[ { "start": 0.0, "end": 4.4, "text": " Welcome everyone. Welcome to part two of this episode," }, { "start": 4.4, "end": 7.92, "text": " \"Complications and Endoscopy Discussion\" with Dr. Srisahabar." }, { "start": 7.92, "end": 15.28, "text": " In part one, we discussed about the complications, what immediate actions one should take." }, { "start": 15.28, "end": 22.48, "text": " We discussed about consent process. We discussed about how to react during a delayed complication." }, { "start": 22.48, "end": 26.88, "text": " So, Srisah is joining us again today. We introduced him in the first episode." }, { "start": 26.88, "end": 31.52, "text": " He's a consultor gastroenterologist and director of endoscopy at Royal Stoke University Hospitals" }, { "start": 31.52, "end": 38.56, "text": " and recently organized the first UK complications in endoscopy symposium. Welcome back, Srisah." }, { "start": 38.56, "end": 42.16, "text": " Thanks, Pramip. Thanks for being again here. Thank you. So, Srisah," }, { "start": 42.16, "end": 48.0, "text": " I want to take you back to the symposium. You rightly so, you invited some patients and" }, { "start": 48.0, "end": 53.68, "text": " relatives who had experienced complications to talk about their experience." }, { "start": 54.72, "end": 61.6, "text": " And for our listeners, can you explain what would be patients' perspective with regards to" }, { "start": 61.6, "end": 65.84, "text": " sort of the consent process and what would they like to know?" }, { "start": 65.84, "end": 68.56, "text": " I think you briefly explained that towards the end of the first episode." }, { "start": 68.56, "end": 73.76, "text": " Maybe you can elaborate on that. Yeah, I think from the from the patients' point of view," }, { "start": 73.76, "end": 78.48, "text": " I think it's important for them to know why we are doing this. I think, as I said," }, { "start": 78.48, "end": 84.16, "text": " the indication is the most important. And I think as long as they know that this is the best option," }, { "start": 84.16, "end": 88.48, "text": " I think because we need to elaborate to them what are the options. And if they're aware that this" }, { "start": 88.48, "end": 95.2, "text": " is the right indication, this is the best option. And irrespective of how complicated the procedure" }, { "start": 95.2, "end": 100.96, "text": " is, most of the time the patients will accept that. And it's also important for us to elaborate" }, { "start": 100.96, "end": 106.64, "text": " our experience as well. Sometimes now I do go to my patients, especially with ERCP, my" }, { "start": 106.64, "end": 113.52, "text": " complication rate. I think maintaining your own personal data, your own unit data, your" }, { "start": 113.52, "end": 120.88, "text": " organization data in detail and quoting them to the patients really helps them to develop" }, { "start": 120.88, "end": 126.0, "text": " that trust between you and the patient. It's the fact that I think that is really important for," }, { "start": 126.0, "end": 132.56, "text": " especially like a procedures like ERCP as well. And in fact, over the years, our complication rate" }, { "start": 132.56, "end": 137.28, "text": " has come down significantly compared to what the quoted complications has been in the studies." }, { "start": 137.28, "end": 144.64, "text": " And then the procedure complications discussion with the patient has to be appropriate for the" }, { "start": 144.64, "end": 150.56, "text": " circumstances as well. Again, as we discussed in the last episode, the patient had other plans in" }, { "start": 150.56, "end": 157.6, "text": " their life. And whether doing this procedure now is appropriate, or when you're quoting such high" }, { "start": 157.6, "end": 163.52, "text": " complications, whether doing these procedures after that important life event is important," }, { "start": 163.52, "end": 167.68, "text": " you know, we have to have that discussion as well. For example, in the previous episode," }, { "start": 167.68, "end": 173.84, "text": " we discussed about whether the patient wanted to go on a cruise. And then I said, yes, you can," }, { "start": 173.84, "end": 179.44, "text": " but then the patient developed complication. But in hindsight, I should have said, you can go to" }, { "start": 179.44, "end": 184.64, "text": " the cruise and then come back and then we'll do this procedure. Because if you have a potential" }, { "start": 184.64, "end": 188.48, "text": " complications, then definitely you can't go on the cruise, which we have been planning for" }, { "start": 188.48, "end": 193.68, "text": " the last two decades. I think it has to be tailored to the circumstance of the patient as well." }, { "start": 193.68, "end": 201.68, "text": " Yeah. And I want to stress that what's best option, what you think for the patient may not be the" }, { "start": 201.68, "end": 206.88, "text": " same from the patient's perspective. For them, the best option or maybe a completely different" }, { "start": 206.88, "end": 212.32, "text": " thing, you know, leaving the polyp all alone and live with the polyp rather than, I guess, you know," }, { "start": 212.32, "end": 216.56, "text": " or live with a stone, for example, I'm happy to take that risk rather than going through this." }, { "start": 216.56, "end": 220.96, "text": " So I think it should be very individual in that aspect." }, { "start": 220.96, "end": 227.36, "text": " Shrisha, early recognition of any delayed complication is important to improve the outcomes." }, { "start": 227.36, "end": 232.64, "text": " We talked about this earlier and our patients often present very late. And you mentioned something" }, { "start": 232.64, "end": 237.44, "text": " about you put certain measures in place. You briefly mentioned some leaflets and things." }, { "start": 237.44, "end": 243.68, "text": " So what's your practice? What measures do you take or have in place to recognize these delayed" }, { "start": 243.68, "end": 249.76, "text": " complications, the support the patients would get in case if that happens? So should you just" }, { "start": 249.76, "end": 255.04, "text": " elaborate a little bit on that? Yeah, I think to prevent the what you say is a delayed complication." }, { "start": 255.04, "end": 261.28, "text": " As I mentioned that majority of the times these delayed complications are undecognized complications" }, { "start": 261.92, "end": 268.32, "text": " at the time of the procedure or at the time of the recovery. So again, my practice has changed" }, { "start": 268.32, "end": 273.76, "text": " because of the experiences I've had over the years. One of the things which I have learned is that if" }, { "start": 273.76, "end": 279.52, "text": " you think something has gone wrong at the time as we discussed last time to doing something" }, { "start": 279.52, "end": 285.12, "text": " endoscopic to Lee, even if you overdo it is the right way than not doing anything. For example," }, { "start": 285.12, "end": 291.52, "text": " you've done a polyp resection. You think hasn't gone a little bit deeper clipping at the time" }, { "start": 291.52, "end": 297.36, "text": " itself will avoid sleepless nights and also potential delayed complication for the patient" }, { "start": 297.36, "end": 303.12, "text": " rather than just nodding anything at all. For similarly, in an ERCP setting, a post-spin" }, { "start": 303.12, "end": 308.64, "text": " trotomy perforation is very difficult to diagnose at the time as an echolonic perforation. And if" }, { "start": 308.64, "end": 313.52, "text": " you think we've just gone a little bit more deeper, putting a fully covered metal stent in" }, { "start": 313.52, "end": 317.84, "text": " is what we think is the right thing to do even it's a bit more expensive. So sometimes we think" }, { "start": 317.84, "end": 324.24, "text": " that overdoing at the time of the procedure is much more better than not doing anything. Similarly," }, { "start": 324.24, "end": 329.68, "text": " doing recovery if the patient is still in complaining of discomfort, just dismissing it" }, { "start": 329.68, "end": 333.92, "text": " saying that I think it should be fine when you go home in a day or two, it will settle down" }, { "start": 333.92, "end": 338.56, "text": " is not a good option. Sometimes if you're worried about it, keeping the patient in the hospital," }, { "start": 338.56, "end": 344.08, "text": " getting a CT scan before they're going might be a better option. I think by doing these kind of" }, { "start": 344.08, "end": 350.08, "text": " measures, and if you're really sure that the patient is completely fine and then giving the right" }, { "start": 350.08, "end": 355.92, "text": " information to the patient about what are the potential complications which they can develop" }, { "start": 355.92, "end": 362.08, "text": " and when they should contact the hospital or when they should go to the A&E immediately," }, { "start": 362.08, "end": 365.36, "text": " not delayed, I think those kind of discussions very, very important." }, { "start": 365.36, "end": 371.2, "text": " Yeah, so detailed post-procedure information is very important. Not all of us do that," }, { "start": 371.2, "end": 377.44, "text": " Shrisha. I think within the UK, I think we are guilty that some of us don't give full information" }, { "start": 377.44, "end": 385.2, "text": " to our patients where and how to seek help. I've had patients go to their GP with melena post" }, { "start": 385.2, "end": 390.24, "text": " polypectomy, which despite giving them information, for example, sometimes. So these things can" }, { "start": 390.24, "end": 398.16, "text": " happen. So I think educating them properly is important. Shrisha, have you come across patient" }, { "start": 398.16, "end": 403.2, "text": " dying after an endoscopic procedure, whether that is your procedure or your colleagues?" }, { "start": 403.2, "end": 409.76, "text": " Tell us what happened. How was the situation managed after that and what are the things that go" }, { "start": 409.76, "end": 417.12, "text": " through? That's probably the extreme end of what one can go through in this field." }, { "start": 417.12, "end": 422.96, "text": " Yeah, I think Pranip, especially for someone like me who has been majority of my work is" }, { "start": 422.96, "end": 429.2, "text": " therapeutic procedures. Unfortunately, I have come across that not once, but in few occasions as well" }, { "start": 429.2, "end": 435.44, "text": " when I take my complications, which happened with my trainee as well. So it's important here to say" }, { "start": 435.44, "end": 440.08, "text": " that when it happens with a trainee, I am there. So it's my complications still. So I would say that" }, { "start": 440.08, "end": 446.24, "text": " it's been few occasions when I've had that. But I think as we discussed earlier, I think in all" }, { "start": 446.24, "end": 451.44, "text": " the situations when the indication has not been right is when you really struggle to deal with" }, { "start": 451.44, "end": 454.56, "text": " things like this. So I think if you're prepared well, when you know that you did this for the" }, { "start": 454.56, "end": 461.68, "text": " right purpose, then you have crossed one battle. And the next aspect is that having that communication" }, { "start": 461.68, "end": 467.2, "text": " with your patient and the family right from the beginning, explaining them, being transparent" }, { "start": 467.2, "end": 473.52, "text": " what has happened. And then as we discussed again, apologizing for what has happened is all very" }, { "start": 473.52, "end": 479.68, "text": " crucial steps in your healing process as well. Again, we are all different. We all deal with" }, { "start": 479.68, "end": 486.96, "text": " it differently. But for me, what's important is that once I've done all of this, I go into deeper" }, { "start": 486.96, "end": 494.16, "text": " aspects of identifying, reflecting on the procedure and where I could have done things better." }, { "start": 494.16, "end": 502.0, "text": " And then I always seek for one or two learning points from every complications. And if I reflected" }, { "start": 502.0, "end": 508.96, "text": " on it and I know that I'm going to apply it on it, then for me, that guilt and shame and all those" }, { "start": 508.96, "end": 514.56, "text": " emotions disappears. I know in things like death happens, it will again, it will not haunt you," }, { "start": 514.56, "end": 519.6, "text": " but it will always be in the back of the mind where similar situations arise. But I don't dwell" }, { "start": 519.6, "end": 525.76, "text": " on it more longer, because if I keep on dwelling on it, then that will affect my further procedures." }, { "start": 525.76, "end": 532.24, "text": " You can become risk aversion and I might not do the right decisions. So for me, the learning ends" }, { "start": 532.24, "end": 537.52, "text": " once I've got the reflective points, and then I move on. Yeah. So do you have a process where" }, { "start": 537.52, "end": 545.52, "text": " serious complications such as that is reviewed by let's say your colleague and kind of not as a" }, { "start": 545.52, "end": 551.52, "text": " pointing blame or whatever, but as a learning process, if there was anything that could have" }, { "start": 551.52, "end": 559.12, "text": " been done. And I'm sure mostly we would have done everything according to the best interest in mind," }, { "start": 559.12, "end": 564.96, "text": " but there may be an occasional learning point that we could have missed or we could have overlooked." }, { "start": 564.96, "end": 568.16, "text": " So do you always have asked one of your colleagues to go through this and" }, { "start": 568.16, "end": 573.68, "text": " go through the case notes, for example, and see if there's any points to improve in such a serious" }, { "start": 573.68, "end": 579.92, "text": " complication? Yes, I think this is a detailed process. I was talking earlier on my personal" }, { "start": 579.92, "end": 585.44, "text": " journey on it, but obviously I get those learning points after a detailed discussion with my" }, { "start": 585.44, "end": 589.68, "text": " colleagues and the team as well. And as you know, as part of the clinical governance, we have to do" }, { "start": 589.68, "end": 593.36, "text": " that to make sure that we have a detailed discussion with the team. We used to have an" }, { "start": 593.36, "end": 599.76, "text": " yearly meeting or once in six months meeting where we'd go through these complications in detail." }, { "start": 599.76, "end": 604.72, "text": " But now I think that's too late. We should disseminate that information, get those learning" }, { "start": 604.72, "end": 610.56, "text": " points quite early on. What in especially in ERCP among our colleagues, what we are doing now is" }, { "start": 610.56, "end": 616.96, "text": " that as soon as there is a complication, we get the team very quickly along and then go through" }, { "start": 616.96, "end": 622.24, "text": " the complication in detail, put out our learning points, what I think I should have done better," }, { "start": 622.8, "end": 627.84, "text": " but then also ask them, is there anything which I haven't missed? Is there anything from your point" }, { "start": 627.84, "end": 633.84, "text": " we should have done differently? And then make this as a team learning effort. And it's also" }, { "start": 633.84, "end": 638.88, "text": " important that you disseminate this information wide as well. I think once we get one or two" }, { "start": 638.88, "end": 643.84, "text": " learning points, there's no point just keeping it in. So there are several instances where in our" }, { "start": 643.84, "end": 648.08, "text": " courses we have said we have had this complication and then there's so many of them said, yes, I have" }, { "start": 648.08, "end": 652.56, "text": " seen this, I have seen this, but if we don't disseminate this information, unfortunately this" }, { "start": 652.56, "end": 656.96, "text": " will happen somewhere else as well. Okay, we'll come to that a bit later. I want to talk." }, { "start": 657.11, "end": 665.19, "text": " about it towards the end of this discussion. Let's move on to the endoscopists. You alluded to" }, { "start": 665.19, "end": 672.95, "text": " that we all deal with things very differently, it depends on our personalities. How does a" }, { "start": 672.95, "end": 678.31, "text": " complication affect endoscopists as a person in terms of their performance, psychologically," }, { "start": 678.31, "end": 684.39, "text": " for example, and their future performance? How could you put measures in place if endoscopists" }, { "start": 684.39, "end": 688.39, "text": " go through an extreme complication such as that or even a serious complication?" }, { "start": 688.39, "end": 694.79, "text": " Yeah, I think as you said, we're all different and unfortunately for some people, this could" }, { "start": 694.79, "end": 702.79, "text": " lead to increased stress, anxiety, the guilt, the shame, all comes in as well. And all of this can" }, { "start": 702.79, "end": 709.59, "text": " make them lose their confidence, make them risk aversive. And unfortunately for some," }, { "start": 709.59, "end": 716.07, "text": " it can also stop them from doing the procedure as well. So I think the emotions can be varied," }, { "start": 716.07, "end": 723.03, "text": " but of all of this, the most dangerous people are those who don't have any insight at all." }, { "start": 723.03, "end": 729.03, "text": " I know there are people sometimes who it is a procedure which was a problem, or it was the" }, { "start": 729.03, "end": 734.63, "text": " instruments which was a problem, or the nurses, or the patient, but never themselves. But most" }, { "start": 734.63, "end": 740.47, "text": " importantly, I think majority of us, thankfully, lie in the other extreme wherein we are actually" }, { "start": 740.47, "end": 747.11, "text": " reflective about, it affects us quite significantly. I think we still have that tendency that, yeah," }, { "start": 747.11, "end": 752.55, "text": " there is a complication in the list, and then we carry on, we crack on and start doing the next" }, { "start": 752.55, "end": 758.47, "text": " procedure. You take about half an hour or 45 minutes, you deal with it and go move on." }, { "start": 759.19, "end": 764.79, "text": " But I think we have to change that attitude. People try to understand how much it has affected" }, { "start": 764.79, "end": 769.67, "text": " them. So I think the best thing for the patients as well, if the complication happens, like somebody" }, { "start": 769.67, "end": 775.91, "text": " else takes over the list, on that day, we don't do that, we should start doing that. And also," }, { "start": 775.91, "end": 782.39, "text": " the debriefing as well, even if it is a consultant colleague, having someone as a mentor to who can," }, { "start": 782.39, "end": 787.19, "text": " they can go and speak to them and discuss about the complications, very, very important." }, { "start": 788.07, "end": 792.87, "text": " So as for the trainees, again, we have to give that debriefing very, very well," }, { "start": 792.87, "end": 798.71, "text": " where is non-judgmental way. And then again, our clinical governance process, thankfully," }, { "start": 798.71, "end": 803.43, "text": " is changing, especially in the UK, where there was a root cause analysis before," }, { "start": 803.43, "end": 809.67, "text": " where in some amount of blame was placed on the individual. Now, the new clinical governance," }, { "start": 809.67, "end": 816.31, "text": " the patient's safety, what is called as a peace surf in the UK now, at least in theory," }, { "start": 816.31, "end": 821.19, "text": " is about not blame the individual, but look at the system and change the system. So" }, { "start": 821.19, "end": 825.99, "text": " how will it is adopted and how well it will change the system without blame the individual," }, { "start": 825.99, "end": 832.07, "text": " we have to see. But I think the thought process should be on these lines to support the individual," }, { "start": 832.07, "end": 835.59, "text": " but also not blame the individual, but look at the system and processes," }, { "start": 835.59, "end": 838.07, "text": " which affects it and change them." }, { "start": 838.07, "end": 844.39, "text": " Hmm. As you mentioned about the invincible endoscopist, who's everything else is at fault," }, { "start": 844.39, "end": 849.51, "text": " except for him or her. Let's talk about the endoscopist in trouble. And those who have a pattern" }, { "start": 849.51, "end": 856.95, "text": " of complications, multiple complications, as an organization or as a leader within your organization," }, { "start": 856.95, "end": 862.79, "text": " I don't want to put a blame on someone. You know, I guess people who do extremely complex" }, { "start": 862.79, "end": 869.27, "text": " procedures by nature will come across more complications. The very nature that I remove" }, { "start": 869.27, "end": 875.59, "text": " failed procedures or complex polyps does mean that I will have my higher burden of complications." }, { "start": 875.59, "end": 882.31, "text": " So we need to recognize that. But there are outliers within those fields. Either, you know," }, { "start": 882.31, "end": 887.27, "text": " you're choosing the wrong indication and you're doing wrong procedures, for example. And sometimes" }, { "start": 887.27, "end": 894.47, "text": " it might just a bad luck in a series of events, one after the other. How do you recognize those?" }, { "start": 894.47, "end": 900.79, "text": " What processes can be put in place within an organization to deal with such individuals?" }, { "start": 900.79, "end": 905.51, "text": " Yeah, I think it's important when you look at that cases in detail, have a detailed discussion" }, { "start": 905.51, "end": 910.79, "text": " among the team and identified what were the learning points as we discussed. And also," }, { "start": 910.79, "end": 914.23, "text": " when you're having the discussion with the individuals, even if there's a series of" }, { "start": 914.23, "end": 919.91, "text": " complications, you know, whether this was something which was avoidable or was it just the nature of" }, { "start": 919.91, "end": 924.87, "text": " the procedure where they had unfortunately a series of complications. But even if it happens," }, { "start": 924.87, "end": 930.23, "text": " series of complications when it was unavoidable, it affects the individual. I think it's very" }, { "start": 930.23, "end": 936.55, "text": " important to support those individuals in those times, even if it was unintended, even if the" }, { "start": 936.55, "end": 941.91, "text": " indications were appropriate, because it does affect them. And in fact, these individuals have" }, { "start": 941.91, "end": 947.67, "text": " significant insight. And in fact, they want help. You know, any measures you put saying that, okay," }, { "start": 947.67, "end": 953.19, "text": " apart from debriefing, having supportive shoulders, offering them that why don't we do" }, { "start": 953.19, "end": 959.67, "text": " a few procedures or a few lists together? I'm sure majority of the individuals who have insight" }, { "start": 959.67, "end": 965.51, "text": " will accept that. But to say that I outliers are the ones who don't have an insight. And those are" }, { "start": 965.51, "end": 970.55, "text": " the ones who will not accept measures like this, where in saying that why don't we do some supportive" }, { "start": 970.55, "end": 977.11, "text": " lists? Why don't we do the list together? Why don't somebody observe you and then offer you support" }, { "start": 977.83, "end": 983.03, "text": " and in fact, people who are outliers who don't have insight don't accept that. And in those" }, { "start": 983.03, "end": 988.87, "text": " situations, I think it's very important that the organizations make every effort to make sure that" }, { "start": 988.87, "end": 993.99, "text": " the patients are protected. So I think gathering all the information from your allied colleagues" }, { "start": 993.99, "end": 999.11, "text": " and nurses will give you information as to how the individual is and your other colleagues as well." }, { "start": 999.11, "end": 1004.15, "text": " So I think if required, we have to be rather than beating the bush. I think it's very important" }, { "start": 1004.15, "end": 1009.11, "text": " the organization takes decisive actions in those times. We're not stopping the individuals from" }, { "start": 1009.11, "end": 1015.19, "text": " doing the procedures. We are just saying that at this moment, I think probably you will not be given" }, { "start": 1015.19, "end": 1021.91, "text": " this accessory for the time being, for example, an ESD knife or something else, until you do" }, { "start": 1021.91, "end": 1027.67, "text": " a few procedures with your other colleagues. And then everyone is deemed that you are fit enough" }, { "start": 1027.67, "end": 1032.79, "text": " to continue doing this. I think you have to put it in a much more diplomatic way. But at the same" }, { "start": 1032.79, "end": 1039.27, "text": " time, the patients comes first. And in those situations, we have to take those efforts," }, { "start": 1039.27, "end": 1043.75, "text": " wherein even if you have to stop the procedure from the individual from doing the procedure for" }, { "start": 1043.75, "end": 1048.87, "text": " that moment, we have to be very, very decisive on that. Yeah. So it's about putting that supportive" }, { "start": 1048.87, "end": 1054.95, "text": " infrastructure rather than putting barriers on such individuals. Exactly. I think we can never" }, { "start": 1054.95, "end": 1058.95, "text": " judge immediately in those situations. I think we should never be doing saying that you will never" }, { "start": 1058.95, "end": 1064.39, "text": " do this again. I think that's not right. I think we have to provide them the supportive environment" }, { "start": 1064.39, "end": 1069.83, "text": " to do that. But you might be able to convert, even though you call this outliers, with support." }, { "start": 1069.83, "end": 1075.35, "text": " Again, majority of the people will turn around. Humans are good and general. That's something" }, { "start": 1075.35, "end": 1080.07, "text": " which we have to take it all. There are only very few individuals who come into that category," }, { "start": 1080.07, "end": 1084.07, "text": " what you call as an outlier, where we have to stop them from doing it completely." }, { "start": 1084.07, "end": 1089.59, "text": " Shrisha, trainees and complications. In brief, where does the responsibility rest?" }, { "start": 1089.59, "end": 1094.79, "text": " Yeah, Pradeep. I think I've been very vocal on this. And I think the responsibility lies" }, { "start": 1094.79, "end": 1098.87, "text": " completely on the trainer. I think we have to take complete responsibility on this. There's" }, { "start": 1098.87, "end": 1103.83, "text": " no second thoughts on this. Shrisha, I just want to briefly talk about the symposium that you" }, { "start": 1103.83, "end": 1109.75, "text": " organized recently. How did you get the idea? How did you go on choosing the content? And who did" }, { "start": 1109.75, "end": 1115.99, "text": " you consult? And I found it very amazing. I think there should be a lot of future events like this." }, { "start": 1115.99, "end": 1122.55, "text": " As being part of a national society organization, how would you take things further in terms of" }, { "start": 1122.55, "end": 1128.07, "text": " educating people, organizing such symposiums, let's say on a national level or an European level?" }, { "start": 1128.07, "end": 1134.71, "text": " And have you already made some, if you want to reveal your secrets, made some progress in this" }, { "start": 1134.71, "end": 1141.27, "text": " aspect? Now, I think this came about the thought about the complications symposium came about," }, { "start": 1141.27, "end": 1146.23, "text": " mainly from the discussion I was having from one of our national colleagues while we were having a" }, { "start": 1146.23, "end": 1151.43, "text": " train journey together after meeting in London. So this is out in the open. So I can say that this" }, { "start": 1151.43, "end": 1159.91, "text": " individual has had the situation wherein he was a national news and wherein he had four complications" }, { "start": 1159.91, "end": 1167.03, "text": " and all the inquests were heard under media scrutiny. And so he asked me, is there an opportunity for" }, { "start": 1167.03, "end": 1173.99, "text": " me to speak somewhere? And when all the aspects he mentioned about was all about positive things," }, { "start": 1173.99, "end": 1178.95, "text": " what support he got after all these events. And then that's when we decided that, oh, why don't we" }, { "start": 1178.95, "end": 1184.79, "text": " put together a complications symposium, which would be very useful. And within about six weeks," }, { "start": 1184.79, "end": 1189.75, "text": " we designed the program mainly because of the support we had from many people I spoke to." }, { "start": 1189.75, "end": 1195.11, "text": " And thankfully, because of the BSE involvement and so on, we have got so many national" }, { "start": 1195.11, "end": 1201.27, "text": " friends and then made a few traps and then showed it to them. And within six weeks, we had the program." }, { "start": 1201.27, "end": 1206.79, "text": " And then going forward, I think one thing we have to, which I've been saying is that we have to" }, { "start": 1206.79, "end": 1213.75, "text": " normalize discussing complications. I think we, this should become a focus, we normally focus on" }, { "start": 1213.75, "end": 1219.19, "text": " things, how to do well, how this procedure is done and how this technique is done very well." }, { "start": 1219.19, "end": 1224.55, "text": " But I think there's so much of learning from when things go wrong. And especially the new" }, { "start": 1224.55, "end": 1231.27, "text": " procedures, we have to keep highlighting every procedure which has gone wrong. And that's when" }, { "start": 1231.27, "end": 1236.47, "text": " we learn more from it. And my own personal journey, I can say that the more I've discussed my" }, { "start": 1236.47, "end": 1242.39, "text": " complications, my procedures, my personal experience, my complications have gone lesser and lesser." }, { "start": 1243.11, "end": 1247.59, "text": " And I think that is what we should be doing nationally and internationally as well," }, { "start": 1247.59, "end": 1253.27, "text": " where complications should be a focus of every meeting and focus on when things go wrong." }, { "start": 1253.27, "end": 1259.03, "text": " We have already recorded from our complications symposium, and we have some ideas how to promote" }, { "start": 1259.03, "end": 1263.43, "text": " this or to disseminate the information which we had from our symposium elsewhere as well." }, { "start": 1263.43, "end": 1264.71, "text": " But early days." }, { "start": 1264.71, "end": 1271.27, "text": " Lovely. I guess the big meetings like UVG Week should have probably half a day dedicated," }, { "start": 1271.27, "end": 1276.55, "text": " or maybe a separate symposium altogether at the European level would make. And I hope," }, { "start": 1276.55, "end": 1281.75, "text": " Shrisha, you will continue to do this yearly or by annual, I won't put one, say, every two years" }, { "start": 1281.75, "end": 1288.23, "text": " or so. Shrisha, thanks for joining us so early today. I know it was 6.30 in the UK, and we both" }, { "start": 1288.23, "end": 1295.43, "text": " have to go to work now. And thanks for your time and effort into the discussions. And I hope" }, { "start": 1296.23, "end": 1302.23, "text": " our listeners benefited from all the discussions that we've had. Any final words before we wind this?" }, { "start": 1302.23, "end": 1308.23, "text": " No, I just want to thank you, Pradeep and the UVG for making this topic a priority and" }, { "start": 1308.23, "end": 1311.35, "text": " discussing this in detail. Thank you very much." }, { "start": 1311.35, "end": 1313.91, "text": " Thanks, everyone. We'll see you in the next episode." } ]