Character failings in the surgeon fallen from grace: a thematic analysis of disciplinary hearings against surgeons 2016–2020

Abstract

Surgeons are commonly evaluated with respect to outcomes and adherence to rules and regulations, rather than a true holistic examination of the character of the surgeon in question. We sought to examine the character failings of surgeons who faced fitness to practice enquiries under the Medical Practitioner Tribunal Service in the UK. In particular, we examined the absence of virtue as perceived through the lens of Aristotelian ethics using thematic analysis of tribunal hearing transcripts from 2016 to 2020. We identified three overarching themes that are explored in depth: ‘the god complex’, ‘reputation over integrity’ and ‘wounded pride’. We hope to use this as the foundation for a re-examination of the place of phronesis in postgraduate surgical education, which we argue should be perceived as an exercise in character development and reformation rather than the simplistic teaching of skills to standardised outcomes.

Senior surgeons as role models in the operating theatre: a thematic analysis through the lens of Aristotelian ethics

“…And the ones who just come to work and do an excellent job aren't remembered as easily as the ones that made everyone cry unfortunately'. This echoes the observations of a previous work regarding the analysis of Medical Practitioner Tribunal Services (MPTS) hearings of consultant surgeons, where only a small proportion, 0.001% of registered surgeons, faced tness to practice hearings 10 .…”

“…Through the lens of Aristotelian (virtue) ethics, a 'good' surgeon is not just one who is technically brilliant and achieves good outcomes 'they are also a surgeon whose character aims for the mean between excess and de ciency in the moral choices inherent in a career in surgery 10 .' We can question whether the surgical training surgeons go through reinforces certain character traits and extremes of behaviours or whether these traits are required to successfully thrive through surgical training.…”

“…The complex was theme identi ed in previous work 10 and was exempli ed by senior surgeons described as being 'snide', 'snappy', 'autocratic', 'condescending', 'demeaning' and 'patronising'. Surgeons who demonstrated these behaviours were seen to adopt a 'surgical persona', imposing a strong agenda on teams, with embedded and accepted poor behaviours being perpetuated by a protective veneer of prestige within the hospital.…”

“…Focus groups were facilitated by the rst author (MLT), an undergraduate medical student at the University of Birmingham. Discussions followed a semistructured interview, utilizing open questions derived from previous work undertaken by the senior authors (JJ and RE) on the applicability of Aristotelian (virtue) ethics to surgical training 3,10 .…”

“…Senior surgeons who are good trainers will enable their trainees to develop good clinical judgment by creating conditions "to understand the need for such thinking and develop their capacity in this area" which enables trainees to acquire clinical experience and contextual awareness 9 . We have previously highlighted the extremes of poor character in surgeons 'fallen from grace' facing tness to practice hearings through the lens of virtue ethics 10 . With the knowledge that positive character attributes can be reinforced through habituation and role modeling, we sought to explore senior surgeon character and behaviour within the walls of the operating theatre at a large teaching hospital, as perceived by other professionals.…”