The Comment in the Operating Room

Picture this. A patient is unconscious on the operating table when the surgeon says, “This is what happens when patients don’t take care of themselves. Honestly, this level of obesity is just irresponsible.”

People in the OR glance around at each other, then return to work.

A medical student hears the comment and feels a knot in their stomach. They know nothing about the patient’s full history — her income, access to food, stress, or attempts to obtain care. They know the risks of speaking up. The surgeon controls the room. The student’s evaluation may depend on that person.

So the student remains silent.

That silence is not unique to the student. Everyone around the table heard the comment, yet no one says anything. They may all recognize it as inappropriate, but the surgery continues. Perhaps they are unsure whether a remark will affect the patient’s care. Perhaps they worry speaking up will be distracting or expose them to criticism.

Patient harm should not be the only reason to speak up. A physician’s attitude affects how others perceive a patient and what is considered acceptable hospital behavior.

This is where moral courage often begins — not with a dramatic act of defiance, but with the uncomfortable recognition that something is wrong.

Moral courage means staying true to your values, even when doing so might bring embarrassment, rejection, or professional consequences. In medicine, these risks can feel significant. Training is hierarchical, and students and residents rely on the approval of the people who supervise, grade, and recommend them.

But the lesson is important: physicians bring assumptions and values into clinical settings. Sometimes those beliefs influence treatment decisions. Sometimes they surface in a casual remark. And sometimes they become normalized because no one challenges them.

That is where moral courage becomes a professional responsibility.

Speaking up does not always mean confronting the teacher in front of the team. People are unlikely to change their behavior if they don’t know how it impacts others. The student might say, “I’m not sure we know enough about the patient’s circumstances to make that judgment.” Or, later, they might tell a team member, “That comment concerned me. It felt dismissive and unrelated to the patient’s care.” They might seek guidance from a mentor or report a pattern of demeaning behavior.

None of these choices is risk-free. But each interrupts the process by which discomfort becomes silence, and silence becomes culture.

The goal is not to demand fearlessness from trainees. It is to create medical environments where ethical concerns can be voiced without retaliation — and to help students, nurses, and other staff practice small acts of courage that protect patients’ dignity.

The patient on the table cannot respond. That makes the responsibility of everyone else in the room greater, not smaller.

Moral courage is not heroism, and it is not easy. Sometimes it simply means refusing to let contempt pass as clinical judgment.

– Dr. Michael Wilkes with a Second Opinion

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