Year :
2023
| Month :
March
| Volume :
17
| Issue :
3
| Page :
PI01 -
Full Version
Introspection in Surgery
Published: March 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/62516.17691
Manika Agarwal, Sharat Agarwal, Ritisha Basu
1. Professor, Department of Obstetrics and Gynaecology, NEIGRIHMS, Shillong, East Khasi Hills, Meghalaya, India.
2. Professor, Department of Orthopaedics and Trauma and Incharge, Paediatric Orthopaedics, NEIGRIHMS, Shillong, Meghalaya, India.
3. Senior Resident, Department of Obstetrics and Gynaecology, NEIGRIHMS, Shillong, Meghalaya, India.
Correspondence Address :
Sharat Agarwal,
Professor, Department of Orthopaedics and Trauma and Incharge, Paediatric Orthopaedics, NEIGRIHMS, Shillong, Meghalaya, India.
E-mail: drsharat88@yahoo.com
Abstract
It is well known that a surgeon needs knowledge and skill to perform good surgeries. A well-executed surgery leads to high patient satisfaction and is a matter of pride for the surgeon. However, in spite of knowledge and good skill, certain practices can compromise the outcome. These practices are built gradually and subtly and sometimes are not realised. This article is written with the aim of giving insight to the surgeons to introspect, reflect on their attitudes and correct them if required.
Keywords
Patient satisfaction, Skill, Surgeon
Introduction
It is well known that a surgeon needs knowledge and skill to perform good surgeries. A well-executed surgery leads to high patient satisfaction and is a matter of pride for the surgeon. However, in spite of knowledge and good skill, certain practices can compromise the outcome. These practices are built gradually and subtly and sometimes are not realised. This paper is written with the aim of giving insight to the surgeons to introspect, reflect on their attitudes and correct them if required. This is a qualitative research based on the author’s observations in hospital settings with 25 years of experience. This data cannot be obtained by the questionnaire-based survey as no surgeon would be willing to actually reveal those practices that are counter-productive but are compelled to act in accordance with them.
Excessive Love for Surgery
Surgeons often love and enjoy doing surgeries for money, fame, or simply for the love of the art of operating. This obsession can lead them to the wrong patient selection for surgery in a patient in whom non operative modality may have been a better option. Recently, the way surgeons come to a decision about ‘whether to operate or not’ was discussed in the Annals of Surgery and the perception concerning a risk/benefit balance varied considerably between surgeons and the perceptions predicted the decision to operate (1). A study highlighted that surgeons with <5 years of experience opted to perform significantly more operations (40+4%) than surgeons with >=5 years of experience (18±2%) (2). Similar observation was found in other studies also (3),(4).
It has been studied that changes that are occurring in surgery indicate a need to place greater emphasis on cognitive processes that underpin the practice of surgery. It is important that surgeons do not become victims of their cult image (3).
Overreliance on Junior Staff/Residents
In a study, it was found that surgeons with over 25 years of experience had lower complication rates (5). Irrespective of years of experience, the non technical skills required for surgeons are communication, team work, leadership, and decision-making (6). Sometimes, senior and experienced surgeons rely completely on residents for examining the patients and interpreting the clinical and laboratory information. The overworked and inexperienced resident may make an error that may have been avoided if the chief surgeon had seen the patient. This casual approach by senior surgeons, who may be preoccupied with other administrative responsibilities, may cause disastrous consequences to the patient.
Hesitation to Seek Help in Difficult and Complicated Cases
Every case is a new case and challenges and complexities can occur in any case, even if it appears simple and routine preoperatively. Even an experienced and senior surgeon should be willing to ask for intraoperative assistance from colleagues if so required. An attitude to call for help should be an important quality to be imbibed in any surgeon, irrespective of years of experience.
Conclusion
Avoidable surgical errors can be committed by trainee surgeons due to inexperience and all their work needs constant supervision and guidance. Similarly, avoidable surgical errors can be committed by experienced surgeons due to overconfidence and over enthusiasm, which should be curtailed. A beautiful surgery with successful patient outcomes is the cause of the greatest happiness to any surgeon.
Reference
| 1. | Sacks GD, Dawes AJ, Ettner SL, Brook RH, Fox CR, Maggard-Gibbons M, et al. Surgeon perception of risk and benefit in the decision to operate. Ann Surg. 2016;264(6):896-903.
[ CrossRef] [ PubMed] | 2. | Szatmary P, Arora S, Sevdalis N. To operate or not to operate? A multi-method analysis of decision-making in emergency surgery. 2010;200(2):298-304.
[ CrossRef] [ PubMed] | 3. | Hamming JF, Marang-van de Mheen PJ. How does a surgeon decide that surgery is the best option? Assessing whether or not to operate. 2017;161:D999.
| 4. | Hall JC, Ellis C, Hamdorf J. Surgeons and cognitive processes. British Journal of Surgery. 2003;90(1):10-16.
[ CrossRef] [ PubMed] | 5. | Guidry CA, Newhook TE, Turrentine FE, Sohn MW, Sawyer RG, Jones RS. Observations on surgeons’ case selection, morbidity, and mortality following board certification. Ann Surg. 2016;263(3):487.
[ CrossRef] [ PubMed] | 6. | Yule S, Flin R, Paterson-Brown S, Maran N. Non technical skills for surgeons in the operating room: A review of the literature. Surgery. 2006;139(2):140-49. [ CrossRef] [ PubMed] |
DOI: 10.7860/JCDR/2023/62516.17691
Date of Submission: Dec 27, 2022
Date of Peer Review: Jan 21, 2023
Date of Acceptance: Feb 04, 2023
Date of Publishing: Mar 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No
PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Dec 30, 2022
• Manual Googling: Jan 03, 2023
• iThenticate Software: Jan 31, 2023 (8%)
ETYMOLOGY: Author Origin
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