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Excising the “surgeon ego” to accelerate progress in the culture of surgery

BMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4537 (Published 21 November 2018) Cite this as: BMJ 2018;363:k4537

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Re: Excising the “surgeon ego” to accelerate progress in the culture of surgery - a Surgeon's view

This paper is interesting but dwells on the tiny percentage of 'super ego' driven surgeons who give the surgical 'dog' such a bad name. I know of no one arrogant enough to have 'branded' their patients in the 2 cases mentioned in Dr Myers et al's paper. Surgeons are often quite shy people, often in some degree of emotional turmoil, but we are usually adept at hiding that from colleagues! Perhaps we are just acting a part in this human tragedy.

What is clear to me is that surgeons literally have their patients' lives "in their hands", and this visceral connection to death is less common amongst physicians and quite rare amongst psychiatrists.

A physician is unlikely to have had an experience that can match, for sheer horror, their patient dying on an operating table. This can happen as a direct consequence of using a scalpel to try to save a life. Aortic aneurysm surgery is one of the most graphic examples. Alive one minute, dead within seconds.

Most surgeons have had such at least one such horrific event in their careers; indeed, if they haven't then they probably haven't operated on enough people or had a long enough career to avoid such a calamity. Not even the most skilful surgeon can avoid a "death on table" in their career.

Do any of the surgical team get counselling afterwards, or are they expected to "man up" and do the next case as though nothing dreadful has happened? PTSD is more common in medicine and surgery than we are prepared to admit.

These tragic outcomes leave scars. Surgeons are asked to "play God" and it is no surprise if they "act like they are God" at times of stress and fulfil the arrogant stereotype in the jokes physicians make about surgeons and their 'God-like' behaviours.

Dr Forrest is spot on with his perception that "kindness", not "excision", may offer a cure for arrogance amongst any group of doctors, possibly especially surgeons. We may not want to admit that we are as vulnerable to stress as others, but we are.

The other solution is to encourage more women to enter the surgical specialties. The lack of excess testosterone and abundance of common sense and pragmatism (as well as talent) they bring may just help balance things out for the weaker sex (men).

Just ask our recent President of the RCS, Dame Clare Marx, if you believe that men can hold women back from achieving their potential in their chosen specialty. Or any of the female Presidents of the other colleges. Be kind to surgeons please.

Competing interests: No competing interests

23 November 2018
Kevin JH Newman
Consultant Orthopaedic Trauma Surgeon (retired)
NHS
Guildford, Surrey