Communicating After Complications: The Untaught Procedure

Show notes

This episode features a recorded lecture by Dr. Gary Ansel on the "last untaught procedure": communicating with patients and families after a procedural complication, introduced by Dr. Rusty Hofmann. It's the kind of firsthand teaching we're proud to bring to Wysdom.

• The Premise: Every proceduralist remembers their first catastrophic complication. We rehearse wire crossings and balloon inflations, but almost none of us were taught what to say when we walk into the waiting room afterward.
• Why It Matters: The US sees 70,000 to 90,000 malpractice claims a year, 25,000 to 40,000 of them related to procedures. Most complications don't become lawsuits because of the complication itself. Many begin because patients believe information was withheld.
• Complication vs. Error: A complication is a known procedural risk that can occur despite excellent care. A medical error is a preventable deviation from acceptable care, and it should be acknowledged honestly. Either way, don't blame the nurses, the industry rep, the equipment or another physician, and don't declare fault or malpractice, because negligence is a legal conclusion that requires a structured review.
• The Conversation: Explain what happened, the patient's current condition, what is known and unknown, the immediate plan, and when the family will hear from you again. Lead with empathy, and avoid speculation, blame, defensiveness and jargon.
• A Case: In a PCI perforation that led to tamponade and a trip to the OR, Dr. Ansel led the family conversation himself, then held a same-day team debrief and reviewed the case for system and training improvements.
• The Curriculum Gap: Communication-and-resolution programs outperform deny-and-defend, with greater family trust, fewer lawsuits and lower liability costs. Yet post-complication disclosure is rarely standardized or assessed in residency, largely absent from fellowship training, and missing from the major meetings. Dr. Ansel's CLEAR framework offers a structured approach.

Tune in to learn why the procedure ends when the sheath comes out, but professionalism begins when you walk into the family waiting room.