Surgical medicine: imperfect and extraordinary

The themes that emerge from these rich narratives by surgeons are familiar ones in the experiences of diverse health care providers. Questions about and difficulties with communication and with informed consent are common and troubling. Uncertainty was also a prevalent theme in these stories, uncertainty about the right thing to do or say and about how to treat the patients and families the surgeons wrote about. Uncertainty is a reality in medicine, and it is often said that medicine is an art, not just a science. Although in medicine it is uncommon to find a situation so black and white that the course of action is obvious, this may be less true in surgery. Surgeons are prototypically confident in their recommendations. Yet, these surgeons poignantly describe uncertainty. Sometimes the uncertainty leads to careful reflection, taking a stand, or changing practice, and sometimes it lead to moral distress.