Abstract

Surgery is the most invasive intervention taken on behalf of health, but significant discrepancies exist between patient expectations and standard operating room practices, especially in teaching institutions. These discrepancies arise from the dual obligations of surgical faculty to present and future patients. On the one hand, in line with a patient’s autonomous election of a procedure and choice of a doctor, faculty are charged with treating patients to the utmost capacity of their knowledge and skill; on the other, in support of a critical community good, they must prepare novice physicians to treat those who will require at least this level of knowledge and skill in the future. Within a broad, contrasting framework of approaches to knowledge, judgment, experience, and nature as described by Hume and Kant, this article explores the complicated concepts of trust, loyalty, assessment, and communications that presently exist between surgical patients, faculty surgeons, and surgical trainees within academic medical centers.