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Surgeons’ Self-Esteem: A Change From Too High to Too Low?

Surgeons in the Past A common subject of discussion at both national and international meetings is the change in the position of surgeons. Retired colleagues remember “the good old days” when the status of the professor in surgery was unquestionable, not only in the surgical department and among the medical faculty but also within the hospital. Options for treating diseases were scarce, and often the possibility of performing some kind of surgery meant the difference between life and death for the patients. Since patients’ lives were pretty much in the hands of surgeons, it was natural that surgery became the main medical profession. All surgeons were general surgeons, which meant that they had (or at least seemed to have) the skill to operate on any organ or tissue of the body. Surgeons were in charge not only of the treatment of patients but also of the whole department. Surgeons, therefore, were highly respected by the community and the patients they treated. They were the kings, and some even behaved accordingly. These kingly attitudes spread easily from the heads of surgery to other surgeons in the department, who eagerly adopted a similar role to that of their chief. Fast decisions and fast operations were the fashion in those days, and slogans like “If in doubt, cut it out!” roared from OR to OR. The self-esteem of the surgeons was high, perhaps even too high. Obviously this picture is a sketch of the surgical stereotype, but it was still a quite familiar one in many medical institutions not too long ago. Our colleagues in the more conservative specialties eventually reacted, and the qualities valued by the surgeons themselves were not only unvalued but dismissed. In the worst-case scenario, other colleagues saw surgeons as peculiar, self-willed butchers and labeled them as unintelligent, uncooperative, and despotic. Is this picture I have just presented true or merely an overstatement? For instance, the image of one who performs operations with speed is not just a cult image of a surgeon. It should be remembered that diagnostic tests for diseases were relatively scarce and, if available, took valuable time to provide answers. Thus, especially in emergency situations, the tests were not as useful as they are today. For instance, abdominal surgeons quite frequently had to perform exploratory laparotomy on patients to find the cause of the disease and, eventually, a surgically treatable one. Often there was no other way. Furthermore, half a century ago anesthesia was still in its infancy and patients could not be managed safely during complicated and lengthy operations. Speed was really a surgical necessity in those days.