Chapter 2

Review of Related Literature

Surgeons’ emotions affect both patient care and personal well-being.

Surgeons appear at particularly high risk, as evidenced by the high rate of burnout

and the alarming consequences in both their personal lives and professional

behavior.

Emotional Attachment

According to Prakash Chand (2007), feelings seem to add an important

dimension of complexity to doctors. When they get emotionally attached to them that

makes them more vulnerable to feelings of loss when these patients die. Surgeons

that are attached themselves emotionally to the patient will suffer from resulting lack

of judgement and will not make clear decisions when it comes to handling of

patients. Having emotional attachment will not help the surgeons do their job

properly because he/she will not function after sometime and would end up taking it

home or will take it personally. Studies have shown that junior surgeons may be

more strongly affected by patient’s death than senior surgeons and female surgeons

report more psychological distress than male surgeons indicating that female doctors

and interns may require more emotional support after patient’s death. By this, that

doesn’t mean that surgeons and other medical professionals should be cold and

heartless, but they have to maintain a certain distance from their patients in order to

keep going on a daily basis. 

In a study of the patients' perspective of the surgeon–patient relationship in

general practice, we noticed that the attachment of the surgeons to the patients
appeared not to be very strong but not just a matter of comfort. In some cases the

bond to the doctor could seem almost irrational. In an attempt to explain this we have

involved attachment theory. Attachment theory was originally developed to

understand the mother–child According to psychologist John Bowlby, the need for

attachment is fundamental and is activated in adults when they are ill, distressed, or

scared. Attachment relationships are emotional bonds that lead an individual to seek

proximity to a safe or powerful person when threatened. The first secure relationship

with the mother is the ideal type for all human relationships, and it may be the same

kind of “secure base” many patients are seeking from their doctor. When individuals

feel vulnerable in the face of major threats they seek attachment figures to help them

feel safe. Using interpretive phenomenological analysis and the theory of attachment

aims to understand why a continuous interpersonal relationship with the patient may

be valuable for surgeon.

According to Frederiksen (2010), which was the need for attachment, was

absolutely central to the understanding of perspectives affecting the surgeon’s

attachment to the patient: (1) stability and condition, (2) time, and (3) vulnerability.

The perspectives all have their background in attachment theory and they illustrate

from different angles of the emotional attachment of the surgeon to the patient.

Surgeon

According to Holland (2008), surgeons specialize in treating injury, disease,

and deformity through operations. Using a variety of instruments, a surgeon

corrects physical deformities, repairs bone and tissue after injuries, or performs

preventive surgeries on patients. Although a large number perform general surgery,

many surgeons choose to specialize in a specific area. Specialties include

orthopedic surgery (the treatment of the musculoskeletal system), neurological

surgery (treatment of the brain and nervous system), cardiovascular surgery, and

plastic or reconstructive surgery. Like other physicians, surgeons examine patients,

perform and interpret diagnostic tests, and counsel patients on preventive

healthcare. Some specialist physicians also perform surgery

According to Eakins (2016), Undergoing surgery can be an extremely

emotionally troubling experience for patients. Performing surgery also makes its

emotional demands on surgical operators. Despite this, the emotional dynamics of

surgery have yet to be fully explored. This project seeks to understand how surgeons

conceive of their work and their relationships with patients in terms of feeling. Often,

these relationships are thought of as being shaped principally by ‘clinical

detachment’, but this project endeavours to push beyond such clichés to explore the

emotional complexities of the surgical encounter.

As well as engaging with current surgical practitioners and patients, this

project brings a historical perspective to bear on the issue of surgical emotion.

Before the advent of anaesthetics in the 1840s, surgical operations were undertaken

with little or no pain relief and occasioned great physical suffering and emotional

distress. However, rather than producing detachment or dispassion in surgeons,

such emotional complexities gave rise to a range of feelings from pity and sympathy

to anxiety, regret and anger. Patients, too, experienced a broad spectrum of

emotions from fear through to joy. Encompassing surgery in both peace and war,

this project will consider how emotions shaped nineteenth-century surgical practice

as well as the identities and reputations of its practitioners. It will explore the patient’s
perspective and their emotional relationships with surgeons, as well as how pain and

suffering came to function as powerful tools for change. It will also examine what

effect such innovations as anaesthesia had on the emotional cultures of surgery and

whether changing social ideas concerning the expression of feeling also played a

role.

By bringing together historical inquiry and modern experience, this project

hopes to stimulate debate about the place of emotion in surgery and to see whether

clinical practice and patient care might be improved by taking emotions seriously.

According to Eloi (2017), doctors and surgeons are human beings that

happened to be assigned the life mission of helping people in some kind of health

distress.

Years on end of training, studying and facing problems of all sorts

(emotionally sapping, or disgusting, or unsolvable life dramas) make them have a

different perspective on people and their problems. So most problems don't look

nearly as serious as they do to the average bypasser - they most likely deals with

that problem a dozen times a month, and has a mental schematic of the causes,

consequences and solutions to it that he/she can almost recite on his sleep already.

Also, doctors and surgeons took an almost religious oath, swearing (amongst

other things) to never take advantage of people in need. Emotional attachment isn't

addressed directly by the oath, but the general tone of the oath is one of

selflessness, and it's implicitly perceived that emotional feelings other than empathy

(which helps understand the emotions and motives of people) are unadvised.
 SYNTHESIS

The emotional attachment of a surgeon to a patient especially for those

who have a severe condition affects their emotion or feelings to the patient. Surgeon

is very critical cause you always need to have a good understanding on the ways

how to handle each situation of a patient. Having emotional attachment will not help

the surgeons do their job properly because he/she will not function properly and

would end up taking it home or will take it personally.