• Massimiliano Orri, Olivier Farges, Pierre-Alain Clavien, Jeffrey Barkun, and Anne Revah-Lévy.
• *INSERM-U669, Paris, France †Université Paris-Sud, Université Paris-Descartes, Paris, France ‡Department of Hepatobiliopancreatic Surgery and Liver Transplantation, Hôpital Beaujon, Clichy, Assistance-Publique Hopitaux de paris, Université paris 7, France §Université Paris Diderot, Paris, France ¶Department of Surgery, University Hospital Zurich, Switzerland ‖Department of Surgery, McGill University, Montreal, Quebec, Canada **Centre de Soins Psychothérapeutiques de Transition pour Adolescents, Hôpital d'Argenteuil, Argenteuil, France.
• Ann. Surg. 2014 Nov 1; 260 (5): 721729721-8; discussion 728-9.

ObjectivesSynthesize the findings from individual qualitative studies about surgeons' account of their practice.BackgroundSocial and contextual factors of practice influence doctors' well-being and therapeutic relationships. Little is known about surgery, but it is generally assumed that surgeons are not affected by them.MethodsWe searched international publications (2000-2012) to identify relevant qualitative research exploring how surgeons talk about their practice. Meta-ethnography (a systematic analysis of qualitative literature that compensates for the potential lack of generalizability of the primary studies and provides new insight by their conjoint interpretation) was used to identify key themes and synthesize them.ResultsWe identified 51 articles (>1000 surgeons) from different specialties and countries. Two main themes emerged. (i) The patient-surgeon relationship, described surgeons' characterizations of their relationships with patients. We identified factors influencing surgical decision making, communication, and personal involvement in the process of care; these were surgeon-related, patient-related, and contextual. (ii) Group relations and culture described perceived issues related to surgical culture (image and education, teamwork, rules, and guidelines); it highlighted the influence of a social dimension on surgical practice. In both themes, we uncovered an emotional dimension of surgeons' practice.ConclusionsSurgeons' emphasis on technical aspects, individuality, and performance seems to impede a modern patient-centered approach to care and to act as a barrier to well-being. Our findings suggest that taking into account the relational and emotional dimensions of surgical practice (both with patients and within the institution) might improve surgical innovation, surgeons' well-being, and the attractiveness of this specialty.

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