16/05/2026
What Not To Do as a Surgeon — Professionally, Technically, and Ethically
A surgeon’s failures are often not due to lack of knowledge, but due to lapses in judgment, discipline, communication, humility, or ethics. The following is a high-yield framework applicable across general surgery, surgical oncology, GI surgery, HPB, and private practice.
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1. Professional Mistakes to Avoid
Never operate for ego, numbers, or prestige
* Do not perform surgery merely to:
* “Keep the case”
* Increase surgical volume
* Compete with colleagues
* Impress hospital administration
* Avoid referring a difficult patient
A technically successful but unnecessary operation is still bad surgery.
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Never promise guaranteed outcomes
Avoid statements like:
* “100% cure”
* “No risk”
* “Simple surgery”
* “You will definitely be fine”
Instead:
* Explain realistic outcomes
* Discuss morbidity honestly
* Document risk counseling
Overconfidence destroys trust after complications.
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Never ignore communication
Many medico-legal cases arise from:
* Poor explanation
* Inadequate consent
* Lack of updates to family
* Arrogant behavior after complications
Patients forgive complications more easily than dishonesty or abandonment.
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Never disrespect colleagues publicly
Avoid:
* Criticizing previous surgeons in front of patients
* Public humiliation of juniors
* Fighting with anesthesia/ICU/nursing teams
Good surgeons build systems, not fear.
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Never abandon a complication
The unethical surgeon:
* Stops answering calls
* Transfers blame
* Delays re-exploration
* Avoids documentation
The respected surgeon:
* Recognizes complication early
* Communicates transparently
* Takes responsibility
* Escalates appropriately
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Never practice beyond competence without support
Examples:
* Complex vascular control without backup
* Advanced laparoscopic oncology without training
* Cytoreductive surgery without ICU capability
Courage without competence is dangerous.
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2. Technical Errors to Avoid
Never ignore anatomy
Most catastrophic surgical injuries happen because:
* Anatomy was assumed, not identified
* Dissection became hurried
* Bleeding caused panic
Golden principle:
“Identify before you divide.”
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Never continue blindly during bleeding
Wrong response:
* Clamping everything
* Aggressive suction without visualization
* Emotional operating
Correct response:
* Compression
* Exposure
* Call for help early
* Gain proximal and distal control
Panic magnifies blood loss.
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Never neglect preoperative optimization
Avoid operating on:
* Severe malnutrition without optimization
* Uncontrolled diabetes
* Uncorrected coagulopathy
* Active sepsis unless emergency
Bad timing creates preventable morbidity.
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Never underestimate postoperative care
Excellent surgery can fail because of:
* Poor fluid management
* Missed sepsis
* Delayed ambulation
* Inadequate pain control
* Failure to monitor drains
Surgery is not finished at skin closure.
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Never persist with unsafe minimally invasive surgery
A major technical sin:
* Delayed conversion to open surgery
Conversion is not failure.
Unsafe persistence is failure.
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Never ignore oncological principles
In cancer surgery:
* Do not violate planes unnecessarily
* Do not compromise margins for speed
* Do not perform inadequate lymphadenectomy knowingly
* Do not manipulate tumors excessively
“Quick” oncology surgery often becomes biologically poor surgery.
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Never operate when fatigued beyond safety
Sleep deprivation impairs:
* Judgment
* Dexterity
* Decision-making
* Emotional regulation
Fatigue-related errors are real.
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3. Ethical Failures to Avoid
Never manipulate indications for financial gain
Unethical behaviors include:
* Unnecessary stenting/surgery
* Inflating disease severity
* Extending ICU stay without indication
* Excessive investigations for revenue
Financial conflict is one of the biggest threats to surgical integrity.
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Never hide complications
Do not:
* Alter records
* Delay disclosure
* Give misleading explanations
Ethical disclosure should include:
* What happened
* Current status
* Planned management
* Prognosis
Transparency protects both patient and surgeon.
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Never falsify documentation
Absolutely avoid:
* Backdated notes
* False operative findings
* Fabricated consent
* Manipulated pathology correlation
One dishonest note can destroy an entire career.
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Never obtain improper consent
Invalid consent includes:
* Rushed signatures
* No discussion of alternatives
* No mention of stoma possibility
* Delegating complex consent entirely to juniors
Consent is a process, not a form.
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Never exploit vulnerable patients
Especially:
* Terminal cancer patients
* Low-literacy families
* Financially distressed patients
Ethical surgery respects dignity and autonomy.
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Never prioritize social media over patient dignity
Avoid:
* Operating room selfies
* Showing identifiable operative videos without consent
* Exaggerated self-promotion
* “Miracle cure” claims
According to guidelines from the National Medical Commission, professional conduct on social media should maintain patient confidentiality and professional decorum.
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4. Cognitive Errors Surgeons Must Avoid
Anchoring bias
* Sticking to initial diagnosis despite contrary evidence
Example:
Assuming postoperative tachycardia is “pain” when it is actually an anastomotic leak.
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Hero syndrome
Believing:
* “Only I can save this case”
* “I must attempt everything myself”
Good surgeons know when to:
* Refer
* Stop
* Call seniors
* Involve multidisciplinary teams
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Outcome bias
Judging decisions only by results.
Bad decisions can occasionally have good outcomes.
Good decisions can still have complications.
Judge the decision quality, not just the outcome.
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5. Dangerous Personality Traits in Surgery
Avoid becoming:
* Arrogant
* Emotionally reactive
* Vindictive
* Non-teachable
* Unable to apologize
* Resistant to audit
The most respected senior surgeons are usually:
* Calm
* Precise
* Humble
* Consistent
* Honest about complications
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6. Principles of a Safe and Ethical Surgeon
A good surgeon:
* Operates only when indicated
* Knows anatomy thoroughly
* Converts early when needed
* Documents honestly
* Communicates compassionately
* Audits outcomes
* Learns continuously
* Respects the MDT
* Puts patient welfare above ego and revenue
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One-line Surgical Wisdoms
* “The enemy of good surgery is unnecessary surgery.”
* “The first complication usually begins with denial.”
* “Fast surgery is not efficient surgery.”
* “A calm surgeon saves more lives than an aggressive one.”
* “Technical excellence without ethics is dangerous.”
