Let’s talk about the surgeon well-being

Surgeons are often working under pressure for unpredictable long hours, and they deal with critically ill patients. In addition, they are known to face different challenges during their surgical training until they become certified surgeons. Consequently, surgeons become at risk for psychological distress and mental health conditions [1], resulting in a high prevalence of anxiety, depression, and burnout among surgeons [2, 3]. This became even more challenging during the COVID-19 pandemic when there was an increased healthcare demand and physicians overload [4].

Many surgeons might believe that their stress resilience is higher than those of other non-surgical specialties. The traits used to define surgeons in the forms of commitment, and self-sacrifice may put them at risk for heavy workload, work-life imbalance, stress, anxiety, and burnout [5]. Previous studies reported that psychiatric morbidity and burnout had a negative effect on surgeons’ families, can negatively impact the surgeon-patient relationship, diminish their productivity, and increase the risk of errors in the workplace [6]. Yet, these can drive some surgeons to leave their training and decide on a career change aiming to improve their work-life balance and mental health [7]. As concerns have been expressed recently about the psychological and physical health of surgeons, risk factors have been studied and different ways to support their well-being have been suggested.

Factors influencing the surgeon’s well-being included work-related stressors such as caseload, working hours, patients’ complications, intra-operative stress, lack of opportunities for career growth, and pressure to succeed in research and academia [8]. In addition to the personal components such as their relationships with family, work-life balance, and emotional health. While alcohol, substance abuse, and dependence were found to be critical problems among surgeons [9], a structured self-care approach by prioritizing physical health habits such as focusing on sleep, exercise, and nutrition initiatives are known to reduce stress among surgeons and improve their well-being [8, 10]. In the operating theatre specifically, the background music could reduce their anxiety and mental workload [11], and better ergonomics including the use of innovations, such as robotic-assisted procedures could minimize fatigue and work-related injuries, as well as improve their well-being [12].

Moreover, a surgeon well-being can be affected by experienced disruptive behaviour in the workplace, which also contributes significantly to the surgeon’s hostility [5]. If surgical trainees throughout their training experience disruptive behaviour, impaired work-life may follow along with a modified experience of the presence of meaning in life [5]. The importance of the presence of meaning in life was highlighted to strongly contributing to surgeon’s self-esteem as well as being predicted by physician empathy, manifesting surgeons’ essential personality qualities [13].

Increasing surgeons’ resilience has been considered as a possible solution. Hospitals and regulatory bodies could work on better understanding surgeons’ values, work on minimising stressors, focus on building teams, and provide surgeons the time and space for healthy families and social lives [14]. One possible source of contextually sensitive resilience training for surgeons is Acceptance and Commitment Therapy, which is known to be a contemporary evidence-based psychological intervention designed to increase psychological well-being and reduce psychological suffering even in the presence of stress and psychiatric symptomology [15]. Yet, some UK institutions started to ensure psychological and emotional support exists in the workplace and new confidential helplines by regulatory bodies have been recently created.

In conclusion, there was a high prevalence of psychological distress among surgeons over the past decade. When surgeon well-being is at risk, their technical and cognitive intraoperative performance can also be impacted. It is imperative to develop strategies to support the surgeon’s mental and physical well-being to ensure patient safety. This collection aims to offer a selection of articles that summarise the available evidence on (but not limited to) the factors affecting surgeon well-being (psychological and physical health), characteristics, disruptive behaviours, the impact of work conditions on surgeon well-being, and different support strategies.