Surgeons
Perform surgery to treat and prevent diseases and illnesses, correct deformities, repair injuries, and improve human functioning and appearance.
A theatre day and a hard conversation
You are a surgeon with an operating list in the morning and a clinic in the afternoon, working with theatre nurses, an anaesthetist and a trainee. It is 7:30am. Your first patient is waiting, the team is preparing and a family member is asking to speak with you before you go in. It is going to be a full day.
Choose what you would do. Then see what happens. There are often good reasons for each choice.
Before you operate on my father, I need you to promise me it will go well. He's all I've got. Can you tell me everything will be okay? I need to hear you say it.
Promise it will go well, because he is frightened, alone and needs something firm to hold on to
He relaxes, but you have said something you can't deliver. If anything goes differently, he will remember the promise and feel betrayed.
Say you can't promise an outcome, but explain how the team is prepared and that you'll keep him informed
He nods, with tears in his eyes. He asks if you will call him when it's finished, and you promise to do that. Honest reassurance means more than a promise.
Tell him you can't discuss the risks right now because the list is about to start and the team is waiting
You are short of time, but he walks away more frightened than before. A minute of honest words would have changed how he felt.
Doctor, before we start, I need to say that I haven't seen the final check on the patient's details yet. I know it's late, and I know you're keen to begin, but I'd feel better if we paused.
Thank her, pause the whole team and complete the full check before anything else happens in theatre
The check is done and everything matches. You lose three minutes, and the team sees that stopping to check is always welcome.
Tell her it's been done already and ask to carry on
You were sure, but you were wrong about one detail. The team catches it later than they should have, and the mistake could have been serious.
Thank her, have the check done now and tell the whole team that stopping is always welcome
The check turns up a missing item. The team resets, and the nurses relax visibly. Speaking up becomes normal in your theatre.
I think I can do this next part myself. I've watched it a few times, and I'd like to try. But I know it's a difficult patient. Would you let me lead, or would you rather take over?
Let him lead on this whole case, since the only way a trainee ever learns this work is by doing it himself
He manages part of it but gets stuck at a critical point. You step in late, and the patient is on the table longer than needed.
Say no, this patient is too difficult and he should watch only, and try again with an easier patient next week
It's the safe choice, and he accepts it. But he doesn't learn what he's ready for, and he feels his confidence slip.
Agree what each of you will do, when you'll step in, and let him lead the part that suits his skills
He leads the planned portion with you beside him, and you step in at the point you agreed. He grows, the patient is safe, and the team sees how teaching works in practice.
How it went
By evening, the patients are recovering and the notes are written. A surgeon needs skill and steady hands, but also honesty with families, trust in the team and judgement about when to hold back. Which of these would you find hardest to balance?
This is a simplified, fictional situation to help you explore. It is not professional instruction or a test of your ability.
Case study: The operation she asked for and did not need yet
A fictional case set in a hospital surgical ward, outpatient clinic and operating theatre.
The situation
Dr Marcus Kowalczuk, an orthopaedic surgeon, was seeing Mrs Pereira in clinic. She was fifty-nine and had a painful hip, and she was clear about what she wanted. Her friend had recently had surgery and was thrilled, so she had come in asking to be put on the list. Her scans showed some wear but not the worst he had seen. Dr Kowalczuk knew an operation was a big step that cannot be undone, and that the waiting list was long. He also knew that Mrs Pereira had made up her mind before she walked in.
What they did
Dr Kowalczuk took his time. He listened to how the pain affected her days and what she could not do. He explained what the scans showed and what an operation involves, including the risks and recovery. He described other ways to manage the pain that she could try first, with a review in a few months. He made clear that surgery stayed an option and that it was her choice. He wrote it all in a letter she could read at home with her family.
How it turned out
Mrs Pereira was disappointed at first, but she tried the other approach with a physiotherapist and found she could do more than she expected. She came back after four months. The pain had eased, though not gone, and she chose to wait. Dr Kowalczuk said that a good surgeon should sometimes be pleased not to operate.
What would you do?
- Why did Dr Kowalczuk explain the risks as well as the benefits?
- How would you feel as a patient if a surgeon said not yet?
- What makes a decision about surgery a shared decision?