When the patient of an internist dies his colleagues ask “What happened?” But when the patient of a surgeon dies, her colleagues ask “What did you do?” 1
When a trauma happens, when a cancer grows, when an organ fails, a surgeon is called. Surgeons cut to heal and hurt to cure: surgeons, by nature, are invasive. While all physicians regularly participate in life or death decisions, the surgeon’s involvement is the most immediate and the most tangible. Lives are saved and bodies are left behind. Surgeons are often not afforded the luxury of deliberation and so we must learn to think quickly, with objectivity, almost automatically. Paradoxically, the very attributes that make one a good surgeon may also subtract from one’s abilities as a physician. The efficiency paramount in a hands-on field might translate into impersonal haste, and the distance to preserve objectivity may limit compassion.
The guidance offered to patients intended in the spirit of beneficence may deteriorate into loss of respect for patient autonomy. To be a good surgeon and a good physician, is a constant balancing-act of virtues and behaviors that may, at times, conflict. Recognizing ethical dilemmas and knowing how to resolve them becomes especially challenging. To internalize the ethical conduct of a surgeon and a physician requires education, practice, and most of all, reflection.
1 Bosk CL: What Would you Do? Juggling Bioethics and Ethnography. Chicago: University of Chicago Press; 2008