Let me start with full disclosure: I was inspired to write this article after reading The Power of Habit by Charles Duhigg. However, I have been equally inspired by such books as The Tipping Point (Gladwell) and The Seven Habits of Highly Effective People (Covey). Without giving away the whole book, Duhigg breaks down the three elements of a habit: the trigger, the routine, and the reward. He goes on further to say that, of these three elements, it is really only the routine that can be changed. Late night snacking is a prime example. The trigger may be boredom, and the reward may be a break from that boredom. Replacing the routine of eating with another activity would satisfy the trigger with the same reward.
I then realized how many habits are developed during years of performing surgery. In fact, becoming a proficient and effective surgeon involves building a large series of “good” habits. But even these good habits often benefit from change. The trigger is often an anatomic finding, and the reward could be a good visual outcome. In any case, these small yet important improvements can require a great deal of conscious effort. This effort can range from adding an additional step to performing the technique in a simulated setting.
Two other factors are also essential to changing habits: belief and craving. The belief arises from past experiences of how surgical techniques have continually advanced. Similar to an athlete, I will often visualize a better way of doing things “off the playing field.” A desire for better patient outcomes provides the craving. I always strive to make every surgical procedure better than the last. In the operating room, there is no place for complacency.