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Comment by klyrs | Hacker News Reader

I swear, a surgeon killed my dad. My dad's surgery was scheduled immediately after the surgeon returned from Australia -- he drove straight from a 30-hour flight to the surgery ward. His scalpel slipped and nicked a chyle duct, which took another half-dozen surgeries to correct. Sure, the cancer was gonna kill him, but spending 3 months in ICU probably took years away from us. I can't imagine the surgeon's hubris in that -- the medical profession seems to know so much, but individual practitioners think they're immune to sleep deprivation, exhaustion, and other simple well-understood aspects of the human condition. It's appalling and tragic

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Individual practitioners are usually aware of the dangers of sleep deprivation. The problem is they have very few options when it comes to controlling their own hours and most of those "top ranked" hospitals are often among the most notorious for having these toxic working conditions. Medical residents are also forced to go through these conditions almost as a form of hazing, justified only by attendings who "also had to go through it, so why shouldn't you?". The whole culture of medical training and hospital administration is corrupt and toxic.

For a part of the program that I'm familiar with, a rotating fellow will be expected to be the sole physician of that specialty on-call for the entire weekend for 3 hospitals in a large US city. Then, on Monday it's back to work again at 6 AM. If it's a busy weekend, good luck getting more than 1-3 hours of a sleep a night during that time.

Just like the rest of us, the surgeon could have returned from his trip (presumably a vacation) a day or three early to recover. But you're spot on about the toxic working conditions and lack of concern that medical institutions give to proper rest.

Sounds like Boston.

I suspect in some professions hubris is so important that people who tend to be humble simply don't make it in them. For example, Chuck Yeager complained about the arrogance of test pilots and I've heard a couple of times surgeons comparing themselves to fighter pilots. The difference, of course, is pilots kill themselves while surgeons kill their patients.

I'm so sorry about your dad.

>I've heard a couple of times surgeons comparing themselves to fighter pilots.

The comparison is a good one, because we have figured out how to minimize the risks for fighter pilots, but doctors rebel when asked to adopt the same style of work.

Before taking off, all pilots - from Cessna to A360 - go through a pre-flight checklist. No pilot is expected to remember all the things that need to be checked - we know that we can't rely on memory. We tried this before, and people died.

Yet doctors only now are starting to adopt checklists, which are known to drastically reduce simple, avoidable deaths[1]. Things like rates of IV-induce infections go down to nearly zero when doctors stick to a checklist -- but many won't; the practice is met with skepticism even though it is known to work.

It took a long time for doctors to start washing their hands and stop killing people that way.

[1]https://khn.org/news/hospital-checklist-mainbar/

To drag this conversation into further despair; an airshow pilot in the UK is currently being charged for manslaughter for when he, allegedly, negligently performed a risky manoeuvre and survived a crash that killed 11 people.

A drunk, alcoholic US Navy surgeon gave my grandmother a radical hysterectomy instead of an appendectomy, involuntarily sterilizing her. She had my father first, at least.

It's also pertinent to recall that surgeons evolved with and into the medical field from surgeon-barbers... yes, the people who give shaves and cut hair also used to cut into people.

How could that have ever happened!? Did she sue? Did she ever get the appendectomy?

That's horrific.

I used to be friends with a surgeon and based on what he told me you need to have a certain level of hubris or arrogance to do that job. He told me of situations during surgery where he had to make a quick decision that could have either severely harmed the patient or led to success. He also knew cases where he had made the wrong decision. It requires a certain kind of person to take that responsibility and live with it.

I wonder if the humble ones are the ones that will adapt best to robotic surgery.

If that ends up being case then 'choosing a human' may quickly become a Market for Lemons situation - you might have gotten better outcomes from human surgeons except the only ones still doing it by hand are full of themselves and too proud to admit they are human and make mistakes.

Surgeons are cowboys. They know it and take pride in it. It's a cultural thing that will take work. This macho culture thing is so common it makes me wonder.

> but individual practitioners think they're immune to sleep deprivation, exhaustion, and other simple well-understood aspects of the human condition. It's appalling and tragic

Those I know do understand the effects of their working conditions. The "appalling and tragic" aspect is that we accept them until they affect us.

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