What Is Surgical Grit?

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One of the greatest thought-provoking articles in hand surgery is Brown’s1 “Less than ten—surgeons with amputated fingers.” Of 183 surgeons who had lost parts of their hands, ranging from a fingertip to an entire hand, only 3 claimed any significant professional disability. All others were able to operate with some modifications. Dr Brown concluded that motivation of the patient is the most important factor in hand function, rather than the injury itself. This motivation could also be known as “grit,” which Webster’s Dictionary defines as “unyielding courage in the face of hardship or danger.” These surgeons had “true” grit.
As evidenced by the cinematic revival of Rooster Cogburn to the academic works of Dr Duckworth, “grit” is the current hot topic. In her highly cited study, Dr Duckworth demonstrated that a noncognitive trait, grit, was incrementally predictive of Ivy League undergraduate grade point averages, West Point cadet retention, and National Spelling Bee ranking over and beyond intelligence quotients. Her grit scale, composed of consistency of interests and perseverance of effort, is now being used to predict an individual’s success in business, military retention, marriage and even surgical residency.2,3
All of us who work with trainees are looking for that individual whose passion for hand surgery is so strong that they will not only persevere when faced with adversity but overcome the challenge and emerge stronger, improved and better. It is that same passion and perseverance, to use the terms of Duckworth et al,4 that led Sir Herbert Seddon and Sir Sydney Sunderland (a partial hand amputee, himself) to lay the foundation for nerve repair and reconstruction. Countless other hand surgeons, standing on the shoulders of the giants of hand surgery,5 have spent their careers advancing the science and our understanding of hand surgery. It is this surgical grit that positively advances our field and enables us to improve the care of our patients.
But is there such a thing as too much grit? Can it lead us to harm our patients? Does that same passion, perseverance, and behavioral ideology that got us through college, medical school, residency, and fellowship(s), and made us who we are today, make it harder or even impossible for us to say “no”? Are we able to say “no” to that hospital committee appointment, to that guest lecture invitation, to that new research project? Sometimes, the hardest, “no,” is the one we have to say to our patients. Especially when the last surgery did not achieve the outcome we expected or were hoping. It is important for us to recognize our own limitations and know when another surgery may be more harmful than helpful. Surgical grit, in this case, would negatively impact the patient.
Fortunately, grit is an evolving characteristic. After years in practice we find that clinical problem, which we are particularly passionate about and strive toward a surgical solution. Sometimes we are successful, sometimes we are not, but we must never jeopardize the safety and primary needs of our patients. As surgeons we all have grit, but with it must also come humility and compassion where the needs of the patient come first.
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