Surgical Teamwork and the Pragmatic Ethics of the Outcome

ABSTRACT

Surgical teams engage in complex social and technical practices to maintain group cohesion and ensure that routine practices stay on track. The work of communication, coordination, and surveillance becomes part of a pragmatic ethics of teamwork through which team members show regard for others, both patients and fellow practitioners, by working agentially from within the team to represent the patient’s interests and keep the surgery moving. When breaks in routine occur, practitioners work to contain damage, restore routine, and communicate the moral stakes of deviating from the routine. This is the pragmatic ethics of the outcome.

KEYWORDS:

• North America
• surgery
• teamwork
• ethics
• routine
• error

Acknowledgments

This paper began with a comment by Sakti Srivastava about team interactions in surgery. Thanks to my writing group—Vivian Choi, Marìa Fernàndez, Durba Ghosh, TJ Hinrichs, Sara Pritchard, Marina Welker, and Wendy Wolford—for their insights into early versions of this paper. And thanks to Christopher Roebuck, who helped with a later version. And thanks to the generous and constructive comments of two anonymous reviewers.

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Notes

1. In keeping with anthropological practice, all names in this article, including names of institutions where I conducted research, are pseudonyms.

2. What counts as a “good,” “favorable,” or “desirable” outcome is surprisingly complex, dependent on factors such as patient expectations, time after the operation, complications and, on the practitioner side, expectations for success, lessons learned by trainees, research-related goals, and other factors that expand well beyond the boundaries of the operating room. Here, I treat the desired outcome as achievement of the surgery’s goals and the patient’s survival past the post-op phase of surgery.

3. This example has been adapted from Prentice 2013.

4. In US hospitals, anesthesiologists often are contractors who do not meet the patient until the patient is in pre-op. Patients often carefully research their surgeons, but have little ability to choose their anesthesiologist.

5. This passage through the abdominal wall, found only in men, explains why many more men than women get inguinal hernias.

Additional information

Funding

Research for this paper was partially funded by a Jacob K. Javits Graduate Fellowship, U.S. Department of Education.

Notes on contributors

Rachel Prentice

Rachel Prentice is an Associate Professor in the Department of Science & Technology Studies, Cornell University. She is the author of Bodies in Formation: An Ethnography of Anatomy and Surgery Education (Duke University Press 2013).