Team and safety
The difficult surgeon: staying clear-headed when tension rises
Practical ways to preserve attention, communicate clearly and protect safety when the tone in the operating room changes.
Some operating-room moments become tense very quickly. A request is missed, the operation becomes difficult or equipment does not behave as expected. The surgeon’s tone changes and the whole room can narrow around that emotion.
When I was new, I treated every sharp comment as proof that I was not capable. Anxiety consumed the attention I needed to solve the actual problem. Over time, I learned to separate tone, information and action.
Find the usable information
A request may be delivered poorly and still contain something the team needs. Ask yourself:
- What is being requested?
- Is the request clear and safe?
- Who is acting on it?
- What must be confirmed?
This does not excuse disrespectful behaviour. It prevents the behaviour from taking control of your next technical decision.
Slow the internal reaction
Under stress, your body speeds up. You may reach before identifying the instrument, stop speaking or focus only on avoiding another criticism.
Use a short reset: breathe out, look at the field, name the request and confirm it. A deliberate second can be faster than an incorrect action followed by recovery.
If you did not hear or understand, say so clearly: “Please repeat the instrument.” If there are two plausible options, name the one you understood. Closed-loop communication matters most when the atmosphere makes people least willing to use it.
Keep safety language short and specific
When a concern must be raised, describe the observable issue:
- “The count is incorrect.”
- “That instrument is not functioning.”
- “I have not heard the site confirmed.”
- “I am concerned that the field was touched.”
Avoid a long defence while the clinical issue is active. State the problem, confirm the response and follow the escalation pathway used by your organisation.
Respect and safety are connected
A culture in which people fear humiliation makes it harder to ask questions or report uncertainty. Teams need psychological safety as well as technical skill.
If behaviour is abusive, threatening, discriminatory or repeatedly undermines patient safety, use the formal support and reporting routes available in your workplace. Speak with an appropriate senior colleague, manager, educator, union or professional support service. Immediate danger requires immediate escalation through local procedures.
Review after the room is safe
Once the clinical situation is stable, separate three things:
- what happened technically;
- what you can learn or practise;
- what behaviour needs to be addressed.
Do not turn every correction into a judgement of your worth. Equally, do not normalise behaviour that prevents safe communication.
Your goal is not to win an argument during an operation. It is to remain lucid enough to protect the patient, communicate accurately and seek appropriate support afterwards.
Return to Closed-loop communication in the operating room and practise the language before the next pressured moment.