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Exploring shared surgical decision‐making from the patient’s perspective: is the personality of the surgeon important?, Bisset et al

It is with great interest that I read the article by Bisset et al. in this month’s issue of Colorectal Disease [1]. This study builds on previous work by Moug et al., which showed that colorectal surgeons are more likely to demonstrate high levels of emotional stability and conscientiousness in comparison with a non-clinical population [2]. The authors currently present a study on the perspective of patients on influence of the surgeon’s personality on shared decision-making. Patients from various predominantly English-speaking countries, mostly from the United Kingdom, filled out online patient surveys distributed through Twitter and Facebook. Within 72 h nearly 300 responses were recorded, illustrating the value of online platforms for scientific studies. Most of the patients had undergone surgery for colorectal cancer (40%) or inflammatory bowel disease (45%). In the second part of the study, a face-to-face patient and public involvement exercise was performed. Participating patients were of the opinion that high scores in emotional stability and agreeableness were positive traits in colorectal surgeons. The trait openness was also considered preferable, supposedly associated with problem-solving skills. Interestingly, patients were convinced that low levels of conscientious behaviour, anxiety and openness were possible risk factors for postoperative complications. Media stereotypes (eg, aggressive behaviour) were not confirmed by patients, nor would most respondents change anything about their surgeon when asked. It was noteworthy that most patients were not aware of the possibility of a second opinion. The expectations patients hold could be influenced by personal experience and cultural influences, especially in terms of communication, perception of formal attire, and the degree of shared decision taking. The degree of operative risks, the acceptance of low anterior resection syndrome or stomas are issues that need to be discussed with patients. However, especially in the setting of the terminally ill, making informed choices and defining a good outcome may prove challenging [3]. Recent evidence supports the presence of gender bias in the patient-doctor interaction. Frequent misrecognition by patients, credibility deficits and positive assumptions from patients and colleagues can be harmful to the reputations of female consultants in particular [4]. This process of gender bias recognition and promotion of gender equality will take time and effort from both female and male doctors at all levels. With growing female representation in colorectal surgery, patients’ biased and unbiased beliefs may prove malleable over time. Surgery establishes a bond between people who might never have met, if not for the disease that brought them together. The study by Bisset illustrates that the basic principles of honest communication, reflection, and collaboration are recognised and valued by patients. Whether in elective or in emergency setting, at the beginning or at the end of life, patients need to feel they can trust the surgeon to do what’s right.