The Anatomy of the Surgeon’s Decision-Making

Despite its enormous significance and the implications that this decision-making process has on surgical outcomes, there are still more questions than answers, how surgeons make decisions. Subsequently, there are only a few studies that have investigated how these decisions are made, despite great importance both for training and patient safety purposes. Often, even surgeons have difficulty describing how they came to specific a decision during surgery. Some describe these decisions as “intuition” or “gut-level” responses. There are several factors that affect decision-making abilities of surgeons during operations and include, among others, the physiologic state of the surgeon, teamwork dynamics, external pressures and situation awareness, and the surgeon’s ability to adapt quickly to a changing environment, to name a few. Yet, the question remains, how to perform an evaluation of the surgical decision while gaining a better understanding of a seemingly gut-level process, which helps surgeons combat the external factors experienced before and during surgery?