strategy so that when the day comes I have something to move on to...”
“I use a professional counselor to help manage my stress”
“Complications are THE most stressful challenges we face”
“Colleagues have a conflict of interest when they (mandatorily) report their local colleagues complications.”
“When complications occur I often feel like a criminal”
“I don’t want this survey to be a college bashing exercise”
Ten per cent of comments related to “audit” and participant’s interest to learn more about it
A number of respondents requested better audit tools and even more colleagues found the idea of comparing surgical skills and outcomes with their colleagues compelling.
“I'm always curious as to how my surgical skills compare with my colleagues - more so for a personal improvement point of view. I'm lucky to have a very supportive wife and family who are always there for debriefing, but it's also important to have fellow peers who understand the nature of our work to debrief to.”
Some people stressed the importance of confidentiality and anonymity.
“To clarify the question about interest in complications of colleagues, I would be interested in those as a group, with defined denominators of types of surgery and patient demographics but not those complications of individual colleagues.”
SurgicalPerformance Audit  and the Urogynaecological Society of Australasia Pelvic Floor Surgery Database  were mentioned specifically.
The most common theme mentioned from participants was around vulnerability, isolation and lack of training and support
The bulk of the support in case of complications comes from family, friends, social networks, MDOs and colleagues. In general, participants of the survey expressed their dissatisfaction with professional standard bodies, such as RANZCOG, AMA, and local hospital management quite clearly.
“Not only do I feel unsupported in dealing with complications, I am aware of hospital management eager to condemn or stab me in the back should any adverse event (or complaint) occur. In this toxic workplace I am planning to retire prematurely.”
“Because all complications have medico-legal implications, the only helpful organisations to us are the Medical Indemnity groups in particular AVANT and NASOG. Other administrative bodies such, as the RANZCOG, the AMA and the Government in particular are useless. Only other O&G's really understand what one goes through and so senior mentors who have been through a career can help younger graduates. The College (better still NASOG) may be useful in this regard by establishing a group of supportive mentors in each State that one may be referred for support. Lastly, 'hired guns' for the plaintiff should be shunned.”
“Because of lack of support over complications I became burnt out and left public work and Obstetrics altogether, and in private work ceased performing certain operations.”
“You can feel very alone when you have a complication in private practice. Partly due to the 'shame' of revealing this I usually write a note of sympathy when I hear of a colleague's misfortune but hardly ever receive a reply. In private practice there is no forum to examine an adverse outcome.”
“Support: what support?”
“In hospital peer review hospital administrators without clear guidelines and in an unprofessional manner have introduced meetings. These have been divisive in the extreme”
“The worst part is the examination of clinical privileges by Administrators with no understanding of clinical work.”
“Complications make me think of ceasing practice in Obstetrics and Gynaecology. Complications will always happen, yet you can be sued and potentially lose your career. There is not enough support from the government eg patients shouldn't be able to sue for recognised complications that could happen to anyone. You can’t guarantee against a complication, so why should they be able to sue? Also, AHPRA makes it too easy for patients to complain. It feels like they aren't on our side. We should feel protected by AHPRA, but it’s the opposite. I haven't had too terrible a complication yet, but I live in crippling fear of the day it happens.”
“I feel very poorly equipped to cope with my surgical complications.”
Andreas and I do thank all RANZCOG members who took the time and effort to take the survey. We will endeavour to honour your efforts by presenting the results to RANZCOG, our professional societies and the public.
We would also like to thank RANZCOG for supporting our endeavours to taking the first step to address this rather prickly issue. The first step is: Measure. You cannot improve outcomes that you don’t measure.
The survey has clearly shown that there are big unmet needs of support for O&Gs. Andreas and I are both very keen to advance existing support systems and lobby for new support that needs to be created.
We will keep you updated through this blog. Subscribe here to receive weekly blog posts.
 SurgicalPerformance is online audit software for audit of general gynaecology, obstetrics and colposcopy (see article from last week). A LITE version is free and provides feedback on the users incidence rates of outcomes; a PREMIUM version compares the user’s outcomes with her/his peers and is $10/$25 per month for trainees and specialists.
 The Urogynaecological Society of Australasia Pelvic Floor Surgery Database is for urogynaecological procedures only. Membership of the Urogynaecological Society of Australasia including Database access is available from $320 per annum.