Heuristics in cardiothoracic surgery.

Cardiothoracic surgical operations are complex procedures. Involved are an enormous number of steps that need to be carried out consistently, accurately (as the margin for error in cardiothoracic surgery is small) and in a time-efficient manner - thus the need for repetition in their performance to achieve excellence. Encompassed within the steps is a range of skills - motor and decision-making. The motor skills span from the gross of median sternotomy and thoracotomy, to the fine of coronary anastomoses. It is the challenge of all of this that I believe entices most prospective cardiothoracic surgeons into training, having already witnessed the difference in the ability of surgeons at surgical heuristics as beautifully described by Michael Patkin. Further, the chase for the 'perfect operation' I believe also is what keeps cardiothoracic surgeons enthralled for a career. As a comment, what will be presented is a personal perspective and should be seen as such - to quote Patton 'if everyone is thinking alike, then somebody isn't thinking'. Now surgery in general is made of movement systems as already mentioned, but critically layered upon by intellect and information. This affects the decision-making process throughout an episode of care - preoperatively, intraoperatively and postoperatively. To contemplate surgical heuristics, the two then, the movement systems and the decision-making process, must be discussed individually and then brought together in the end, for it is the gel that determines patient outcomes and then becomes the science to our craft.