Gynaecologist & Endoscopic Surgeon

What time of day is best for your operation?

Occasionally patients ask if they can be put in a particular time on a list usually first in the morning. I usually attempt to accommodate these requests although other considerations such as the availability of equipment, staffing and health issues of other patients also come into play. More recently I was reading the book “Thinking Fast and Slow” by Daniel Kahneman. Some of this work resulted in the 2011 Noble Memorial Prize in Economics for Kahneman. In the book he describes a paper published in The Proceedings of the National Academy of Sciences describing how Shai Danziger and colleagues followed 8 Israeli judges for 10 months as they ruled on over 1000 applications made by prisoners to parole boards. The plaintiffs were asking either to be allowed out on parole or to have the conditions of their incarceration changed. The team found that at the start of the day the judges granted around two thirds of the applications before them and as the hours passed that number fell sharply and eventually reaching zero. The clemency returned after each of two daily breaks during which the judges retired for food. The approval rate shot back up to near its original value before falling again as the day wore on. Kahneman opined that this decision process mostly related to blood sugar levels.

Judgement day

If true this finding casts significant concern on the structure of the judicial system and clearly many others also. The situation can probably be stretched to the operating theatre and the performance of a surgeon during the course of the day. It is tempting to think that food is a major issue but other studies as outlined in an article aired in The Economist  reveal that decision making is mentally taxing and if forced to keep deciding things people tend to get tired and start looking for easy answers. Whilst it would be nice to consider surgeons as simply technicians clearly they are humans and subject to all sorts of biases which may interfere with decision making.

The medical literature has attempted to look at performance after surgeons have been on call the night before with variable outcomes. I am not aware of any strong studies from a surgical perspective in relation to meals and rests during the day although common sense suggests it is probable that surgeons perform better after a rest and a meal. My personal view is that some degree of exercise before a list is also beneficial. I suspect those patients wanting to be first on the list are asking the right question. It is probably best for patients to have their surgery either first in the morning or immediately after a lunch break.