On health sustenance and surgical innovation: an inquiry into linear and circular causality

Innovative surgery teeters on the horns of a dilemma. Although a surgical innovation may offer substantial improvement over conventional treatment strategies on one hand, it may on the other be perceived as involving significant risk by both the surgeon and the patient. Based on primary data collected from field research in the operating rooms of a local hospital and from in-depth interviews with a consultant surgeon of orthopedics and traumatology, this article looks into 2 real-life spine surgery cases: an exploration of the possibilities for cervical spine fusion surgery and the creative use of a computerized surgical navigation tool. The discussion centers on how a surgeon thinks and acts when presented with such scenarios. It is argued that surgical innovation as well as the responses to it develop through a process of "nested" circular causalities that arise from a linearly directed intention-that is, the intention to cure illness. In relation to how a surgeon thinks, it is argued that if the causes for intervention were different-that is, the surgeon's desire to cure an illness and, at the same time, allow the patient to live a better and happier life-then the effect would be the decision to carry out an alternate procedure, thus, presenting a new choice. In relation to how a surgeon acts, it is argued that rigid, unquestioning adherence to prevailing assumptions and practices can serve to stifle originality. Surprise and novelty emerge only when the surgeon challenges existing assumptions as well as the validity of their constituent elements.