As a medical student, I had never considered urology as a specialty. But after a brief rotation, I was immediately drawn to the field’s constant use of innovation to creatively solve problems: using robotics to perform challenging operative cases or applying statistical methodology to solve health services research questions. Thinking outside the box was the norm, and I found myself excited to approach each case and research question as unique, determining which new tool I could apply successfully to achieve the best result.
This year at the Society of Urologic Oncology annual meeting, innovation again took center stage. A panel on organ preservation debated the merits of focal therapy for prostate cancer while another session highlighted innovative methods to improve outcomes of muscle invasive bladder cancer patients. Though these sessions addressed crucial areas of innovation in our field, I found myself reflecting on another session topic entirely: failure.
On Thursday night, the SUO Young Urologic Oncologists forum discussed failure – failure as a surgeon, failure as an educator, failure as a researcher. In a surgical culture where stoicism reigns supreme, this event starkly contrasted with our day-to-day reality as surgeons. We expect perfection of ourselves – and we believe our patients expect it as well. For years, I felt that this was appropriate. After all, if you don’t aim for perfection, aren’t you selling yourself short?
The SUO YUO theme was Resilience: The Art of Failing Forward. Four speakers shared personal stories of their failures. We’ve all been there. However, as I listened to each, I realized how little we speak about them. A failed but well-intentioned educational endeavor. A postoperative death. Countless grant rejections. The evening culminated in a poignant presentation by Dr. Sasha Shillcutt of Brave Enough. Tears welled in my eyes as she retold the story of a death of a child: how she lost its airway during a procedure, how she planned to quit medicine forever, how for years she lived in shame of that event. It resonated with me, because I’ve felt that shame – and I’d be willing to bet you have, too. As I left the session, I wondered why we haven’t spoken of this before. Why have we been so silent? We speak about burnout, but what about its solution? Unlike the many presentations on the topic that we have both given and sat through, this one was different – this one was actionable.
Many believe the solution lies in changes within the administration or electronic health record. While these solutions may play a part, they are external and beyond our immediate control – scapegoats to a degree. In reality, the solution is our empowering ourselves – the solution is us. In our surgical culture, in which emotion is widely considered weak, we have to be willing to share our successes and failures equally. We must put this into practice as we would any other innovation in our field. Share our experiences, manage our thoughts, forgive ourselves, and understand each failure is an opportunity for growth – “fail forward.”
After a conference, we are asked how we will apply what we’ve learned to our practice. In my case, I plan to talk openly to my colleagues when I fail. And I’m also going to carefully observe and offer a sincere ear to those who may need help. Resilience and burnout are real – but the solution is not others, it’s our peer collective.