Saturday, October 17, 2015

A Surgeon's Loneliest Responsibility

We often denigrate surgeons who hold the view that they are the captain of the ship. They think they are fully in charge of the operating room and everyone else has to do their bidding. We scoff at such antiquated thinking. Don't they realize that surgery is a team approach, with the entire operating room staff responsible for the welfare of the patient?

We sneer at such attitudes, but guess what--when the shit hits the fan, the only person in the operating room who approaches the patient's family is the surgeon. When there is a death in the OR, such as a trauma patient, it's not the entire OR staff who walk the long walk to the family waiting room to disclose the passing of their loved one. It is the surgeon alone. The rest of us merely go about our business cleaning up the operating room to get it ready for the next case. But the anguished cries echoing down the hall are not easily ignored.

Worse are the unexpected complications that can occur in the operating room. Whether it be a pneumothorax from a poorly attempted central line by the anesthesiologist or a sponge inadvertently left inside the patient because the nurses didn't do a proper final count of the equipment, the culprit rarely is the one who has to go to the waiting room to tell the family about the complication. We recently had a patient who died on the OR table. Unfortunately, this happened after the case was finished and the surgeon had already gone out to tell the family that the operation was a success. Guess who had to go back out there to notify the kin of this tragic turn of events? While the rest of the OR personnel kept their heads down safely behind the security doors, naturally it was the surgeon who had to face the music and answer all the angry accusations hurled at him outside in the lobby.

So next time before you accuse a surgeon of being an imperious bastard, just remember that great power comes with great expectations. Unless the anesthesiologist or nurse in the OR are willing to go right out there with the surgeon to confront the family after an unanticipated event, we should give the surgeon some slack if he wants to act like the overlord of the OR. I suspect most of us would rather leave that unpleasant task to the surgeon alone.


  1. Great reminder! Everytime the surgeon goes to talk to a patient post op i actually go with them. It only seems fair

  2. Good article reminding us of our surgical colleagues tough job but don't belittle our own responsibilities. If the patient dies in the OR or has a serious complication from anesthesia related incidents of course the anesthesiologist is obligated to go with the surgeon or even alone to talk to the relatives. As an anesthesiologist and doctor you should have experience talking to terminal patients or the families of the deceased. As an operating team you back each other up, an orthopedic surgeon shouldn't have to explain alone to the family why the patient aspirated during intubation or why the patient coded peri-operatively and couldn't be resuscitated.

  3. I agree with Haraldur. It should go without saying that the anesthesiologist should speak with the family if there's a serious anesthesia-related complication. I know I have. Are you saying you never have? I find that surprising and, frankly, a bit troubling.

    1. Not talking about myself. But I've seen it happen too many times.