Transformations in Self-understanding in Surgeons Whose Treatment Efforts Were not Successful

Abstract

This study, dealing with cardiac and cancer surgeons' reactions to treatment failure (i.e., situations where surgeons despite their best efforts were unable to successfully treat their patients) found changes in the surgeons that bore striking resemblance to certain changes in people undergoing psychotherapy. Twenty surgeons participated. Each reported on two of his patients, all of whom had undergone surgery that failed to stem the progress of their disease. The life expectancy of these patients was approximately one year. Each surgeon saw one of his patients only until completion of the customary postoperative care and then referred him/her back to the original physician. The other patient was seen by the surgeon on a once-monthly basis even after postoperative care had been completed. While the surgeons had decided to be part of the study "for the possible good of the patients," many reported experiences of transformations in their own self-understanding. The particular elements of healing and self-understanding included a sense of self-forgiveness and acceptance, a strengthened feeling of human connectedness, an enhanced sense of meaning about what they were doing, and a sense of openness and hope for the future. Perhaps this self-transformative process and the possible mechanisms for change discussed mimic what happens in psychotherapy patients.

Surgeons Expect Patients to Buy-In to Postoperative Life Support Preoperatively

“…On the one hand, a significant outlay of resources is invested during a high-risk operation for which it seems unreasonable to cease expected and short-term postoperative life support. In addition, surgeons have a strong aversion to being an “agent of death” [6, 7] and struggle with boundary issues linking their performance to the patient’s outcome (irrespective of public reporting),[3, 9, 20] particularly when their hands are tied with restrictions on life supporting treatments. However, given the problem of affective forecasting (where patients are unable to predict the value of a future health state[21]) and the immense burden of unwanted prolonged life supporting treatment, a contractual stance is overly paternalistic.…”

Cognitive Transformation as a Marker of Resilience

“…Pain and disfigurement from severe burns undoubtedly have negative physical and psychological effects, yet Andreasen and Norris (1972) found positive psychological outcomes, particularly increased maturity, trust, and closeness to a spouse, in many such cases. Transformations in self-understanding have been reported by surgeons who were not successful in preventing impending death in their patients (Gerber, 1990). In addition, studies of ORDER REPRINTS individuals held hostage have found that, along with reports of enduring negative effects, a large number of people also reported long-term positive effects, such as a new ability to view stressors as relative (Bastiaans, 1982), or a greater sense of leadership, cohesiveness, and solidarity with others (Ayalon, 1983).…”

Promoting Forgiveness: A Comparison of Two Brief Psychoeducational Group Interventions With a Waiting‐List Control

“…sense of personal power and self-esteem (Rhode, 1990;Trainer, 1981); (c) physical health (Huang, 1990;Strasser, 1984); and (d) improved relationships (Gerber, 1990;Nelson, 1992;Woodman, 1991). In fact, in modern society, with increasing amounts of stress, anger, violence, and relational discord, forgiveness could prove increasingly valuable for preventing problems and promoting well-being.…”