Hello everyone,
There is something fundamentally wrong in how surgical decisions are made in many contexts.
I am not only referring to clear cases of malpractice or obvious gross errors, and that should not be downplayed. I am also referring to something broader: a system in which the decision to operate can move forward with a level of scrutiny that is simply not proportional to the fact that we are dealing with irreversible interventions on the human body.
What should be one of the most critical and protected moments in medicine — the decision to operate — is often not treated with the weight it deserves. There is a lack of truly independent scrutiny. There is insufficient serious and structured comparison with well-evaluated non-surgical options. There is no effective external “brake” that prevents the decision from depending almost entirely on a single clinical decision pathway.
And this is not naive. There are incentives. There are conflicts of interest. There is economic, institutional, and cultural pressure that pushes the system towards intervention. Not in a simplistic or caricatured way, but in a normalised, silent, almost invisible way.
The result is this: surgical decisions that may appear acceptable at the time, but are made within a structurally biased environment that makes operating easier than should be acceptable given the permanence of the outcome.
At the same time, there are situations where this is not only structural: there are cases of individual clinical negligence, clearly imprudent decisions, or poorly justified surgical indications that cannot simply be diluted into “clinical variability” or “complications.” In some cases, there is direct responsibility that needs to be acknowledged as such.
And this coexists with a more subtle reality: even when the decision appears defensible on paper, the framework, the level of caution, and the individual clinician’s judgement make a major difference. Depending on the doctor and how risk is interpreted, the same clinical situation can lead to very different decisions — and this fundamentally changes how the outcome is experienced.
In the end, what remains is a difficult combination: structural failures, normalised grey zones, and in some cases individual negligence that should not have occurred.
This is not a series of isolated failures. It is a structural problem of accountability.
And it is becoming increasingly difficult not to feel anger about this — both towards the system and towards individual decisions that have directly contributed to avoidable outcomes.
If anyone is aware of initiatives, campaigns, or petitions trying to expose or change these structural mechanisms, I would appreciate if you could share them.