The Surgeon’s Ego Has A Purpose


By:  The Generation Y Surgeon (@GenYSurgeon)


I’m Interested In The Surgeon’s Ego…

Social sciences fascinate me.  Social psychology, influence, compliance gaining, emotional intelligence, interpersonal dynamics, how to lead change…all of these topics run rampant in our workplace.  It’s no wonder why there are so many medical and hospital dramas on television.  Our workplace, including the hospital as well as pre-hospital workplaces, medical school, academic labs and private practices, abound with pathological behaviors and interactions.  Some of which are purposeful and useful, others of which are clearly not.  Stereotypes abound: the outwardly loving yet passive-aggressive pediatrician, the lifestyle-obsessed and distracted emergency department doc, the painfully awkward yet brilliant physician-scientist and my personal favorite, the egotistical, over-confident, sharp-tongued surgeon.  The surgical ego is one of my favorite subjects and I have many thoughts on how this came about as well as why it continues to exist.

(Pre-hospital staff, nurses, administrators and ancillary staff….you’re not off the hook.  I see you and your time will come–I will be writing about you as well!  This blog post however is dedicated to my fellow physicians, specifically my surgical colleagues.)

The Stereotype Of What It Is

The stereotype: inappropriately confident, stern and unwaivering, ruthlessly focused on the task at hand…and ignorant of the surrounding emotions of other people–or just not caring what they may be.  Surgeons thrive on chaos and adrenaline and they’re proud of it. 

Everyone knows surgeons have big egos.  What you may not think about is why.  I will offer this: the surgical ego has a purpose, and that purpose is to protect the surgeon.

Here’s Why It Exists…

Medicine is hard.  Doctors struggle to stand out in undergrad, struggle to succeed in medical school and struggle to remain standing upright throughout residency.  Physicians sacrifice years of their lives, putting off high incomes, personal growth and even family until they emerge as an attending.  And even then they work obscene numbers of hours in high stress positions.  Yes, the work is personally and (eventually) financially rewarding; however, the cost of getting to attending-hood is often underestimated.  

Surgeons undergo the longest and most rigorous training.  Residency teaches more than knowledge; it’s about decision-making, leadership and technical skill.  The environment is high stakes for teacher, patient and learner alike.  That’s where the surgical ego comes into play.  And the ego is shaped by the environment in which it must exist.  

IQ and emotional intelligence are often in conflict.  Pitting these against professional duties in a hospital?  Well this is where even the smartest and most socially adept doctors begin to fail.  Before we get to the pathology associated with the surgical ego, let’s talk a little more about what the most emotionally intelligent physician may look like.

Let’s Go To The Books

In Daniel Goleman’s famous book Emotional Intelligence, emotional intelligence is defined and broken down into five domains:

1. Knowing one’s emotions. This is self-awareness, the ability to monitor feelings from moment-to-moment and stand confidently behind your decisions.

2. Managing emotions.  This is resilience, the capacity to deal with how your feel and manage what comes next.  

3. Motivating oneself.  Controlling emotions for productivity, creativity, mastery and attention.  This is how you achieve the “flow” to continue with outstanding performance. 

4. Recognizing emotions in others.  In other words, empathy.  

5. Handling relationships. Popularity, leadership, interpersonal skills and mastery of labile social situations.  

Now imagine you are a trauma surgeon and you are leading the resuscitation of a young pregnant woman who was stabbed by some low-life outside the grocery store.  The patient is about to die, and so is the baby.  The injury is severe & it requires a procedure that you’ve only read about before.  The trauma bay is chaos and the staff are clearly upset about the scenario.  You can hear family members wailing outside.  What do you do?  How do you act?

Let’s Apply Our Definition

Let’s put this in the context of emotional intelligence.  After all, we just read about it above.  Think about the definition of emotional intelligence:

Know your emotions.  Easy, you’re scared, likely tachycardic, unsure of yourself and your ability.  But you cannot show it because…

You must stifle your feelings because someone’s life depends on it.  The only way you can manage is to ignore the fear and….

Motivate yourself.  You think hard and develop a game-plan for the operating room.  You quickly prioritize what must be done and there is no time for…

Other people’s emotions.  The family, the nurses, the onlookers, they are about to decompensate into puddles of tears, frantic with emotion so you…

Manage the room with firm leadership, loudly commanding the staff with clear, unwaivering words in an effort to get this patient to the operating room and save a life.

It Makes Sense, Doesn’t It? 

To the fly on the wall you are inappropriately confident, stern and unwaivering.  You are ruthlessly focused on the task at hand, ignorant of the emotions surrounding you.  You thrive on the chaos and adrenaline and you’re are proud of it.  Wait….isn’t that how we described the stereotypical egotistical surgeon at the beginning of this blog?!  Think about it. 

I’m not saying that we should excuse all of surgery’s pathologic behavior, the point is to understand why some of these behaviors exist.  To bring this back to the theme of the website, systems matter.  When a surgeon exists in an effective system that eliminates uneccessary stress and tension between staff, they are less reliant on the surgical ego for protection and productivity.  Surgeons have often grown into the surgical stereotype because they have no other choice.  Where they perceive threat or challenge they fall back on what they know and the ego defenses appear.  After all, it works in the high stress situation of the trauma bay. 

In an ineffective system, the stereotype becomes necessary and after a short while the surgeon is unable to snap out of it.  It becomes a way of life and they identify with it.  Remember, surgeons spend years to get where they are and it comes at great personal sacrifice.  Even so, there is always room for improvement.  How do we get ourselves and our colleagues to identify when the situation is different and it’s time to drop the surgical ego for a bit?

I’m NOT saying the ego is inherently bad or useless.  In fact, as we described, sometimes it’s necessary and adaptive.  The question is “how do we teach and learn when it’s time to shut it off for a while?” Surgeons are smart (but often tired) so how do we learn when the situation requires different tools and instruments?

The surgical ego is one of my favorite subjects and I have many thoughts.  There will be much more to come in future blog entries.  Until then, stay curious and stay objective.  So, what are your thoughts on it?  Let me know beneath.