The evolution of the surgical personality

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Short Communication

The evolution of the surgical personality
Prannoy Paul*
Department of Orthopaedics and Trauma, Government Medical College, Kannur, Kerala, India

The initial ideas about the personality of surgeons originated
in an era before anaesthesia. In those days, surgeons were by
default considered to be impulsive, narcissistic, authoritative
and hierarchical. Surgeons at that time always had to work
to a background music of screams of the patient. Hence,
surgeons naturally needed to develop a tough shell to work
in such violent situations. The French army surgeon at the
time, Dr. Henri de Mondeville, wrote: ‘to be a surgeon, you
need to have a strong stomach and the ability to cut like an
executioner’.[1]
Most characters of surgeons that we attribute today have
its origins from those times. Many still consider that the
surgeons credo is – ‘sometimes wrong, but never in doubt’.
Some argue that these characters that made up the ‘typical’
surgeon were actually advantageous in their work.
In the book ‘The wisdom of psychopaths: What saints, spies
and serial killers teach us about success’, by the British
psychologist Kevin Dutton in 2013, he writes about some
common characters found in psychopaths – they are often
fearless, confident, charming, ruthless and focussed. But
strangely enough, these are actually also the characters seen
in highly successful people.[2] In his book, Dutton also reveals
the professions with the highest number of psychopaths.

Surgeons ranked 5 in the list, below CEOs and lawyers.
In a 1991 study analysing the personality of medical students
and follow‑up to see the speciality they ended up,[3] they
noted that students who were warm, and emotionally
vulnerable ended up being gynaecologists, those who
were highly sociable, and enjoyed close interactions with
patients ended up with paediatrics and those who were
Submitted: 08‑Dec‑2021 Revised: 07‑Mar‑2022 Accepted: 14‑Mar‑2022 Available Online: 26‑Apr‑2022

competitive, aggressive and highly confident, ended up
to be surgeons.[4]
With the invention of anaesthesia in 1840s and the
discovery of aseptic techniques, surgeries became more
successful than ever and the prestige of surgeons rose
exponentially. But even when surgeries became more
peaceful and pain free, most surgeons retained the old
traits attributed to their predecessors. Many surgeons in
the past considered themselves at par with war heroes or
fighter pilots. Public also seemed to accept their heroic
image in view of the miraculous successes they had in
their work.
Over the years, the surgical field witnessed drastic changes,
and certain characters which were previously considered
appropriate for a surgeon slowly became outdated and
often times, even proved dangerous to patients. Many of
the previous heroic surgeries are now replaced by specific
medicines, minimally invasive surgeries and molecular
therapies. The days when surgeons used to shout at nurses
or juniors or throw instruments when angry are gone. In
the present day, yelling at subordinates might get you an

incident report and throwing instruments might even end
up in a suspension from service.
In addition, the public is now aware of the preventable
complications in surgery and surgical mistakes like
retained instruments or operating on the wrong limb.
Modern patients demand more respect and kindness from
their surgeons. When it came to working together with
*Address for correspondence: Dr. Prannoy Paul,
Department of Orthopaedics and Trauma, Government Medical
College, Kannur, Kerala, India.
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DOI:
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How to cite this article: Paul P. The evolution of the surgical personality.
Curr Med Res Pract 2022;12:87‑8.

© 2022 Current Medicine Research and Practice | Published by Wolters Kluwer - Medknow

87


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Paul: Surgical personality

their medical counterparts, surgeons were traditionally
considered as natural leaders, but terrible team members.
However, in the present day, surgeons need to be part of the
multidisciplinary team, and hence, surgeons need to involve
in more teamwork.
A study in 2013[5] revealed that patients who received more
empathy from their treating surgeons had better outcomes.
Today, medical and paramedical staff prefer a calmer and
less toxic working environment. Many surgeons are willing
to accept this character of the modern surgeon. Studies
have shown that arrogant and narcissistic characters of
surgeons were a threat to patient safety.[6] For instance,
nurses or assistants who were afraid to speak up to the
senior surgeon eventually resulted in poor outcome for the
patients. Conversely, studies have also proved that friendlier
senior staff resulted in better patient safety.[7]
In spite of all these, we cannot ignore the fact that surgery
still remains a stressful and unpredictable job. Very minor
errors could make differences between life and death, and
hence surgeons still need to be focussed, confident and
perfectionists. We cannot forget the old saying that ‘the
scalpel does not cut well when it loses its edge’.

Studies report that most surgeons experience anxiety and
grief, which lead to increased rates of burnout in surgeons.[8]
This reveals that often under the mask of an overconfident
and narcissistic surgeon could be anxiety and pain. Surgeons
may need to take occasional breaks and find ways to cope
with the stress that comes with the job. In a study on trauma
surgeons, they found that being friendlier and empathetic
increased job satisfaction.[9]
Research analysing the psychology of surgeons provides
mixed results. However, findings that were consistent across
most studies were that surgeons are almost always action
oriented, perfectionists and are ready to push to their limits
during their job.[1] The traits that some may find inappropriate
may be a by‑product of this so called surgical personality.
This surgical personality could also be a product of the years

88

of intense surgical training, rather than being innate to the
individual.[10]
In the present day, surgeons may have to rapidly shift from
being kind hearted with patients and relatives to becoming
a cold‑blooded warrior in the operating room and then back
in a matter of time. We want the best of both worlds – a
surgeon with brilliant technical skills and best interpersonal
skills. Modern surgeons need to find the grey area between
confidence becoming arrogance, leadership turning into
dictatorship and being calm until chaos erupts when they
have to take charge of the situation and come out victorious.
Financial support and sponsorship

Nil.
Conflicts of interest
There are no conflicts of interest.
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Current Medicine Research and Practice / Volume 12 / Issue 2 / March-April 2022