Surgical Professionalism: The Inspiring Surgeon of the Modern Era

B efore the development of general anesthesia, barber surgeons operated with the patient screaming and strapped to the operative table. Understandably, the historical surgeon was valued for technical ability above all else, with little regard for bedside manner. However till today, surgeons are perceived as the specialty most likely to exhibit disruptive behavior. In the modern world of patient-cantered care, however, tolerating disruptive behavior in exchange for technical mastery is no longer an option. The American College of Surgeons defines professionalism in surgery by stating: ‘‘a good surgeon is more than a technician, and reliance on technical expertise alone as the basis of professionalism might weaken our claim to public legitimacy.’’ Deft fingers and a steady hand may be required for surgical excellence, but professionalism in surgery demands something more. The latter half of the 20th century saw a major shift in the physician-patient relationship, moving from paternalism to an era of shared medical decision making. The magnitude of this change can be fully appreciated by contrasting 2 similar studies on medical communication, performed just 18 years apart. In 1961, Dr Donald Oken surveyed physicians at Chicago’s Michael Reese hospital, asking whether they regularly disclose a cancer diagnosis to their patients. Overall, 88%of physicians, and the samefractionof surgeons, indicated that they did not. A follow-up survey in 1977 revealed a reversal of this policy with 98% of physicians indicating they disclose the diagnosis to cancer patients. This remarkable shift in concept and behavior informs our ideal of the surgical professional in the modern age. Patient-centeredness has placed emphasis not only on communication skills, but also on transparency of practice outcomes and publically available patient satisfaction scores. Modern surgical practice requires engagement with multiple reporting regulations, such as the Centers for Medicare and Medicaid Services’ (CMS) Physician Quality Reporting System; or the inpatient, outpatient, and ambulatory surgery quality programs; the Joint Commission’s Surgical Care Improvement Project; the Agency for Healthcare Research and Quality’s (ARQH) Patient Safety Indicators; or the joint CMS and ARQH Hospital Consumer Assessment of Healthcare Providers and Systems Survey (HCAHPS), which is publically reported on the internet.