Intraoperative surgical decision-making: Is it art or is it science or is it both?

How do we surgeons make decisions under what can be inauspicious conditions is not entirely clear. One would think and hope that we have streamlined this process clearly by now since such decisions are made countless times daily across the world. Dissecting the anatomy of this process is of great importance to all surgeons and those who work with surgeons. Most importantly, however, is the question, do patients understand entirely the thought process of their surgeon and how is this incorporated into the consent for the operation. Many of us make decisions for which later we may not have solid reason why we did it. Usually, these are decisions made on the basis of “a gut feeling” or “intuition” or the “gray hair effect” among other “techniques.” The aim of this chapter is to set the stage for the entire book on this complex and very important process, which if done properly and timely may prevent, minimize, or avoid altogether serious intraoperative and postoperative complications.