• “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.


    • So how do we lower the status of surgeons? All Doctors? Make more of them?

    • This is something that many of my young docs, and even some of my older docs have trouble with. What this article misses, is that in private practice there is often economic pressure involved with making these decisions. When working at a surgicenter, people are afraid that if they say no to a surgeon, he/she will take their cases elsewhere. The same actually holds true for hospital cases, but there is not nearly the sense of immediacy. For this reason, I tend to keep my younger docs away from surgicenters until they have the experience, and the security to know they will not get fired if they cancel a case.


    • As a policy hobbiest/wonk, I feel the same conflict. What should I say when a friend tells me that they are having a nuclear treadmill as part of their routine annual work up? Or that they have decided to have a TURP and have not worked their way through all of the intermediate non-surgical alternatives, telling me that ‘their surgeon’ has good outcomes for continence and sexual function? Do I say, hey, Joe, you need to do some reading? Or do I say, well, gee, good luck with that. I tend to do the latter. And it’s not just the surgeon to whom I am defering; it is the decision that my friend has taken and his confidence in it.