Confessions of a Surgeon

1. Surgery: A Profession of Awe, Flaws, and Complicated Choices

My profession is complex and complicated.

The surgeon's paradox. The profession of surgery is often viewed with awe and respect, yet it is also fraught with flaws, ethical dilemmas, and complicated choices. Surgeons are seen as life-savers, but they are also human beings capable of making mistakes. This duality creates a complex and challenging environment.

Art and science. Surgery is not a purely scientific endeavor; it is also an art that requires skill, judgment, and intuition. The best surgeons are those who can combine their technical expertise with compassion and empathy. However, even the most skilled surgeons face limitations and uncertainties.

The good, the bad, and the complicated. The life of a surgeon is a mix of exhilarating successes, devastating failures, and morally ambiguous situations. Surgeons must navigate these complexities while striving to provide the best possible care for their patients.

2. The Grueling Path to Becoming a Surgeon: A Survival Test

The training is designed to test your mental and physical endurance as much as your intelligence or skill with a scalpel.

Endurance and resilience. The path to becoming a surgeon is a rigorous and demanding process that tests mental and physical endurance. It requires years of intense study, long hours, and constant pressure. Only those with a deep reservoir of desire and drive can survive the crucible of surgical training.

Old school vs. new school. Surgical training has evolved over time, with a shift away from the brutal, old-school methods towards a more humane approach. However, the debate continues about whether the new methods adequately prepare surgeons for the challenges of independent practice.

Fear as a motivator. Fear, particularly the fear of failure, can be a powerful motivator during surgical training. However, it is important to balance fear with a healthy dose of self-confidence and a willingness to learn from mistakes.

3. Emotional Armor: Surgeons and the Human Facade

Once a patient is on the operating room table asleep, draped off, and ready to be cut open, I do not consider him or her human.

Detachment as a coping mechanism. To perform their jobs effectively, surgeons often develop a degree of emotional detachment. This allows them to focus on the task at hand without being overwhelmed by the emotional weight of the situation. However, this detachment can also lead to a dehumanizing view of patients.

Conflicting emotions. Surgeons often grapple with conflicting emotions, such as the desire to save a life versus the knowledge that a patient may not deserve it. They must also balance their compassion for patients with the need to maintain professional distance.

The human side. Despite their emotional armor, surgeons are still human beings with their own fears, insecurities, and vulnerabilities. They experience the full range of human emotions, but they must often suppress these emotions to function effectively in the operating room.

4. The Surgeon's Dilemma: Harm vs. Benefit

Surgery takes place on a fine line between benefit and harm.

The potential for harm. Every surgical procedure carries the risk of complications, errors, and even death. Surgeons must constantly weigh the potential benefits of surgery against the potential for harm. This requires careful judgment, technical skill, and a deep understanding of human anatomy and physiology.

The burden of decision-making. Surgeons often face difficult decisions with life-and-death consequences. They must make these decisions quickly, often with limited information and under intense pressure. The weight of these decisions can take a heavy toll on their mental and emotional well-being.

The quest for perfection. Surgeons are trained to strive for perfection, but they must also accept the reality that mistakes happen. The ability to learn from mistakes and adapt to unexpected situations is crucial for success in surgery.

5. The White Coat Code of Silence: A Culture of Complicity

If it didn’t kill you, surgical training made you stronger.

The culture of silence. A "white coat code of silence" can exist within the medical profession, making it difficult for surgeons to speak out against incompetent or unethical colleagues. This culture of silence can protect bad doctors and put patients at risk.

Fear of retribution. Surgeons may be reluctant to report concerns about a colleague's performance due to fear of legal action, loss of referrals, or professional ostracism. This fear can create a climate of complacency and prevent necessary reforms.

Breaking the silence. Overcoming the white coat code of silence requires courage, transparency, and a commitment to patient safety. It also requires a willingness to challenge the status quo and hold colleagues accountable for their actions.

6. Operating Room Realities: Control, Chaos, and the Unexpected

Surgeons hate surprises.

The illusion of control. Surgeons strive to maintain control in the operating room, but the reality is that unexpected events can and do occur. They must be prepared to adapt to changing circumstances and make quick decisions under pressure.

The surgeon's toolkit. The operating room is a unique environment filled with specialized tools, equipment, and personnel. Surgeons must be proficient in using these resources to achieve the best possible outcome for their patients.

Conversations with organs. The operating room can be a surreal place where surgeons engage in conversations with organs, berate instruments, and grapple with their own inner demons. These behaviors are often coping mechanisms for dealing with the stress and pressure of the job.

7. The Weight of Responsibility: Life, Death, and the Surgeon's Soul

I can describe, with one word, the driving force behind my five years of surgical training: fear.

Accountability for outcomes. Surgeons bear the ultimate responsibility for the outcomes of their operations. This responsibility can be a heavy burden, especially when things go wrong. They must be prepared to face the consequences of their decisions, both good and bad.

The emotional toll. The constant exposure to life-and-death situations can take a significant emotional toll on surgeons. They must find healthy ways to cope with stress, grief, and the knowledge that they cannot save everyone.

The search for meaning. Despite the challenges and sacrifices, many surgeons find deep meaning and satisfaction in their work. They are driven by a desire to help others, to make a tangible difference in the world, and to push the boundaries of medical knowledge.

8. The Evolving Landscape: Transparency, Accountability, and the Future of Surgery

I would qualify him as a safe surgeon.

Transparency and accountability. The medical profession is moving towards greater transparency and accountability. This includes public reporting of surgical outcomes, increased scrutiny of physician performance, and a greater emphasis on patient safety.

The impact of technology. Technology is transforming the practice of surgery, with new tools and techniques emerging at a rapid pace. Surgeons must be willing to embrace these innovations while also maintaining a focus on fundamental surgical principles.

The future of surgery. The future of surgery will likely be shaped by a combination of technological advancements, increased transparency, and a greater emphasis on patient-centered care. Surgeons who can adapt to these changes will be best positioned to thrive in the years to come.

Last updated: April 2, 2025