A new study led by York University sheds light on the intense emotional and relational bonds formed with patients from the surgeon’s side of the bed. The findings, published in the British Journal of Neurosurgery,show pediatric neurosurgeons care deeply about their patients and feel emotionally invested as if they were their own children.
In the study, lead author Leeat Granek, associate professor, School of Health Policy and Management in the Faculty of Health at York, found that pediatric neurosurgeons find meaning, joy and pleasure in the relationships they form with their patients and their families, while also experiencing difficult and painful emotions when these patients decline during the course of their disease or experience a complication during surgery.
“This research was surprising because we often think that surgeons don’t have feelings and remain detached in order to do their very difficult work,” said Granek. “Our research showed that the opposite was the case. These neurosurgeons develop meaningful long-term relationships with their patients and their families, and care very deeply about them. Caring about patients means that you are vulnerable. When things go wrong with one of your patients, you take it home with you, you can’t sleep thinking about it, you care.”
The goal of the study was to explore the relational and emotional components of the patient-surgeon bond from the perspective of practising pediatric neurosurgeons in the field. Granek and her team did interviews with 26 neurosurgeons from 12 countries using video-conferencing technology. Data was analyzed using a qualitative method that involves coding the data for major themes.
These themes included having a relational attachment to patients, forming bonds with the parents/caregivers of these patients, dealing with patient suffering, death and complications, and communicating bad news. One of the most significant findings was that neurosurgeons found it particularly emotionally challenging to communicate bad news. This began with the diagnosis where neurosurgeons had to tell parents that their seemingly healthy child would require brain surgery. Surgeons described feeling apprehension and difficulty in either having to share the bad news, or fear of disappointing the family when things did not go as planned in the operating room.
One surgeon who participated in the study noted being very emotional in their work. The surgeon described experiences of being influenced by cases and by families, which created additional meaning in their life.
Many surgeons in the study noted the deep attachment to patients was a product of working with children, with whom bonds are easier to form and where the relationship with the patient is more straightforward, honest and trusting than it might be with adult patients. The relationship with caregivers was described as a mix of feeling the strain of accountability, a sense of empathy and identification with the parents, and a deep sense of care towards these families. Data collected also showed that while the attachment to patients and their families provided meaning and joy to the work that pediatric neurosurgeons do, the challenging side of these relational bonds was being witness to patients who are suffering or who die as a result of surgery.
Another study participant noted that when they couldn't prevent harm from coming to a child, it felt like human nature to "take things a lot harder."
Very few studies have looked at the surgeon-patient relationship and none have looked at neurosurgeons. Granek says this may be an especially important issue within the field of pediatric neurosurgery, where young patients face significant health challenges that may involve one or more brain surgeries in their lifetime. The patient and their caregivers are required to put their trust and their child’s life in the hands of a neurosurgeon, often whom they have just met. An important implication of this study is the need for more extensive research on the surgeon-patient relationship within pediatric surgery that focuses on how this relationship affects the surgeons, patients and families, and how these relationships may potentially affect patient outcomes, said Granek.
“Despite the importance and centrality of the surgeon-patient bond, there is no research on this topic and more data is needed to understand the nuances of this relationship and how it may affect patient care and surgeon well-being," said Granek. "Training neurosurgical Fellows should include pedagogical modules about the relational and emotional dimensions of their work, with a specific and dedicated focus on communicating bad news.”
See below for a video explaining this research.