Book Review: “Confessions of a Surgeon” by Paul A. Ruggieri, MD

confessions of a surgeonI just finished reading “Confessions of a Surgeon” by Dr. Paul A. Ruggieri. The book details Dr. Ruggieri’s impressions of life as a general surgeon. He beautifully illustrates the highs and lows of training, medical practice, and surgery.

His experience resonated within me. I identified with the high level of perfection he demanded of himself and his frustration acknowledging that perfection is not always attainable. Sometimes things don’t go perfectly, regardless of your surgical skill. He detailed this internal struggle of determining how and when to deliver bad news to patients, the development of a justified fear of malpractice lawsuits despite his best efforts, and how it changed his practice to a more defensive medicine.

My favorite portion of the book reminded me of a lesson my mother gave to me. She used to say, “Lance, you never know if you have integrity until you have been tempted.” In Dr. Ruggieri’s words:

“Yes, I am a surgeon. I get paid for performing surgery. If a patient is referred to me for an operation, I am expected to operate. But there are times I have to resist the peer pressure, the referral pressure, the patient pressure, and the financial pressure, and do the right thing: not recommend surgery. Resisting is not always an easy position to maintain. Unnecessary surgery can lead to unexpected complications, which can lead to more surgery and more pain. I can live with the pain I inflict on patients when I am convinced the reasons for operating are just. I have. That’s part of being a surgeon. I know the pain I cause patients is only temporary. What I know I cannot live with, and hope to never face, is unnecessary pain inflicted by unnecessary surgery. Every day, before I commit a patient to the risks of an operation, I look in the mirror and ask the question: Is this absolutely necessary?”

For 11 years, I have asked myself this same question, and I’ve been able to live with the answer.

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Lance Silverman, MD

Orthopaedic Surgeon and founder of Silverman Ankle & Foot. Treating Minnesotans with Ankle & Foot problems since 2004.

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  1. says

    I had seen this book reviewed in the WSJ. I must say I liked your review much better!. Have you ever had to talk a patient out of surgery? I would think that would be a delicate and challenging discussion. How to hang the “crepe” and let them know a surgical scar won’t make everything perfect.

  2. says

    Thanks Tom!

    Having to talk a patient out of surgery is a challenging and delicate task. Patients become frustrated when you push them away from surgery as they believe that it is the quick cure. I tell people routinely, “You don’t want to have surgical guilt. Things most often go without complication but if you have problems after surgery you are going to second guess your decision. Employing the other reasonable options before surgery will minimize any concerns of jumping the gun.”

    Talking a patient out of an expensive test used for pre-operative planning, like an MRI, is even more challenging. In many cirucmstances, the test never has all the answers, often identifies more conditions than we ever would treat, and is an unnecessary waste of health care dollars.


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