I still remember that evening vividly. It wasn’t just another day in theatre—it was the day I truly found my voice.

Back then, I was working as a trust-grade SHO in the UK. It was my first surgical job, and as an international medical graduate, everything felt new and daunting. The language, the culture, the humour—even the way we communicated in theatre—was different. For someone like me, an introvert from an ethnic minority background, speaking up wasn’t easy. But in surgery, silence can be dangerous.

That day, I was assisting in what was supposed to be a straightforward laparoscopic cholecystectomy. Morgan, one of my SHO colleagues, was eager to start the procedure. Our registrar, Robert, was guiding him through the initial steps, while I stood as second assistant. The consultant was in the room but unscrubbed, watching from the sidelines.

Surgeons come from different cultures, have different religious beliefs, work in varying health systems and resources and are ultimately guided by legal requirements of the country they work in. We link all of these factors by describing the science behind decisions, heuristics, cognitive processing and human factors. We discuss how surgeons interpret the risk of surgery to the patient but have to be conscious that they are also balancing the risk to themselves. The latter being an increasing consideration as surgical outcomes are reported according to key quality performance indices, such as anastomotic leak. The personality of the surgeon is explored finding not a ‘bad’ trait but traits that may respond suboptimally in certain circumstances. To overcome this, achieving ‘personality awareness’ is proposed.

Most surgeons would say that they learnt decision-making through experience in their day-to-day job, with few having had formal training within their surgical training programmes. Residents also describe indirect training and alongside a medical student, give us insights into the progression of decision-making from student to independent surgeon.

When things do not go as planned, we question our decisions and although often not wrong, we can have a strong and negative emotional response. We describe the difference between adverse events and errors and how both can lead to burnout. Human factors can cause both as a result of a longer term stress with the delicate interplay of the surgeon, hospital and job discussed. Mentoring or support programmes could play an important role.

Correspondence to: Wenjiang Wu (email: 1053660645@qq.com)

Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine

Shenzhen

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The health of political leaders has always been of public interest. In the US, in particular, health issues surrounding the president continue to create headlines, and although it may be debated whether private information about diseases and their treatments should be made public, nowadays everyone, including the presidents, agree that information about the health of officials could and should be open to the public eye. After all, conditions that may affect the wellbeing of the president, especially when surgery is involved, could have huge implications from both a political and economic standpoint.

My book, Presidents Under the Knife. Surgical Successes, Failures, and Deceptions, narrates surgeries performed on presidents while they were in office. The surgical procedures are described from a surgeon’s perspective, but importantly, the book also recounts many of the political fallouts and implications of the procedures. As implied in the subtitle of the book, we find successes, failures, and deceptions when learning about the surgeries on American presidents.

Even the country’s first president had surgery. In June of 1789, only a couple of months into his presidency, Washington had surgery for a “tumor” on his left leg. It turned out to be a large abscess giving rise to immense pain and “threatening” fevers. The cutting open of the abscess and drainage of its content may have saved the president from dying of sepsis.

Wright RM, Nelson G.

BJS 2025; 112: znaf194.