A surgical error that saw a patient operated on the wrong part of their spine eventually led that patient to medical school. The author, who had endured multiple spinal procedures, recalled the 7am hospital arrival, the frustration of being denied morning coffee in the name of “fasting”, and the acute apprehension of lying on the operating table for a second corrective operation. “As you can imagine, my nerves were frayed,” they wrote. The first surgical mistake required months of rest, rehabilitation and extensive engagement with medical and allied health services. During that downtime, the author decided to apply to medical school, driven by a desire to see what they might contribute as a doctor.
From Patient to Observer
Years later, the author found themselves back in an operating theatre, this time as a medical student about to assist for the first time. Their previous experience had left a deep suspicion of surgeons. “I was determined to speak up if I saw anything inappropriate,” they said. As they watched the first patient being wheeled in, the anaesthetist struck up a brief conversation once out of the patient’s earshot. “Why do we keep patients fasted?” he asked. The author answered correctly – to prevent regurgitation and inhalation of stomach contents – but admitted they had long held that some might prefer to risk asphyxiation if it meant arriving at hospital happily caffeinated.
The patient walked over to the operating table, clutching the back of their hospital gown closed. The author smiled warmly behind their mask, but the patient did not notice. Within minutes the patient was unconscious, their heart rate beeping on a small screen while the ventilator heaved lazily. “I was on edge, primed to sweat my way through a high-stakes procedure,” the author wrote. What came next surprised them. Once the patient was sedated, a certain levity enveloped the room. Music was put on. Colleagues chatted about personal news. People came and went. A coffee run was organised among staff who were not scrubbed in.
The shift from patient to observer exposed a stark contrast. For the patient, surgery carries immense gravity – it is often one of the most serious and vulnerable experiences of a lifetime, trusting strangers to sedate and alter your body in the hope of being better off. The operating team, however, treated the procedure with a familiarity born of volume. The author realised that a single operation is unlikely to be the most important event in a team member’s career because of the sheer number they perform. This is not to suggest a lack of focus; rather, familiar workplace dynamics emerged once the patient was safely under anaesthetic.
NHS data underline the rarity but severity of surgical errors. Between 2020 and 2025, 661 cases of surgery performed on the wrong patient or body part were reported in English hospitals – a 46% increase over that period. In 7% of those incidents, patients suffered serious harm. Such errors are classified as “never events” by the NHS, meaning they are considered entirely preventable. In the 2022-2023 financial year, there were 169 instances of wrong-site surgery, and in 2023-2024, NHS England recorded 370 never events of all types. The financial cost is also substantial: between 2014 and 2024, 774 claims were made for surgical never events, with 574 successful payouts totalling £37.6 million, an average of approximately £65,000 per claim. More broadly, NHS trusts paid out over £1.2 billion in misdiagnosis-related medical negligence claims between 2019/20 and 2024/25. In the 2024/25 financial year, 14,428 new medical negligence claims were lodged nationwide, a 4.7% increase on the previous year.
Patient-reported safety concerns highlight the importance of communication: a study found that communication issues were the most frequently cited safety worry (22%), followed by staffing problems (13%) and care environment issues (12%). The Care Quality Commission (CQC) regulates surgical procedures in England, while the National Institute for Health and Care Excellence (NICE) publishes guidance on the safety and efficacy of new interventional procedures. The NHS Patient Safety Strategy aims to foster a safer culture and systems through insight, involvement and improvement.
Reflections on the Operating Theatre
Over the course of that first day in theatre, the author observed that the operating environment was, in many ways, similar to any other workplace. The work was high-stakes, and casual collegiality could quickly shift to heart-thumping action in an emergency. Instances of inappropriate or negligent behaviour do occur – the author’s own experience being a case in point – but these are the exception rather than the rule.
Reports indicate that bullying, discrimination and sexual misconduct can occur in operating theatres, creating distress for staff and potentially jeopardising patient safety. Steep hierarchies can make it difficult for junior staff to speak up about concerns – a dynamic exemplified by a case in which a medical student’s warning about an impending error was ignored. The author’s determination to speak up reflected an awareness of these risks. At the same time, harmonious teamwork and effective communication are crucial for good patient outcomes. Research shows that a positive work environment, where staff feel valued and supported, can lead to improved performance and patient safety, while incivility and rudeness significantly impair cognitive ability.
Surgeons and surgical teams face significant pressure. Studies have found that surgeons have an elevated risk of burnout and depression but are often unlikely to seek help. Burnout can negatively affect performance, increase errors and reduce empathy, ultimately affecting patient safety. The COVID-19 pandemic exacerbated these issues. The Royal College of Surgeons of England provides guidance on recognising and addressing mental health problems among surgeons.
By the end of that first surgical rotation, the author came to a conclusion: people should be able to balance serious work with enjoyable engagement with their colleagues. Positive workplace dynamics often translate into better performance. “I also realised there are some lovely surgeons and theatre nurses out there,” they wrote. “It’s always useful to glimpse the human face behind a life-changing experience.”