Editorial
The management of the complications and adverse effects at our professional activity
La gestión de las complicaciones y efectos adversos en nuestra actividad profesional
J. Jiménez Benito
, N. Gajate Paniagua, C. Gordon Bolaños
Corresponding author
Hospital Universitario de Burgos, Burgos, Spain
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Jiménez Benito, N. Gajate Paniagua, C. Gordon Bolaños" "autores" => array:3 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Jiménez Benito" "email" => array:2 [ 0 => "javijimenezbenito@gmail.com" 1 => "jjimenez@saludcastillayleon.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "N." "apellidos" => "Gajate Paniagua" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Gordon Bolaños" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital Universitario de Burgos, Burgos, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La gestión de las complicaciones y efectos adversos en nuestra actividad profesional" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Our profession is not always easy or pleasant. During our working life we will have conflicts related to unexpected outcomes that our patients will find unsatisfactory as there is a growing (and probably unstoppable) demand for solutions to all illnesses and, perhaps even more so, in surgical outcomes. This demand for health is motivated by cultural changes that consider contemporary medicine to be one of the greatest debtors of the Enlightenment’s faith in scientific progress and its total dedication to it, associated with the belief in the infinite possibility of improving health<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and, in the case of ophthalmological surgery, aggravated by an excessive trivialisation of the surgical act both by the public and by some of our colleagues.</p><p id="par0010" class="elsevierStylePara elsevierViewall">There is a belief that physicians should have 100% diagnostic and therapeutic reliability, but the human condition is bound to error in any activity and the practice of medicine is no exception due to being by nature an imperfect science, and the expectation of perfection is neither realistic nor possible.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Never has medicine, and in our case ophthalmology, offered better results for diseases and the growing degree of dissatisfaction among patients is surprising. Present day cataract surgery technique, for example, offers an effectiveness that was almost unimaginable only 70–80 years ago. As the incidence of complications is very low, when they do occur, the patient – and their relatives – attribute it to an error by the ophthalmologist and thus the possibility of a legal claim.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">It should be emphasised that adverse effects are inherent to our medical and surgical practice and can be referred to as “fortuitous events or unforeseeable accidents”<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>; examples include endophthalmitis or expulsive hemorrhage, which are very distressing for both the patient and the ophthalmologist and (almost) always involve a conflict that is difficult to manage with the patient and his or her relatives. Although the law does not consider it a medical error, as there has been “neither imprudence nor negligence”, it is very common for the ophthalmologist to feel uneasy, which can often lead to a questioning of his or her surgical expertise, following the example of post-surgical endophthalmitis: “if only I had been a quicker surgeon”; moreover, the concept of “negligence” is not absolute and has an important subjective component.</p><p id="par0025" class="elsevierStylePara elsevierViewall">When patients are not satisfied with the result of the care received, it is very common for them to go to another ophthalmologist, often to colleagues of recognised reputation and usually in the field of private ophthalmological care. Unfortunately, it is not uncommon for this second opinion after an unsatisfactory result to be the cornerstone of a legal claim “[…] the contribution of medical colleagues who, in a second consultation, make gratuitous comments, unnecessarily extending more or less veiled criticisms of the performance of the colleague who is often assumed, with notable superficiality, to be the cause of the poor evolution of the condition”.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">To conclude this editorial, it seems appropriate to present some articles of the Code of Medical Ethics,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> which we remind you are mandatory for all doctors:</p><p id="par0035" class="elsevierStylePara elsevierViewall">Article 37:</p><p id="par0040" class="elsevierStylePara elsevierViewall">2. Physicians must treat each other with due deference, respect and loyalty, regardless of the hierarchical relationship between them. They have a duty to defend a colleague who is the object of unfair attacks or allegations.</p><p id="par0045" class="elsevierStylePara elsevierViewall">3. Physicians shall refrain from derogatory criticism of the performance of their colleagues. Doing so in the presence of their patients, their relatives or third parties is an aggravating circumstance.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">No conflicts of interest were declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Los fines de la medicina. Cuadernos de la Fundació Víctor Grífols i Lucas. 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