The role of surgeon personality in surgical decision-making.

Individual surgeon decision-making plays an important role, especially for conditions without a standard treatment.

Choice of anastomosis in colorectal surgery can be really complex. Each decision has specific short and long term implications for both the surgeon and patient. Quality of life, bowel function, and surgery-specific complications are affected by this choice.

A recent article by Bisset et al.¹ shows that certain traits of surgeon personality could be associated with decision-making in specific scenarios.

Colorectal surgeons worldwide were invited to participate in a two-part online survey. Part 1 evaluated surgeon characteristics using the Big Five Inventory to measure personality in response to scenarios presented in Part 2, involving anastomotic decisions. Five domains were evaluated: agreeableness, conscientiousness, extraversion, emotional stability, openness. Surgeons could choose between formation of a primary anastomosis alone, a primary anastomosis with a temporary loop ileostomy, or permanent end colostomy, following diversion of the bowel.

Previous studies^2,3 suggested that older surgeons, and surgeons with confidence are more likely to form primary anastomosis alone and construct fewer stomas.

The individual surgeon’s perception of their anastomotic leak rate can influence decision-making. Surgeons with lower perception are more likely to perform the higher-risk option (i.e. primary anastomosis alone).

Variation in surgical decision-making is influenced by the personality of the surgeon^1-3. Personality can be considered a cumulative result of life experiences and changes throughout a medical career. It is influenced by the various successes or failures during their surgical career.

There remains little evidence in the medical literature about surgeon personality and patient outcomes. The decision to operate versus non-operative management, pre-operative procedure planning, intra-operative changes in approach and postoperative management, all require careful consideration, that must include the response to complications³.