Surgery & Emotion: Have We Moved on From Sir Lancelot Spratt?

Edna Astbury-Ward

February 19, 2020

The traditional image of a surgeon is often depicted as male, aloof, in control of their emotions and to an extent a rather cold person. Caricatures such as Sir Lancelot Spratt, of the 1954 Doctor in the House British film comedy, who famously declared "Remember, to be a successful surgeon you need the eyes of a hawk, the heart of a lion, and the hands of a lady", one hopes are consigned to the archives of farce. Nevertheless, there is some suggestion that although Sir Lancelot Spratt may be history, the public perception and understanding of surgeons in 2020 may still require some illumination.

Agnes Arnold-Forster, PhD, research and engagement fellow on the Surgery and Emotion Project told Medscape UK that her research indicates that the general public still has a low opinion of surgeons: "They have a high opinion of their skill and their technical ability and their contributions to society, but a low opinion of their ability to communicate effectively and to act compassionately and to be good carers." She added the caveat, "I don't think that's necessarily an accurate perception or that it should be the perception, but I do think that stereotypes about surgeons do still exist and dominate expectations."  

Emotional Control

We've previously reported on trauma surgeons' daily lives - Surgeons at the Sharp Edge: Doctors Dealing With Knife Crime and 'Emotional Control' Key to Knife Crime Life-saving Trauma Surgery - where two surgeons indicate that emotional control, blocking out feelings, and having a thick skin, are a key part of a surgeon's personality. However, they were equally keen to point out that compassion is one of the most important qualities of a doctor. The requirement for compassion in surgery is not new. Benjamin Brodie (1783-1862), the famous surgeon and physiologist, told medical students at the Hunterian School in Great Windmill Street, London, "I do not hesitate to say that he who can look with indifference on the agonies of a fellow creature is not the person to practise surgery."

Surgery and Emotion is an interdisciplinary 4-year project exploring the emotional landscape of surgery from 1800 to the present, and is an innovative Wellcome Trust Investigator Award. It's led by Dr Michael Brown, PhD, reader at the Department of Humanities, University of Roehampton. Medscape went along to a public event held at The Royal College of Nursing headquarters in London to find out more and to hear talks given by the project team.

Stereotypes

In a talk given by Dr Brown, he confirmed the stereotype of surgeons in popular culture as "heroic and difficult individuals with a degree of clinical detachment and dispassion". He said, "this stereotype has remained fairly unchanged and timeless", but he hoped that the Wellcome Project would dispel the caricature of an emotionally bankrupt surgeon and instead reveal their true compassion and humanity.

During his talk Dr Brown gave the audience some insight from the project's research into the difficulties and complexities of life as a surgeon. In particular, he spoke about the profound emotional toll that intraoperative death has on a surgeon and that often such emotions were difficult to express.

Talking About Feelings

His research colleague Dr Agnes Arnold-Forster, concurred, she said she had interviewed surgeons at all stages of their surgical career who spoke to her about their feelings. She said, "for a lot of them it's the first time they've ever actually talked to anyone about how they feel". Dr Arnold-Forster went on to say that she thought initially it would be difficult to get surgeons to talk to her about their feelings, but once they started it was actually difficult to get them to stop!

Agnes Arnold-Forster

She found it extremely interesting because she said: "You end up having these really deep emotional conversations with people who haven't had much opportunity to talk, or to examine their own lives in that sort of way and they see it (the research interview) as a bit like therapy…. Obviously I'm not a therapist or a qualified counsellor so I'm not in a position to offer any advice and I do make that clear." However, she went on to say that she had received letters afterwards from the participants who said: "The session was so needed, it was so cathartic, and it's really helped me come to terms with things." Dr Arnold-Forster said this clearly demonstrated "there are insufficient outlets for surgeons to talk about how they feel".

Medscape UK asked her more about her role in the project and the findings so far.

Q&A

You have said that "surgeons are deeply affected by their work, but often feel that they can't talk about their emotions because of the 'culture' of the profession". How do you see this project changing that?

Dr Arnold-Forster: I hope the project can change or at least shift the discussion in a way so that more people who aren't in clinical fields are aware that surgeons have feelings, they are humans who have emotional responses to things. I hope that through our project the general public can imagine the humanity of the surgeons that are caring for them. Part of our work is about making people more aware about surgeons as humans by portraying a more complex and nuanced version of what the surgeon has been and what the surgeon is now. The project is not specifically interested in mental ill health or mental illness, that's part of the broader story, we're interested in non-pathologised emotional responses.

It's certainly possible to be deeply moved emotionally by your work without becoming mentally unwell, which is not to say that it doesn't also sometimes mean that people become unwell as a result of their work. However, you can be mentally healthy and still have profound and deep emotional responses to things. One could argue that having those sorts of emotional responses is emotionally healthy and an appropriate response to grief and tragedy.

You said that the research interview was often the only place surgeons had to talk about their emotions. What recommendations will you suggest as a result of the project to improve formal and informal emotional support for surgeons?

Alongside Schwartz Rounds [a group reflective practice forum] there needs to be systematic and structural counselling services in hospitals. In the 1970s it was a fundamental part of occupational health in hospitals. It is no longer a fundamental part of occupational health but lots of people working in hospitals do not have access to counselling services or professional psychiatric support within their jobs. This differs from the current situation where we have clinical supervision, the boundaries between who is there to support you emotionally and who is your professional superior or someone involved in your professional development can be blurred. You are not likely to share your deepest emotional feelings with someone who may be involved in your professional development. It is very important to keep those boundaries separate, especially if you are a junior doctor and you are dependent on a more senior staff member to facilitate your career progression. You do not want that person to be the same person you would speak to about your feelings. No matter even if you are an amazing surgeon you are not qualified to provide emotional support. 

There's a lot of talk about the crisis in surgical recruitment. What do you see as the future for upcoming young surgeons?

A lot of young doctors are put off a career in surgery because of their perceptions of what it means to be a surgeon and the behaviours they see to be acceptable, so there is a lot of under-recruiting into the specialty.

Have you noticed different responses between recently retired surgeons and those still working?

Yes, one of the common themes that recurs is a nostalgia for how it once was, a waxing lyrical for how great it was to work as part of a firm, to know who all your colleagues were and before the introduction of the European Working Time Directive. However, by the end of the conversation they admitted that actually they were exhausted and maybe made mistakes and actually they were miserable and never saw their children. I think that shows how individuals can hold multiple conflicting opinions of themselves. People rarely have a coherent account of themselves.

Retired surgeons tend to be a little more reflective and open about their experiences, and I think there are very obvious reasons for that. Partly because they have a lot more freedom to talk about their work, but also having distance from your day-to-day grind as a surgeon means you have a bit more time to think about what it is that you've experienced and what it is that you do. They talked about how professionalism and a sense of vocation has been eroded in currently practising surgeons.  

Dr Brown talked about the profound emotional toll that intraoperative death has on a surgeon and that often such emotions were difficult to express. Can you tell me what your research has found out about this aspect of a surgeon's life?

As surgery has become increasingly highly specialised there may be surgeons who will hardly ever (if at all) encounter intra-operative death. However, for other specialties such as oncology, cardiac, or neurosurgeons, that may not be the case. That said, whilst events such as these are traumatic for the surgical team they are thankfully fairly rare occurrences.

Yet it seems that more often than not the things that worry surgeons most are not these big questions of life and death but the more everyday mundane, such as hours worked, control over rotas, annual leave, autonomy in the institution, and levels of administrative tasks -these are the questions that keep cropping up, not as you might imagine, the questions of life and death.

Have you observed any specific personality traits in the surgeons you have interviewed for the project?

Perfectionism! And also that they went into a surgical career because they are 'fixers and doers', interventionists who are practically minded individuals. They're not the sort of people who are interested in subtle interventions, waiting to see if different pharmacological treatments work over weeks or months. They are people who want to intervene and solve problems quickly.

So impatient then?

It's difficult to generalise but there is definitely an air of self-confidence.

What do you hope for the outcomes of the project?

We want to work with medical students' curriculum to have emotional topics and communication introduced into the curriculum early on. We also want to make it clear to medical students that it's OK to talk about your feelings and to express emotions and that good doctors and good surgeons are not emotionally detached or dispassionate. We also want to demonstrate surgery as an attractive career path even if you don't consider yourself Sir Lancelot Spratt!

Comments

3090D553-9492-4563-8681-AD288FA52ACE
Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as:

processing....