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Around 200 million surgical procedures are performed globally every year. Even with a conservative low estimate of 1% to 2% average complication rate, at least 2 to 4 million patients annually will suffer harm from their surgical care. These stats impose some intuitive questions:

  • How many of these patients and their families have been involved in a transparent shared decision making process for surgery?

  • How many times have other treatment alternatives been discussed, including the option of not having surgery?

  • How many times have these patients been encouraged to seek a formal second opinion?

  • How many of these patients may have undergone unnecessary surgery, and therefore suffered “unnecessary” complications, including preventable death from unneeded treatment?

The answers remain elusive.

Here’s a “moment of truth” question for all surgeons: How likely are you to consider having a surgical procedure done on yourself that you would recommend to one of your patients? This question was actually tested in a landmark publication by the “Science of Variation Group” (CORR 2015, 473:3564-72). The study’s null hypothesis was that surgeons would recommend the same treatment for their patients as they would for themselves, with the same level of confidence. Half of the participants were randomly assigned to choose their own treatment, whereas the other half was randomized to make a treatment recommendation for a hypothetical patient matched to their own age and gender. The study revealed that the participating surgeons were more likely to recommend a procedure to another person, with a higher level of confidence, than to choose the same surgery for themselves. These provocative insights unveil that we, as surgeons, are intrinsically biased towards recommending (and thus likely providing) unnecessary surgery. Arnold Relman, the late editor of the New England Journal of Medicine, stated the insightful quote: “Of all the forces coming together to harm or even kill the patient, their physician should not be one of them!” This notion provides an irrefutable imperative for surgeons to embrace the concept of “shared decision making” as a core pillar in the partnership with our patients. Listening skills, empathy, and compassion should no longer be considered optional humanistic virtues for surgeons, if we are truly dedicated and committed to providing appropriate and safe surgical care to our patients.

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