Surgeon Decision-Making: A Contemporary, Qualitative Analysis of Urologists

The decision to operate is one of the most complex and essential responsibilities surgeons hold yet remains poorly understood. Existing interventions often overlook the intuitive nature of surgical judgement, limiting their impact. This study explores how surgeons make the decision to operate and identifies factors that shape this process.

Twenty-five interviews were performed with practicing urologic surgeons from June to July 2020. Participants were recruited from the 2019 American Urological Association Census, purposefully sampled to ensure diversity in experience, patient load, gender, geography, and practice type. Interviews focused on the decision-making processes, including information sources, risk assessment, and driving factors. Data were analyzed using inductive and deductive coding to identify key themes and patterns.

Surgeon decision-making is a dynamic, iterative process that includes evaluating the patient, assessing treatment options, matching surgeon assessment with patient preferences, and communicating with the patient and family. Often beginning before the patient encounter, surgeons integrate a range of input from visual, written, and verbal cues. While surgeons consider numeric data, decisions are largely driven by intuition and heuristics - honed by experience and shaped by patient, surgeon, work/environment, and external factors. This largely unconscious process aims to balance benefit and harm in pursuit of both patient and surgeon goals.

Through qualitative interviews, this study found surgeon decision-making is predominantly intuitive, shaped by experience and subject to heuristics. Intervening early and designing tools that align with intuitive reasoning may enhance the effectiveness of decision support interventions.