The more surgeries you perform, the more experienced you get, and as all surgeons know, part of this gain includes identifying and managing adverse outcomes.
How to proceed forward? How to discuss them with your patient?

I wish there was a great answer, however people respond differently to a doctor presenting an unfortunate scenario. Also, doctors do not always know how to address it.

These are a few steps I find may guide many physicians.

1) Once you recognize an adverse outcome, contact your liability insurance carrier, get information about your protection, explain the scenario and listen to any suggestions. Why do this first? In my view, so that you do not act with anxiety or self-doubt from this point on, and move wisely, confidently and responsibly in order to help the patient get through it.

2) Explain to the patient – in person – what happened, how did it happen, and what will be done so it does not happen again.
If you do not know how the event happened, explain so, and let them know that you are working to understand what happened and will keep him informed.

3) Incorrect information is worse than incomplete information. Never speculate, never guess, NEVER LIE.

4) Give the patient your contact information. It defuses the perception of avoidance.

5) Timely interaction is essential. Don’t wait to tell the patient. And be available, some patients need to communicate with physicians more frequently that the physicians feel is necessary. Discuss any changes in treatment plans immediately.

6) Recognize the patient’s emotional state. This is probably the hardest one. Be compassionate and take this opportunity to reinforce the relationship and rebuild the patient’s trust. “I am sorry you are going through this” – goes a long way.
Empathetic communication is key.

7) Documentation preserves the facts. Document only objective observations, including manifested complications. Document what the patient/family was told. Do not blame other professionals in the medical record. Do NOT change anything previously written. Dated addendums are okay.

8) Do your best to handle the adverse event, if necessary with the support of colleagues. The patient’s well being comes before your ego. Review your informed consent process for the future. An apology to the patient is offered after it is verified a true medical error has occurred.

Let me know of any changes or suggestion to these steps anyone may have.