“Who are you to question a surgeon?”

Ranjana Srivastava, a medical oncologist, writes in NEJM:

[I]f the surgeon admitted the patient, surely he can decide what’s best. If necessary, the anesthesiologist can call off the procedure. I quickly convince myself that I’m a bit player in this patient’s journey. And that if my gut instinct says “Don’t operate,” it’s no stronger than the surgeon’s instinct that says “Get it over with.” The winning argument in my head is the one saying “Who are you to question a surgeon?” Although I know this attitude is baseless, it sits comfortably with me; my colleagues and I commonly defer to surgeons — considering them unequivocally right, unassailable, or simply not worth antagonizing. In an era when many patients have multiple reasonable treatment options, it seems more expedient to yield to the surgeon than go to bat for a patient. And that attitude is absorbed by generations of doctors who simply have to watch to learn.

The episode ends badly for the patient, but in a way that promises better outcomes for Srivastava and the surgeon’s patients. The piece is ungated.


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