Intended for healthcare professionals


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

BMJ 2018; 363 doi: (Published 21 November 2018) Cite this as: BMJ 2018;363:k4537
  1. Christopher G Myers, assistant professor1,
  2. Yemeng Lu-Myers, resident surgeon2,
  3. Amir A Ghaferi, associate professor3
  1. 1Carey Business School and School of Medicine, Johns Hopkins University, Baltimore, MD 21202, USA
  2. 2Department of Otorhinolaryngology—Head and Neck Surgery, School of Medicine, University of Maryland, Baltimore, MD, USA
  3. 3Department of Surgery, School of Medicine and Stephen M Ross School of Business, University of Michigan, Ann Arbor, MI, USA
  1. Correspondence to: C G Myers cmyers{at}

Healthy self confidence has an important role in surgery, but we must take care that it doesn’t develop into disruptive ego, say Christopher G Myers and colleagues

Recent years have seen a palpable change in the surgical community, with major efforts made to shift towards a more positive, humanistic surgical culture.123 This reflects a broad recognition that ego driven behaviours and disruptive attitudes pose a risk to surgical culture and to patients.245 The objective and subjective evidence that has prompted these efforts, however, has not been thoroughly explored and understood by the surgical community.

Periodically, drastic examples of ego driven behaviour generate increased scrutiny and discussion, but these are often fleeting and do not fuel substantive changes. In December 2017, for example, transplant surgeon Simon Bramhall was convicted of assault in the United Kingdom for cauterising his initials on patients’ livers during operations.6 Unnecessary cauterisation of any kind may be considered a reckless behaviour, but the choice to cauterise his initials highlights an element of ego in his behaviour. The judge in his case described the action as “conduct born of professional arrogance of such magnitude that it strayed into criminal behaviour.”6

Fortunately, such cases of extreme arrogance are rare among surgeons—although, this is not the first time patients have been allegedly marked with surgeons’ initials.7 But milder forms of ego driven behaviour are still observed in modern surgery. A study of “unsolicited patient observations” among surgeons8 found examples of patient complaints about surgeons’ arrogant, intimidating, or rude behaviour, such as: “I asked Dr Y how long he thought the operation would take. He said, ‘Look, your wife will die without this procedure. If you want to ask questions instead of allowing me to do my job, I can just …

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