Decision-making in surgery
Seance of wednesday 20 november 2024 (Communications libres)
DOI number : 10.26299/zhkn-3903/emem.2024.31.01
Abstract
Deciding means making a cut, analyzing and choosing means having the power to ACT. From "decision" to "incision", and then to the precision of the surgical act, the common semantic thread is the division, the separation, the cut.
Recent advances in cognitive and physiological neuroscience allow for a better understanding of the brain mechanisms involved in decision-making, which are inseparable from the information processing capabilities of the sensory organs perceiving the environment.
In the practice of surgical art, one can distinguish between the action of global patient care, which should allow for lengthy and collective deliberations before a strategic decision—except in cases of immediate life-threatening emergencies—and the technical act itself, which requires a personal and immediate capacity for "perceptive decisions" in a short loop, aimed tactically at each stage of its execution.
In this spatio-temporal parenthesis, the patient must be "objectified," but the surgeon must be capable of making quick decisions and difficult choices to adapt to unprecedented and unforeseen situations.
This quality, which is more about inherent traits than any specific training, is often referred to, outside of the medical context, as "surgical temperament."
A "surgeon," to maintain their value as such, should therefore remain, in strict adherence to medical ethics, a decision-maker capable of performing therapeutic acts themselves—potentially dangerous acts of great precision that intrude into the deepest and most intimate aspects of "Alter" (Human Being)—and personally assume full responsibility for their decisions.
The evolution towards "operators," abandoning all strategic decisions to external and irresponsible agents, to become nothing more than agents of execution of standardized, even mechanized tactics, is a perspective widely open to a lack of chances for "good outcomes' for patients and a rapid and significant professional burnout of these new "operators" due to a loss of meaning in their activity.
Pierre DEVALLET Orthopedic surgeon - Montauban (France)
Recent advances in cognitive and physiological neuroscience allow for a better understanding of the brain mechanisms involved in decision-making, which are inseparable from the information processing capabilities of the sensory organs perceiving the environment.
In the practice of surgical art, one can distinguish between the action of global patient care, which should allow for lengthy and collective deliberations before a strategic decision—except in cases of immediate life-threatening emergencies—and the technical act itself, which requires a personal and immediate capacity for "perceptive decisions" in a short loop, aimed tactically at each stage of its execution.
In this spatio-temporal parenthesis, the patient must be "objectified," but the surgeon must be capable of making quick decisions and difficult choices to adapt to unprecedented and unforeseen situations.
This quality, which is more about inherent traits than any specific training, is often referred to, outside of the medical context, as "surgical temperament."
A "surgeon," to maintain their value as such, should therefore remain, in strict adherence to medical ethics, a decision-maker capable of performing therapeutic acts themselves—potentially dangerous acts of great precision that intrude into the deepest and most intimate aspects of "Alter" (Human Being)—and personally assume full responsibility for their decisions.
The evolution towards "operators," abandoning all strategic decisions to external and irresponsible agents, to become nothing more than agents of execution of standardized, even mechanized tactics, is a perspective widely open to a lack of chances for "good outcomes' for patients and a rapid and significant professional burnout of these new "operators" due to a loss of meaning in their activity.
Pierre DEVALLET Orthopedic surgeon - Montauban (France)