Skip to main content

The Role of Physiology and the Surgeon’s State of Mind in the Surgical Decision-Making Process

  • Chapter
  • First Online:
Surgical Decision Making

Abstract

The surgeon is like the captain of a complex ship that often travels and navigates through some rough waters. Just like with any other leadership position, such as those associated with a business organization, flying an aircraft, a military unit or squadron, or even a sports team, a lot depends on this one person. The direction in which how he or she will steer the ship, which in this case represents the operating theater, through the dangerous and sometimes uncharted seas between life and death, will have substantial effects on everyone involved with the voyage. The difference between the realities of an operating theater and this wrecked ship metaphor is if things go wrong, the only one who is lost and never returns home is the patient. The aim of this chapter is attempt to understand the role of physiology and surgeon’s state of mind on surgical decision-making.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. HCUPnet. Healthcare cost and utilization project (HCUP). 2013 [cited 2015 October 16]. http://hcupnet.ahrq.gov/.

  2. Wiegmann DA, et al. Disruptions in surgical flow and their relationship to surgical errors: an exploratory investigation. Surgery. 2007;142(5):658–65.

    Article  PubMed  Google Scholar 

  3. Mehtsun WT, et al. Surgical never events in the United States. Surgery. 2013;153(4):465–72.

    Article  PubMed  Google Scholar 

  4. Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a Safer Health System, vol. 6. Washington, DC: National Academies Press; 2000.

    Google Scholar 

  5. Gawande A, Lloyd JB. The checklist manifesto: how to get things right, vol. 200. New York: Metropolitan Books; 2010.

    Google Scholar 

  6. Lupien SJ, et al. The effects of stress and stress hormones on human cognition: implications for the field of brain and cognition. Brain Cogn. 2007;65(3):209–37.

    Article  CAS  PubMed  Google Scholar 

  7. Driskell JE, Salas E, Johnston JH. Decision making and performance under stress. In: Britt TW, Adler A, Castro CA, series editors; Britt TW, Castro CA, Adler A, editors. Military life: the psychology of serving in peace and combat, vol 1. 2006. p. 128–54.

    Google Scholar 

  8. Cannon WB. The emergency function of the adrenal medulla in pain and the major emotions. Am J Physiol–Legacy Content. 1914;33(2):356–72.

    CAS  Google Scholar 

  9. Cannon WB. The influence of emotional states on the functions of the alimentary canal. Am J Med Sci. 1909;137(4):480–6.

    Article  Google Scholar 

  10. Cannon WB, Shohl AT, Wright W. Emotional glycosuria. Am J Physiol–Legacy Content. 1911;29(2):280–7.

    Google Scholar 

  11. Cannon WB. Studies on the conditions of activity in endocrine glands: the isolated heart as an indicator of adrenal secretion induced by pain, asphyxia and excitement. V. 1919. Publisher not identified.

    Google Scholar 

  12. Cannon WB. Studies on the conditions of activity in endocrine glands: the influence of motion and emotion on medulloadrenal secretion. XX. 1927. Publisher not identified.

    Google Scholar 

  13. Mendl M. Performing under pressure: stress and cognitive function. Appl Anim Behav Sci. 1999;65(3):221–44.

    Article  Google Scholar 

  14. Arora S, et al. The impact of stress on surgical performance: a systematic review of the literature. Surgery. 2010;147(3):318–30. e6.

    Article  PubMed  Google Scholar 

  15. Ahmed A, et al. Effect of distractions on operative performance and ability to multitask—a case for deliberate practice. Laryngoscope. 2015;125(4):837–41.

    Article  PubMed  Google Scholar 

  16. Mentis H, et al. A systematic review of the effect of distraction on surgeon performance: directions for operating room policy and surgical training. Surg Endosc. 2015:1–12. [Epub ahead of print].

    Google Scholar 

  17. Arora S, et al. The imperial stress assessment tool (ISAT): a feasible, reliable and valid approach to measuring stress in the operating room. World J Surg. 2010;34(8):1756–63.

    Article  PubMed  Google Scholar 

  18. Joels M, et al. Learning under stress: how does it work? Trends Cogn Sci. 2006;10(4):152–8.

    Article  PubMed  Google Scholar 

  19. Spencer R, McEwen B. Adaptation of the hypothalamic-pituitary-adrenal axis to chronic ethanol stress. Neuroendocrinology. 1990;52(5):481–9.

    Article  CAS  PubMed  Google Scholar 

  20. Durmer JS, Dinges DF. Neurocognitive consequences of sleep deprivation. Semin Neurol. 2005;25(1):117–29.

    Article  PubMed  Google Scholar 

  21. Abel T, Lattal KM. Molecular mechanisms of memory acquisition, consolidation and retrieval. Curr Opin Neurobiol. 2001;11(2):180–7.

    Article  CAS  PubMed  Google Scholar 

  22. Backhaus J, et al. Impaired declarative memory consolidation during sleep in patients with primary insomnia: influence of sleep architecture and nocturnal cortisol release. Biol Psychiatry. 2006;60(12):1324–30.

    Article  CAS  PubMed  Google Scholar 

  23. Scoville WB, Milner B. Loss of recent memory after bilateral hippocampal lesions. J Neurol Neurosurg Psychiatry. 1957;20(1):11–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Prince T-M, et al. Sleep deprivation during a specific 3-hour time window post-training impairs hippocampal synaptic plasticity and memory. Neurobiol Learn Mem. 2014;109:122–30.

    Article  PubMed  Google Scholar 

  25. Abel T, et al. Sleep, plasticity and memory from molecules to whole-brain networks. Curr Biol. 2013;23(17):R774–88.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Deary IJ, Tait R. Effects of sleep disruption on cognitive performance and mood in medical house officers. Br Med J (Clin Res Ed). 1987;295(6612):1513–6.

    Article  CAS  Google Scholar 

  27. Goldman LI, McDonough MT, Rosemond GP. Stresses affecting surgical performance and learning: I. Correlation of heart rate, electrocardiogram, and operation simultaneously recorded on videotapes. J Surg Res. 1972;12(2):83–6.

    Article  CAS  PubMed  Google Scholar 

  28. Nelson CS, et al. Residents’ performance before and after night call as evaluated by an indicator of creative thought. J Am Osteopath Assoc. 1995;95(10):600–3.

    CAS  PubMed  Google Scholar 

  29. Harrison Y, Horne JA. The impact of sleep deprivation on decision making: a review. J Exp Psychol Appl. 2000;6(3):236–49.

    Article  CAS  PubMed  Google Scholar 

  30. Saletin JM, van der Helm E, Walker MP. Structural brain correlates of human sleep oscillations. NeuroImage. 2013;83:658–68.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Rocklage M, et al. White matter differences predict cognitive vulnerability to sleep deprivation. Sleep. 2009;32(8):1100–3.

    PubMed  PubMed Central  Google Scholar 

  32. Drummond S, Gillin JC, Brown GG. Increased cerebral response during a divided attention task following sleep deprivation. J Sleep Res. 2001;10(2):85–92.

    Article  CAS  PubMed  Google Scholar 

  33. Blum AB, et al. Implementing the 2009 Institute of Medicine recommendations on resident physician work hours, supervision, and safety. Nat Sci Sleep. 2011;3:47.

    PubMed  PubMed Central  Google Scholar 

  34. Oreskovich MR, et al. Prevalence of alcohol use disorders among American surgeons. Arch Surg. 2012;147(2):168–74.

    Article  PubMed  Google Scholar 

  35. Rosta J, Aasland OG. Female surgeons’ alcohol use: a study of a national sample of Norwegian doctors. [Erratum appears in Alcohol Alcohol. 2005 Nov-Dec;40(6):590]. Alcohol Alcohol. 2005;40(5):436–40.

    Article  PubMed  Google Scholar 

  36. Schermer CR, et al. National survey of trauma surgeons’ use of alcohol screening and brief intervention. J Trauma Inj Infect Crit Care. 2003;55(5):849–56.

    Article  Google Scholar 

  37. Groote Veldman R, Meinders AE. On the mechanism of alcohol-induced pseudo-Cushing's syndrome. Endocr Rev. 1996;17(3):262–8.

    Article  CAS  PubMed  Google Scholar 

  38. Mendelson JH. Biochemical mechanisms of alcohol addiction. In: The biology of alcoholism, vol. 1. New York: Springer; 1971. p. 513–44.

    Chapter  Google Scholar 

  39. Gallagher AG, et al. Persistent next-day effects of excessive alcohol consumption on laparoscopic surgical performance. Arch Surg. 2011;146(4):419–26.

    Article  PubMed  Google Scholar 

  40. Dorafshar AH, O’Boyle D, McCloy R. Effects of a moderate dose of alcohol on simulated laparoscopic surgical performance. Surg Endosc. 2002;16(12):1753–8.

    Article  CAS  PubMed  Google Scholar 

  41. Kocher H, et al. Surgical dexterity after a ‘night out on the town’. ANZ J Surg. 2006;76(3):110–2.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

There are no identifiable conflicts of interests to report.

The authors have no financial or proprietary interest in the subject matter or materials discussed in the manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rifat Latifi M.D., F.A.C.S. .

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Latifi, R. (2016). The Role of Physiology and the Surgeon’s State of Mind in the Surgical Decision-Making Process. In: Surgical Decision Making. Springer, Cham. https://doi.org/10.1007/978-3-319-29824-5_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-29824-5_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-29822-1

  • Online ISBN: 978-3-319-29824-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics