How Your Surgeon Feels

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Overall, general anesthesia is very safe, and most patients undergo anesthesia with no serious issues. Here are a few things to keep in mind:. On your day of surgery, a nurse will help you through any preoperative preparations before you are taken to the operating room. Once there, your anesthesiologist and surgeon will discuss the process with you before administering the medication via an injection or IV drip. Many patients report that undergoing general anesthesia is a surreal experience—and practically no one remembers anything between when the medication is administered and waking up in the recovery room.

That meant that I made an anastomosis once, twice, three times, and I forgot everything around me. Stressors also come from factors unrelated to either the ongoing operation or patient care. The first is time pressure and management, reported by both junior and senior surgeons—although for different reasons.

Someone who operates fast, even if he operates badly, that's good, because he doesn't spend too much time, that's good for everyone. If I have two patients to do who are sort of complex and I have a meeting afterwards, at 5 in the afternoon or in the evening… I really need to put pressure on everyone to get a move on …. Fatigue is also a major distressing factor. It is perceived as an innate characteristic of surgery, generally enshrined in and sustained by surgical culture.

Ability to deal with the erratic hours is a requirement for surgeons and a challenge for trainees. We also have to be ready: There's a state of fatigue, when you have accumulated really lots and lots of patients, when you do lots of surgery, […] it is anxiety-inducing sometimes, to start saying, I'm tired; that's one of the things that are, that are, that can be very worrisome. Complications negatively affect surgeons after they finish an operation.

The related emotional burdens vary in their timing and manifestations S3 Table , but were always described as horrendous:. How did I experience it? As a catastrophic failure, basically […] it was a really awful experience, the next day I was … It was horrible. Something I wouldn't wish on anyone, really, it was just horrible…. In some cases, surgeons reported struggling to acknowledge the occurrence of a complication and described their delayed awareness as denial:. We are very invasive, necessarily at one moment or another, even if we step back … we are directly responsible for what we do, I mean, if it goes badly, a surgeon always feels guilty.

This is mirrored by their concrete involvement eg, long working hours, remaining on call and is the key feature according to the interviewees distinguishing surgeons from other physicians:. Surgeons have trouble leaving the hospital when their patient is doing badly. And that probably makes them more willing to be at the hospital from morning to evening, Saturday morning, Sunday, on call …. That is something that is indeed very difficult in our job.

What's It Like to Have Surgery?

That is, to cope with complications. Especially when you have built up a relationship, that is, something … a bond … that … oh … I'll say, … I don't know how to define it, but truly, the doctor-patient relationship that … that is made of trust.

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When people rely wholly on the doctor, and therefore, coping with complications, it's annoying… finally, still, you have to do it a little…. Emotions due to postoperative complications are also exacerbated by the specific surgical cultural milieu, the myth of the surgeon. They thus described feelings of failure when surgery does not achieve this goal. We're in a process where we operate on people, therefore we're in a process to cure them […] what we experience with a patient who has relapsed, who has metastases, it's practically a failure for us.

Second, the institutional procedures and processes for discussing complications do not facilitate the integration of either complications or emotions into surgical culture. As one surgeon said: Feelings are thus aggravated by the emotional impact of relations between OR team members. Surgeons described the pressure to meet the expectations of their surgical culture:. At the beginning it's training, you are supposed to be trained. When you're no longer so young, you still do stupid things … but you can't do too many, because normally you need to have some expertise that justifies that you're where you are now.

Because precisely, in this phase, you are not allowed to make mistakes. And when you are even older, you can do stupid things, because finally you have saved so many patients that you can do stupid things. Surgeons considered that the way in which institutions deal with examining complication were not closely related to the ostensible goal of improving patient care. Morbidity and mortality meetings, for example, are experienced as a way to find out who was responsible—even if in a socially accepted way.

Even if there was a desire to do precisely this … morbidity and mortality meetings to discuss all this, somewhere there is always some amount of … judgment …. Moreover, when surgeons informally discuss complications, mistakes, and poor outcomes with colleagues, implicit cultural rules impose a way of discussing them that is ineffective in appeasing these emotions. They told me, no you couldn't do it a different way, blah blah, to please me, I think […] I'm the old man on the team, so the guys, my collaborators, I think they like me a lot and that they,…they didn't lay into me….

The present study shows that addressing only these acute situations, although they are relevant, is inadequate. Our study of the causes of these emotions and the coping strategies that surgeons use shows that they appear to be embedded in a structured cultural network and thus provides new insights into the practice of surgery and the malaise of the surgical profession.

Indeed, the interviewees descriptions made clear that the emotional situations they face are present throughout the preoperative, intraoperative, and postoperative periods and invade life outside the hospital. This observation is important as psychoneuroimmunology studies have shown the predominant role of chronic, compared to acute, stressors in the onset of both somatic and psychological diseases [ 20 , 21 ].

Moreover, the surgeons did not distinguish acute from chronic stressors. This is evident, for example, in the narratives about complications in which surgeons failed to differentiate between actual complications, acute stressors that are fortunately rare [ 12 ], and potential complications, chronic stressors that overwhelm their daily practice and the pre- intra- and postoperative relationships they have with their patients. Surgery is therefore experienced simultaneously as an act that might save and an act that might kill [a patient, an organ, a function].

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  6. First, interviewees described surgery as an aggressive act performed on a human being and the unique bond which it creates between them and their patients. This bond has been shown in this and previous studies to be particularly tight when surgeons identify with the patient or when the case is challenging [ 13 ]. Second, they acknowledged their subjectivity and uncertainty in every aspect of their practice. Surgical decision making is indeed a subjective balance between competing avowed, unavowed and disavowed priorities [ 22 ]. Third, surgeons considered the institutional framework in which they work a source of pressure or fatigue and more generally as being unsupportive [ 7 ].

    They also described, however, how these strategies may be used ineffectively or diverted from their rationale. Moreover, these personal decisions are made as part of an implicit contract between the surgeon and the patient, a contract that has been shown to be fragile and to have negative effects on patient-centered care [ 32 ]. During the operation, surgeons keep other team members distant at emotionally charged moments and rarely mention them in their narratives.

    This observation parallels the difference in the perceived role of, and the definition of performance by, surgeons, anesthetists, and scrub nurses [ 33 ]. The OR is also the place where disruptive behaviors typically occur [ 5 ]. In other medical fields, emotions are managed differently at an institutional level: Emotions are even used as a therapeutic tool [ 36 — 38 ]. This gap between surgeons as individuals and the environment they work in strengthens their feelings of loneliness, an emotion made obvious throughout the interviews, where they restricted surgery to a technical act and found their only escape in distancing through technical prowess.

    By doing so, surgeons cast themselves as the only active actor in what they perceive as a necessary but uncertain drama that may result in either life or death success or failure.

    Surgeons’ Emotional Experience of Their Everyday Practice - A Qualitative Study

    The interaction of these elements may explain the acknowledged malaise of the surgical profession. The continuous flood of emotions recognized or not paves the way for emotional exhaustion; distancing through technical activity is a way of disconnecting from or dehumanizing others and thus of depersonalization; performing surgery with subjectivity and casting oneself as the sole actor responsible for its outcome entails, among other things, an innate risk of personal failure.

    Emotional exhaustion, depersonalization, and a sense of low personal accomplishment are the three symptoms of burnout [ 39 ]. The main strength of this study is the specific qualitative approach used. Instead of questioning surgeons about particular emotional issues by specific prompts, as most previous studies have done [ 7 , 8 ] with the built-in risk of promoting technical answers, we chose a simple technical question i. Interviews were performed face-to-face by a psychologist who was not known by the surgeons interviewed, and thematic analysis of the interviews was performed by three researchers, each with a different background.

    The interviewees were purposively sampled by gender, academic position, experience, and workplace to include both information-rich participants in particular the most senior surgeons and informants who would potentially contradict or seem to contradict the findings in particular, the most junior surgeons , according to Grounded Theory theoretical sampling procedure. There are also certain limitations that need to be considered. First, the qualitative approach used in this study allows hypotheses to be formulated but is not designed to confirm them.

    Second, our sample of surgeons performed HPB surgery, which is considered a high-risk specialty. In addition, these surgeons practice in a single country and in the specific setting of teaching hospitals. Assessing the transferability of our findings will therefore be interesting, for each specialty may have its own specificity, the health care system or the cultural attitudes towards surgeons may vary between countries and team-based sharing of responsibilities and accountability might be perceived differently from one department to another.

    Because emotion is a subjective phenomenon and surgeons have been shown to calibrate their level of distress unreliably [ 42 ], they must be taught to understand that the way they describe their work contains the seeds of burnout.

    What is it Really Like to Undergo General Anesthesia? - American Board of Cosmetic Surgery

    The first—difficult—step must be to achieve insight and acceptance of the emotional difficulty inherent in being a surgeon:. The authors thank the participants of this study, and Ms Jo Ann Cahn for the revision of the English. OF granted the funding. The funders had no role in study design, data. National Center for Biotechnology Information , U. Published online Nov Author information Article notes Copyright and License information Disclaimer. The authors have declared that no competing interests exist. Received Aug 30; Accepted Nov 9. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.

    This article has been cited by other articles in PMC. Additional quotes from the interviews for each theme. Domains of emotional impairment. Having food or liquids in your stomach can lead to vomiting during or after the surgery and cause harmful complications. Before your operation takes place, you and your family will have a chance to meet with the anesthesiologist — the doctor or certified registered nurse anesthetist CRNA who specializes in giving anesthetics, the medications that will help you fall asleep or numb an area of your body so you don't feel the surgery.

    There are several types of anesthesia. If you're having general anesthesia, the anesthesiologist or CRNA will be present during the entire operation to monitor your condition and ensure you constantly receive the right doses of medications.

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    If surgery is done under local anesthesia, you'll be given an anesthetic that numbs only the area of your body to be operated on. You'll be asked to take off any jewelry, including barrettes and hair ties, and you'll need to take out contact lenses if you wear them. You'll be given a hospital gown to wear in the operating room. A nurse will put an IV intravenous line in your arm and attach it to thin plastic tubing that is connected to a soft bag of fluid.

    This line will probably be used to give you anesthetic if you're having general anesthesia or provide you with fluids or medicine that may be needed during the operation. Patients are vulnerable to infection during an operation, so this protective gear lowers the chance of infection while you're in the operating room. The nurse or technician will then place monitoring equipment, such as sticker-like patches on your skin to measure your heart rate, and an inflatable cuff on your arm to check blood pressure at regular intervals.

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    Sometimes medical and nursing students observe surgeries, so don't be surprised if doctors and nurses aren't the only people in the room. After your surgery is over, you'll be taken to the recovery room, where nurses will monitor your condition very closely for a few hours.

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