[Downloaded free from http://www.cmrpjournal.org on Thursday, April 28, 2022, IP: 51.79.206.184] Short Communication The evolution of the surgical personality Prannoy Paul* Department of Orthopaedics and Trauma, Government Medical College, Kannur, Kerala, India The initial ideas about the personality of surgeons originated in an era before anaesthesia In those days, surgeons were by default considered to be impulsive, narcissistic, authoritative and hierarchical Surgeons at that time always had to work to a background music of screams of the patient Hence, surgeons naturally needed to develop a tough shell to work in such violent situations The French army surgeon at the time, Dr. Henri de Mondeville, wrote: ‘to be a surgeon, you need to have a strong stomach and the ability to cut like an executioner’.[1] Most characters of surgeons that we attribute today have its origins from those times Many still consider that the surgeons credo is – ‘sometimes wrong, but never in doubt’ Some argue that these characters that made up the ‘typical’ surgeon were actually advantageous in their work In the book ‘The wisdom of psychopaths: What saints, spies and serial killers teach us about success’, by the British psychologist Kevin Dutton in 2013, he writes about some common characters found in psychopaths – they are often fearless, confident, charming, ruthless and focussed But strangely enough, these are actually also the characters seen in highly successful people.[2] In his book, Dutton also reveals the professions with the highest number of psychopaths Surgeons ranked in the list, below CEOs and lawyers In a 1991 study analysing the personality of medical students and follow‑up to see the speciality they ended up,[3] they noted that students who were warm, and emotionally vulnerable ended up being gynaecologists, those who were highly sociable, and enjoyed close interactions with patients ended up with paediatrics and those who were Submitted: 08‑Dec‑2021 Revised: 07‑Mar‑2022 Accepted: 14‑Mar‑2022 Available Online: 26‑Apr‑2022 competitive, aggressive and highly confident, ended up to be surgeons.[4] With the invention of anaesthesia in 1840s and the discovery of aseptic techniques, surgeries became more successful than ever and the prestige of surgeons rose exponentially But even when surgeries became more peaceful and pain free, most surgeons retained the old traits attributed to their predecessors Many surgeons in the past considered themselves at par with war heroes or fighter pilots Public also seemed to accept their heroic image in view of the miraculous successes they had in their work Over the years, the surgical field witnessed drastic changes, and certain characters which were previously considered appropriate for a surgeon slowly became outdated and often times, even proved dangerous to patients Many of the previous heroic surgeries are now replaced by specific medicines, minimally invasive surgeries and molecular therapies The days when surgeons used to shout at nurses or juniors or throw instruments when angry are gone In the present day, yelling at subordinates might get you an incident report and throwing instruments might even end up in a suspension from service In addition, the public is now aware of the preventable complications in surgery and surgical mistakes like retained instruments or operating on the wrong limb Modern patients demand more respect and kindness from their surgeons When it came to working together with *Address for correspondence: Dr Prannoy Paul, Department of Orthopaedics and Trauma, Government Medical College, Kannur, Kerala, India E‑mail: prannoypaul@gmail.com Access this article online Quick Response Code Website: www.cmrpjournal.org DOI: 10.4103/cmrp.cmrp_120_21 This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non‑commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms For reprints contact: WKHLRPMedknow_reprints@wolterskluwer.com How to cite this article: Paul P The evolution of the surgical personality Curr Med Res Pract 2022;12:87‑8 © 2022 Current Medicine Research and Practice | Published by Wolters Kluwer - Medknow 87 [Downloaded free from http://www.cmrpjournal.org on Thursday, April 28, 2022, IP: 51.79.206.184] Paul: Surgical personality their medical counterparts, surgeons were traditionally considered as natural leaders, but terrible team members However, in the present day, surgeons need to be part of the multidisciplinary team, and hence, surgeons need to involve in more teamwork A study in 2013[5] revealed that patients who received more empathy from their treating surgeons had better outcomes Today, medical and paramedical staff prefer a calmer and less toxic working environment Many surgeons are willing to accept this character of the modern surgeon Studies have shown that arrogant and narcissistic characters of surgeons were a threat to patient safety.[6] For instance, nurses or assistants who were afraid to speak up to the senior surgeon eventually resulted in poor outcome for the patients Conversely, studies have also proved that friendlier senior staff resulted in better patient safety.[7] In spite of all these, we cannot ignore the fact that surgery still remains a stressful and unpredictable job Very minor errors could make differences between life and death, and hence surgeons still need to be focussed, confident and perfectionists We cannot forget the old saying that ‘the scalpel does not cut well when it loses its edge’ Studies report that most surgeons experience anxiety and grief, which lead to increased rates of burnout in surgeons.[8] This reveals that often under the mask of an overconfident and narcissistic surgeon could be anxiety and pain Surgeons may need to take occasional breaks and find ways to cope with the stress that comes with the job In a study on trauma surgeons, they found that being friendlier and empathetic increased job satisfaction.[9] Research analysing the psychology of surgeons provides mixed results However, findings that were consistent across most studies were that surgeons are almost always action oriented, perfectionists and are ready to push to their limits during their job.[1] The traits that some may find inappropriate may be a by‑product of this so called surgical personality This surgical personality could also be a product of the years 88 of intense surgical training, rather than being innate to the individual.[10] In the present day, surgeons may have to rapidly shift from being kind hearted with patients and relatives to becoming a cold‑blooded warrior in the operating room and then back in a matter of time We want the best of both worlds – a surgeon with brilliant technical skills and best interpersonal skills Modern surgeons need to find the grey area between confidence becoming arrogance, leadership turning into dictatorship and being calm until chaos erupts when they have to take charge of the situation and come out victorious Financial support and sponsorship Nil Conflicts of interest There are no conflicts of interest REFERENCES 10 Shen W Is the quest to build a kinder, gentler surgeon misguided? Pacific Standard 2014 https://psmag.com/social–justice/bloody–nice–better– cold–heartless–surgeons–84256 [Last accessed on 2021 Nov 18] Dutton K The Wisdom of Psychopaths New York: Scientific American/ Farrar, Straus and Giroux; 2012 Schwartz RW, Haley JV, Williams C, Jarecky RK, Strodel WE, Young B, et al The controllable lifestyle factor and students’ attitudes about specialty selection Acad Med 1990;65:207-10 Zeldow PB, Daugherty SR Personality profiles and specialty choices of students from two medical school classes Acad Med 1991;66:283-7 Derksen F, Bensing J, Lagro-Janssen A Effectiveness of empathy in general practice: A systematic review Br J Gen Pract 2013;63:e76-84 Bosk CL Is the "Surgical Personality" a Threat to Patient Safety? Patient Safety Network Web M&M2006 https://psnet.ahrq.gov/webmm/ case/122/is–the–surgical–personality–a–threat–to–patient–safety [Last accessed on 2018 Mar 20] Taylor B, Slater A, Reznick R The surgical safety checklist effects are sustained, and team culture is strengthened Surgeon 2010;8:1-4 Balch CM, Freischlag JA, Shanafelt TD Stress and burnout among surgeons: Understanding and managing the syndrome and avoiding the adverse consequences Arch Surg 2009;144:371-6 Foulkrod KH, Field C, Brown CV Trauma surgeon personality and job satisfaction: Results from a national survey Am Surg 2010;76:422-7 Rebecca GS The surgical personality: Does it matter? Bull R Coll Surg Engl 2018;100:130-2 Current Medicine Research and Practice / Volume 12 / Issue / March-April 2022 ... their limits during their job.[1] The traits that some may find inappropriate may be a by‑product of this so called surgical personality This surgical personality could also be a product of the. .. when they have to take charge of the situation and come out victorious Financial support and sponsorship Nil Conflicts of interest There are no conflicts of interest REFERENCES 10 Shen W Is the. .. in the operating room and then back in a matter of time We want the best of both worlds – a surgeon with brilliant technical skills and best interpersonal skills Modern surgeons need to find the