Humanism in Surgery: A Warm Story About What Medicine Truly Is
Every day, a new book may find its way into your hands. But this one is different. It weaves together science, medicine, art, communication, and technology, all centered on the human being and the surgeon. At its core, it reminds us of what cannot be measured: compassion, empathy, and dignity.
It advocates for balance, using technology as a tool while remembering that a patient will always recall the tone of voice, the look in the eyes, and the support offered. These are lessons medicine must never forget.
Inspired by a Conference in Porto
In October 2022, a conference dedicated to humanism in surgery was held in the enchanting city of Porto, Portugal. The city was bathed in gentle autumn sunlight, with temperatures between 16 and 22 °C, creating the ideal atmosphere for gathering experts. Although the pandemic had not fully passed, infection rates were significantly lower, and protective measures were gradually eased, allowing for an in-person event.
The conference was organized by the i3S Institute and the organization The Doctor as a Humanist, with a clear intention: to highlight a humanistic approach to surgery. It was precisely this event that inspired the book Humanism in Surgery, a warm, human story about what medicine truly is: about the human being.
Since ancient India, when Sushruta performed the first known reconstructive surgery more than three thousand years ago, through ancient Greece and Hippocrates, to Leonardo da Vinci, who studied anatomy with awe and love for the human body, the history of surgery has been constantly intertwined with humanism. Every doctor carries within them traces of those who taught them, not only how to operate, but how to be human. In a world that keeps accelerating, mentorship becomes precious, and constructive criticism becomes a necessity for every professional. It is worrying that empathy tends to decline over time, a trend that affects patients, doctors, and the healthcare system.
Dedicated to John Bryan McFarland
This book is dedicated to John Bryan McFarland, a surgeon from Liverpool, whose son Jonathan is one of the four editors. As explained, it was his legacy that inspired the creation of the organization now called The Doctor as a Humanist, co-organizer of the Porto conference with i3S. Jonathan McFarland was one of its founders in 2017 and remains active as its president. “My father is the overriding reason for my interest in this intersection between medicine and the humanities and humanism, which we can call Medical Humanities he was a man who loved life, and who went into medicine, not because both his parents had been doctors, but because, as he once told me, he was interested in people, and wanted to understand them better…” wrote Jonathan McFarland.
Right at the very beginning of the book, Jonathan emotionally includes his daughter Aina speaking about her grandfather, saying that he always taught her and her sister to be creative with their hands, whether it was painting, writing, or even making ice cream, but he also emphasized that regardless of age, they must always be creative and curious… She sympathetically adds that perhaps that is why, even in his last days, he was still learning Spanish in bed.
A Book for All of Us
Even from movies, people know the vulnerability under the white lights of an operating room and the hope in a doctor’s look. Through twelve interviews and over twenty independent chapters, readers gain insight into perspectives ranging from pediatric urology and patient identity to humanitarian work, ethics, education, mentorship, personal philosophy, religion, and family life.
Art also finds its place: music, painting, and poetry offer healing where the scalpel cannot. Anyone who has ever waited for test results, cared for a loved one, or entered a hospital will connect with this book. Its 400 pages show that surgeons, too, have fears, doubts, and emotions, offering readers a rare glimpse into the personal side of medicine. In a world of speed and digital technologies, we need a reminder that knowledge without empathy is incomplete.
A Word from the Editor
The editors of the book are Jonathan McFarland from the Faculty of Medicine, Pompeu Fabra University in Barcelona, Spain; Susana Magalhães from the Institute for Research and Innovation in Health (i3S) – University of Porto and Fernando Pessoa University in Porto, Portugal; Jacek Mostwin from the Department of Urology, Johns Hopkins Medical Institutions in Baltimore, USA; and René Genadry from the Carver College of Medicine, University of Iowa in Iowa City, USA.
Their international and interdisciplinary experience provides the book with a strong professional foundation, and Jonathan McFarland also answered one of the key questions, further emphasizing the book’s significance.
Which chapter would you particularly recommend for a doctor, a patient, and a politician, and why?
Jonathan McFarland: For a doctor or surgeon, I would recommend Jacek Moswin’s interview with Manuel Pera. I think Manuel Pera explains his story very beautifully, both the personal and professional side of what it is like to dedicate one’s life to being a doctor, and in his case, a surgeon. Manuel Pera’s determination, strength of character, and innate humanism come out very well in this interview. And I also think that it’s very interesting to get the personal side. We hear about Manuel Pera and the importance of his father, who, at the age of 98, is still alive, and who was, along with other surgeons, a great mentor; a great example to follow as Manuel Pera is now for the younger generation of surgeons.
I would like to recommend another chapter for a friend or relative: the introductory letter, a personal letter to the readers. Reading it might help them better understand what I do and where I’m coming from.
I would recommend Anna Felipe Cardosa’s chapter for nurses, firstly because she is a nurse herself, but also because it is a beautiful chapter emphasising that the story of the patient is very important and that a patient is not a number but a person.
And as for the chapter for the politician, this is not an easy one because I think that politicians or policy makers should read the whole book, but even I ( a born optimist) think this is highly unlikely. However, they should read aloud the Interview with Ana Pastor because she is critical of the role of the politician, and I think that this is important, and more so, coming from a highly respected neurosurgeon. The politicians must listen to the doctors and healthcare professionals, just as the doctor must listen to the patient.
Behind the Closed Doors
The book’s style allows the reader to feel each moment. It takes you behind the closed doors of hospital corridors, operating rooms, and medical classrooms, not through technical manuals or statistics, but through human stories, experiences, and emotions that shape the very essence of medicine. It is not about diseases or diagnoses; it is about people: patients, students, doctors, and surgeons, their doubts, decisions, and life-changing moments. From a 15-hour journey for a patient to give a doctor a Bible, to obstetric fistulas, to differences in approaches between countries, to cultures that either fear or accept death.
Medicine means daily learning, constant challenges, doubts, struggles, and losses. From surgeons who feel they cannot go on, to those volunteering in humanitarian missions, and even to those attending a patient’s funeral, the reader gains insight not only into who heals us but also into how they should heal us. It teaches us how to engage: what to ask for, how we can help the doctor help us, and in what direction we want our healthcare system to evolve.
The book can be a source of motivation for anyone who doubts themselves or their work.
“You can do what you want or be what you want, but nobody is going to hand you anything. You have to do it on your own. And then I think the second thing that was instilled into me was that it’s a privilege to work and to do something that you’re passionate about. I followed what I loved.” Christopher Wolfgang
Quotes: From stagnation to the importance of women and how they are often marginalized and vulnerable in many societies
“I was the only surgeon available in the city of 800,000…. She made a 15-hour drive to give me the Bible.” Steve Arrowsmith
“Human beings are specialists in creating boxes. Unfortunately, many times, the boxes end up limiting growth, learning, progress, and the development of innovative ideas. Routines (often boxes in disguise) frequently become the determining factor for creating feelings of comfort and security. This can be good up to a point. But when routines begin to close the door for courage to risk trying something new or different, the sad result is often gradual stagnation in the work. Stagnation is not synonymous with life. Learning, growth, development, and enthusiasm begin to slowly deteriorate. Joy or excitement fades away….” Mark Mekelburg
“We suffer in silence, becoming a secondary victim of our failures, developing feelings of guilt, sadness, and anxiety, in need of strong support not only from friends and family but also from our institutions...” Paolo Casella
“It really makes you angry: when you’re on the ground and seeing the damage that is being done, and the millions of dollars wasted that’s just to no benefit to patients.” Michael Breen
“I think if you want to improve education, you have to put money and time into it….It’s quite difficult in Spain, at least, to be a junior doctor. Healthcare is going in the wrong direction because it’s politicized. We are managed by politicians; we are managed by people who don’t know what medicine is about.” Ana Pastor
“I never seemed to lose my way, and when the future was unclear, all I did was ask for God’s help. It is my belief that the first responsibility of surgeons is to know their patients well… The moral of this story is to never take away hope… Never take away hope.” Patrick C. Walsh
“And I just felt like she was really marginalized—in the community, in the marriage, and both sides of the families for various reasons, but that made me think more about women, the importance of women, and how they are often marginalized and vulnerable in many societies.” John Varallo
These quotes set the stage for individual stories, showing humanism in action. For example, Prof. Suzy Elneil recounts her early work in Tanzania, emphasizing character, empathy, and ability.
In his chapter, José Poças reflects on society and the abnormalities of today’s system. He writes with exceptional honesty: “Those who only see figures and financial returns, often for their profit and speculative origin, look at the patient as a mere means of survival. Or equally reprehensible, those who only care about their fame and appearing in columns at the expense of disproportionate propaganda of their successes. Those who sit comfortably at a desk across multiple departments (governmental or private), exercising their power in a detached, despotic manner, constantly using linguistic euphemisms to hide their repugnant hypocrisy and their profound indifference to those who suffer….” In this chapter, the author reminds us of the importance of life’s basic joys: profound happiness, absence of pain, restful sleep, parents, children, and grandchildren, a child’s first cry, a favorite song… even the scent of perfume or the touch of a loved one.
Meet the doctors through their stories
Through twelve interviews, the book illustrates the human side of surgery in vivid detail. For example, Dr. Manuel Pera and Dr. William Reiner.
Dr. Manuel Pera is a surgeon from Barcelona, whose professional path comes from a family of doctors. His grandfather worked as a physician in a small Spanish village, and his father was a surgeon and professor of surgery: “I was born in the South of Spain. My grandfather was originally a general practitioner in a small village in Extremadura, near the border with Portugal. His brother, Cristobal, was also a doctor, a surgeon, in Seville at that time.” Dr. Pera admits he faced difficulties and emphasizes that humanism is best learned through mentor examples. Theory is useful, but real understanding comes from experience and observing how experienced surgeons communicate and care for patients.
Dr. William Reiner began his career in pediatric urology, and the reader gains insight into treating the patient as a person, not merely a physical problem: “The most startling case to me was a 14-year-old girl who came to me and said, ‘I’m not a girl, I’m a boy.’ And this was a child with an intersex condition, not a transgender child in the current sense, by any means…” Private challenges, but also a touch of humor, appear in this chapter: “And at the same time, my father died and I just sort of threw up my hands and said, ‘This isn’t going to work. I don’t want to do it anymore.’” Reiner also describes a situation in which a patient’s mother asked: “She said, ‘I only have one question.’ I said, ‘Okay, sure. What’s that?’ She said, ‘Are you old enough to be operating on my baby?’”
Beyond personal stories, the book also explores the intersection of medicine and art, highlighting how creativity supports well-being.
Scientific evidence confirms that art promotes health and well-being
Some chapters highlight the importance of music, writing, and drawing, arguing that being a doctor is also a form of art: the art of caring for others and demonstrating genuine concern and compassion. Music has a strong effect on the brain, activating networks associated with emotion, cognition, motor skills, and memory. Other artistic activities, such as drawing, creative writing, poetry, dance, and museum visits, also have therapeutic effects.
The book also emphasizes the importance of empathy and its development, referencing Leo Tolstoy’s The Death of Ivan Ilyich, one of the most cited literary works in medical education. The authors also explored the doctor–patient relationship: shared decision-making requires time and understanding of the patient and their illness. Without this, there is neither informed consent nor trust.
Readers will encounter stories on the evolution of medical curricula, about global inequalities, but also about the Spanish doctor, historian, and philosopher Laín Entralgo, describing the moment of encounter between doctor and patient, pandemics, bureaucracy, and working in environments where water and electricity were turned off at 10:00 PM and back on at 6:00 AM.
Together, these chapters remind us that surgery is as much about empathy and understanding as it is about technical skill.
The greatest strengths and the price
One of the greatest strengths of this book is its clarity and comprehensibility. It features experts who have gained rich experience in challenging situations worldwide. The chapters can be read independently, allowing every reader to find their favorite surgeon or topic. Beyond medicine, the book also touches on the pandemic, the MeToo movement, and even Jennifer Lopez…
A potential shortcoming is its price, which may limit accessibility. It seems particularly important for ordinary people to have access, as they are the ones who can influence the direction of healthcare in their countries. I also feel a second part could be valuable, exploring how this book shaped and inspired younger generations.
A heart that needs no surgeon
Humanism in Surgery provides insight, compassion, and guidance, demonstrating that medicine is inseparable from empathy and ethical responsibility. Through detailed narratives, interviews, and historical perspectives, the book encourages readers to understand the personal, professional, and emotional dimensions of surgical practice. Whether read in airports, waiting rooms, classrooms, or at home, the book leaves readers with a lasting impression because, in the end, we all seek the same thing: to be seen, heard, and understood. That is precisely what this book offers: the feeling that medicine has a heart that needs no surgeon.
Image: Humanism in Surgery, Springer Nature Link
