“Look at every path closely and deliberately, then ask ourselves this crucial question: Does this path have a heart? If it does, then the path is good. If it doesn't, it is of no use.” ~Carlos Castaneda

Saturday, December 8, 2007

To be a good surgeon, you must be confident ... but do you need to be arrogant?

“Be who you are and say what you feel because those who mind don't matter and those who matter don't mind.”
~Dr. Seuss
It is cold, but not cold enough for snow. It is freezing rain cold. The kind of weather that brings rain and sleet. The kind of weather that covers the road and your car with ice. Driving is hard in this weather. With experience and patience, a driver can learn to prevent the skid into the side rail or another care during a sharper turn. Although you can read about how to drive on ice, many of us have learned more from the experience of driving in icy weather than any book can teach.

I drive a Subaru. The all wheel drive that provides me with the capability to move quickly on the icy roads, but does not give me improved stopping ability. I am aware of the limitations. Unlike the 18 year old with his dads SUV who speeds past me, I am patient. My speed is tempered by my previous experiences and fluctuates based on the number of curves in the road and cars on the road.
If you ask someone in the medical field to describe a surgeon, they may tell you that a defining characteristics of a surgeon is "arrogance". Of course this does not speak to all surgeons, but it is one of those stereotypes people have about surgeons. As a medical student I even asked a attending surgeon the question, "does the surgery residency make you an @$hole?" Okay I probably didn't use those specific words, but you get the picture. Her response was, "no, but it will amplify it if it already exists." Although the prevailing view of surgeons is that they are arrogant, my slightly biased view is that not all are arrogant, but their confidence is perceived as arrogance. I personally believe to be a surgeon it is important to have confidence; it is important to believe in your skill set and decision making ability. Who wants a wishy washy surgeon? There is a fine line between confidence and arrogance. It is arrogance that can get a surgeon into trouble; it is arrogance that can make you dangerous.
Driving on icy roads is much more difficult than new snow or even packed snow. Driving on ice or a zero friction surface makes the ability to stop and/or maneuver very difficult. There has to be anticipation and patience. It is not a time to multi task in the car. Full attention must be given to the road. There should be no quick movements, no sudden stops, no quick turns.
Arrogance is something that is common in academic centers. Unless controlled, it can fester. The belief is "we do it better that is why the tough cases get sent to us." I can't count how many times I have had a resident say in reference to a referral or second opinion, "why would they do something like that" or "I can't believe they did that." My response is "there aren't many dumb orthopaedic surgeons, therefore there is usually a reason." It is my role to guide the young surgeon in his/her thought process. To get the resident to understand we are not perfect; we don't get every question right; we can't understand everything about every disease process. What we can do is be understanding and responsive to other opinions, while being confident in our own opinions and skill sets.

What is the actual difference between arrogance and self-confidence?

  • Arrogance: an attitude of superiority manifested in an overbearing manner or in presumptuous claims or assumptions.‘Arrogance’ is an attitude of overbearing, proud, self-importance that shows itself in contempt or disregard for others and their opinions.
  • Self-confidence: self-confidence is an attitude which allows individuals to have positive yet realistic views of themselves and their situations. Self-confident people trust their own abilities, have a general sense of control in their lives, and believe that, within reason, they will be able to do what they wish, plan, and expect.
In icy weather, I drive cautiously. I don't fear the weather or road, but respect it. I understand that not respecting it can lead to disaster. We have an unspoken understanding.


Self-confidence is an important trait for a surgeon to have. Having self-confidence does not mean that individuals will be able to do everything. Self-confident people have expectations that are realistic. Even when some of their expectations are not met, they continue to be positive and to accept themselves. When a surgeon is self-confident, he/she is able to look critically at their decisions and adjust based on their outcomes (good and bad). They possess the "force of character" to take ownership of both their successes and their failures. Arrogance prevents a surgeon from having the insight to correct their own errors and thus, their growth will be stunted. The acceptance of newer ideas and other's insight into a disease or procedure is key in ones growth, both as a clinician and surgeon. Having self-confidence allows for growth; having arrogance prevents growth.
I have driven many nights on icy roads. I personally don't like doing it, but I am confident in my ability to perform the task. I respect ice. I am aware the obstacles it provides. I drive confidently on the road. It is not the time for risk taking. Unlike the teenage driver, I drive respecting the road.

As I write this post, I look back at my own career and can make note of countless times were I have been wrong. Knowing how people have taken other posts, I must state that I am not immune to being arrogant. I am not perfect. I write this to because I believe that the line between arrogance and self-confidence is extremely thin. We all must remain self aware. We must be willing to continue to grow and look at ourselves as lifetime students. I continue to grow both as an educator and learner. My views are constantly being reshaped and molded. Do you have the "force of character" to do continue or do you believe you know the right answer already?

“Confidence comes not from always being right but from not fearing to be wrong.”
~Peter T. Mcintyre

11 comments:

Chrysalis Angel said...

Excellent post! I loved this, "Having self-confidence allows for growth; having arrogance prevents growth." That is so true.

You may lapse into arrogance on occasion (as you said, I'm not saying it), but I see a strong ability to self correct, not unlike the back end of your car beginning to slip to the side, and you note it and correct it. (Loved the references back and forth in this post, great photos too!)

make mine trauma said...

Just last night, I was chatting with a friend at a coffee house and an elderly man who had sat beside us noticed the book I had been studying (Review of Surgery)and asked me how it was working with surgeons and didn't I think that they were arrogant!

Unfortunately I know of an arrogant surgeon, although I didn't tell the old man that. He fits the definition you give almost to perfection.
On the fortunate side of things, he has good outcomes, and of all of the surgeons I have worked with, there is only one I would describe this way.

Bongi said...

the fine line between arrogance and confidence. no one human being is more important than another. to place oneself above others is arrogant. but to be a surgeon, confidence is absolutely essential.

Midwife with a Knife said...

Completely true.

Chrysalis Angel said...

miss you.

Someonetc said...

Chrysalis: thank you for continuing to visit. humility and self-awareness, in my mind, are the keys to becoming a great clinician.

make mine trauma: i just watched the movie malice again last night. that is the stereotypical arrogant surgeon.

bongi: i totally agree that confidence is essential for a surgeon. the key is to be humble enough to realize that you are just human.

MWWAK: thanks

Hildy said...

Confidence: I'm good.

Arrogance: I'm better.

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