Wednesday, August 31, 2011

Surgeons vs. Pilots: There Is No Autopilot in the O.R.

We’ve all heard the comparison of surgeons to pilots.

Surgeons should be more like pilots.
Surgeons need more rest. They should have work hours restrictions like pilots do.
You wouldn’t want to fly with a pilot who had been awake for 24 hours.
Blah, blah blah.

A while back I blogged [see links below] that surgeons really cannot be compared to pilots because, unlike the boring, monotonous work that pilots do, surgeons perform tasks that are highly variable, both mentally and technically. I even said that the only time pilots really have to work is when the plane is taking off or landing. I had no idea how right I was.

Now comes proof. An article from the Associated Press entitled “Automation in the air dulls pilot skill,” discusses some recent plane crashes and notes that pilots increasingly seem to be making poor decisions when confronted with emergencies. Flying a plane is becoming more automated and the pilots’ skills are eroding. New air traffic control mandates are calling for GPS positioning rather than the use of radar. This will allow more accurate knowledge of a plane’s true location enabling planes to descend faster and closer together, possibly leading to more challenges for pilots.

The following statement sums up the current state of affairs:

Even when not using the new procedures, airlines direct their pilots to switch on the autopilot about a minute and a half after takeoff when the plane reaches about 1,000 feet, [Bob] Coffman [member of the FAA pilot training committee and an airline captain] said. The autopilot generally doesn't come off until about a minute and a half before landing, he said.

Do you get it? With the rare exception of the malfunctioning autopilot, pilots are actually hands-on flying their airplanes for 3 minutes per flight.

There is no autopilot in the operating room. Machines can’t perform surgery. Even the robot has to be guided by a surgeon every second.

So please tell me how can you compare what a surgeon does to what a pilot does? 


James said...

I think when people make that comparrison, they mean to use the safety record of pilots as something surgeons should aspire to. Both are responsible for other people's lives. Pilots have multiple systems and several layers of redundancy in place to protect passengers. Surgeons have more team and system support now than they used to. But additional regulations, such as having limited work hours the way pilots are regulated, would seem to make sense. The fact that a surgeon doesn't have anything equivalent to an "autopilot" is an argument for putting more safety features in place, not fewer.

Skeptical Scalpel said...

I understand your point but my post was directed at those who try to compare the working hours of pilots to those of surgeons. The comparison is not valid because surgeons and pilots do not do the same kinds of work.

Limiting work hours might "seem to make sense," but there are no data to support that. Recent papers have shown that outcomes of complex surgery done at night are no different that similar operations done in the daytime. Please read my previous blog about this at

Shanky said...

Nice Job

Anonymous said...

some physicians are too pilots. i wonder what, if anything, that might tell us.

this old article is still interesting:

Skeptical Scalpel said...

Yes, many MDs have become pilots. Not many pilots have become MDs. Interesting link. MDs are overconfident, a well-known risk factor for crashes.

Anonymous said...

First of all, by comparing professions, you are revealing your insecurity. It is highly immature to compare professions for the purpose of winning the who-is-better argument.

You say that 'unlike the boring, monotonous work that pilots do, surgeons perform tasks that are highly variable, both mentally and technically', you have simply no idea how fun flying is for those who love it. If we were to make a surgeon construct a building, I am pretty sure he would find it boring, unless he has interest in Civil Engineering.

If you're referring to 'the usual routine of pilots' as monotonous, it as routine as a normal surgery. Whereas variables are concerned, you failed to do your homework, because every flight is a different flight.

The complexities of managing the 'automation' cannot be excluded. Pilots have to continuously monitor the equipment with full concentration and even slightest of errors have resulted in disasters.

By looking at your blog, it is clear you have some kind of a hatred for pilots.

And by the way, doctors who are pilots don't die because of their 'over-confidence', but lack of experience and judgment (Google for doctor killer aircraft).

Do unbiased research before puking.

Skeptical Scalpel said...

I appreciate your taking the time to comment. I don't hate pilots. What I don't like is people who are neither pilots nor surgeons trying to equate the two.

I sometimes exaggerate to make a point. If you've read some of my other posts on this topic, you will note that I discussed things like the distraction that the Air France crew faced from multiple alarms. This is something that occurs in medicine too. I empathized with their plight and pointed out the similarities between them and us.

Anonymous said...

I couldn't agree more with this post. Sure, we can learn by "checking" and "double-checking" everything before we cut. But we don't learn on simulators. . .when we cut and crash, it is always for real. Besides, if I was supposed to learn how to set-up, maintain, clean, transport, and stock all the equipment and supplies I use, I would probably do even MORE yelling at the incompetents I work with because, then, I REALLY know how to do everybody's job in the OR (except the anesthesiologists!)

Captain of the ship? I don't think so.

Well, "they say" the "Pilot is committed. If he/she crashes, they die with the passengers."

You mean if I stick myself with that HIV/Hep C needle I won't die because I'm not committed.

Great column. . .as usual.

Skeptical Scalpel said...

Good points and thanks for the kind words.

Unknown said...

Dear Skeptical Scalpel
There are 4 levels of automation being used in flightdeck.
1. manually 2. guidance 3. short-term strategy 4.manage

Unknown said...

All of them must be used in appropiate situation and no one fit for all.
Pilot has to practice hand fly even 3 minutes in each flight but it is the most difficult part to do , unlike 10 hours during cruise with aircraft in trim
and no need to make a flight control input. Also manually hand fly in simulator atleast 8 hours for every 6 months to improve their skills.
The most difficult part to be a pilot is a skill to detect any abnormality
to predict something might occur and to make a suitable decision within time limit. Sometime decision making becomes a most difficult part in our daily task let's say Whipple's operation , is the tumor resectable ?
this is sometime more difficult to make decision than performing a surgery .
The example of automation in the O.R. is Autosuture , , linear cutter ,self retractor ,,stereotactic brain tumor locating ( guide manually fly) (like a pilot hand fly with flight director.) Automatic blood flow and temp control during Cardiopulmn bypass , auto cut off power of ultrasonic scalpel or laser when maximum watt has been sent - ( pilot who make a bank angle morethan limit will be corrected by flight control logic in normal law but you can override ) Actually in routine normal day life we are being involved from automation in many tasks , driving , using the elevator , parking , even now when we are reading from screen which automatically turn off in ...mins if not been used.
The philosophy of automation topic teaching in aviation school is very interesting .

..... said...

could be, but autopilot is not one button, there are lot of buttons to operate the autopilot, including the most powerful computer in the world, the fmc. Also to setting a route on autopilot is way difficult, codes nav maps and all that stuff, the average of setting autopilot is for 30-45 min,
And think this, a surgeon commit an error, kill one person, if pilots commit an error, kill +200 people, including they lifes.

Bob John said...

You just like many people don’t understand what an autopilot does or how it works, it doesn’t take away from the pilot’s job and in many cases it even increases the pilot’s workload. Autopilot is more like cruise control than an actual pilot. It can’t make decisions and you still need a boatload of training to fly a plane even if it has a sophisticated autopilot. The pilots are working for the full duration of the flight even if they aren’t using the manual flight controls. They have better things to do than eyeball an HSI and altimeter for hours on end. They aren’t just sitting their watching screens and doing nothing until landing they are actively making decisions and controlling the airplane by using the autopilot. To be honest with you flying is extremely tiring even with an autopilot it’s a lot of work and people who don’t do it don’t even realize it. Saying our job is “boring and monotonous” because we have an autopilot (especially when the autopilot is a straw man) is almost insulting. I have flown flights with an autopilot and without and the workload be high in both cases.
Also as you said many surgeons become pilots (most of the time they become private pilots) and you know what? They usually become horrible pilots...
We aren’t at the point where pilots just sit there as a backup. That’s what people think we do but that’s nowhere near the case. By the time that is the case the same will probably be the case for surgeons.
Both our jobs are demanding and difficult in their own ways and demand skill and professionalism whether you like it or not.

Skeptical Scalpel said...

As I mentioned in several other responses to comments above, I was not trying to insult pilots, nor do I hate pilots. What I hate is the analogy that surgeons can be compared to pilots.

I agree with you that when physicians become pilots, they may not be experts possibly because of overconfidence.

Since I published this post nine years ago, I believe further advances in autopilot technology have been made. There is even a program that will land a plane when a pilot becomes disabled.

I'm not sure that flying the plane when it's on autopilot is as difficult as you say. For example, here's a story about two pilots overflying an airport by 150 miles because they were distracted. [] I can only assume the plane was on autopilot at the time.

Here's another story stating that a survey found more than half of pilots have fallen asleep while in charge of a plane. [] The article was published because two pilots fell asleep at 35,000 feet.

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