Can You Be A Surgeon With Shaky Hands

This insurance, in most cases, lasts their whole career.

Do Surgeons Need Steady Hands? (Explained!)

One thing most people assume about surgeons, especially after seeing one too many medical dramas, is that they must be the coolest, calmest doctors in the room. All that intricate handwork, they make look easy. There’s no room for the shaky or unsteady, surely?

But do surgeons actually need steady hands?

Most surgeons don’t need super steady hands. There’s plenty of opportunities to rest their hands on machinery, trays, and the body wall of the patient themselves. Surgeons specializing in finer work, especially those in cardiovascular or thoracic surgery, are more in need of steadiness.

So the good news is most people have the hand dexterity it takes to cut it in general surgery. As long as they don’t experience tremors!

We’ll dive into this issue a little deeper, however. Here you’ll learn:

• If surgeons have shaky hands
• What kind of hands are best
• How you can improve your hand strength and stability for surgery

As a med student with a keen interest in surgery myself, this is a topic I’ve had the chance to ask several surgeons about. I always find their answers pretty interesting!

Ready to find out more? Let’s go.

Do surgeons have shaky hands?

The vast majority of surgeons have stable hands. That’s something that’s been developed by lots of routine practice. Experience and confidence also helps.

Trainee surgeons just starting out, or med students on surgical rotations, are much more likely to experience shaky hands. This mainly comes down to a couple of factors:

Both these factors obviously reduce over time as students and trainees get more exposure to the task at hand (as well as via exercises – more on this later!)

Interestingly, some surgical residency programs do look at things like this in their assessment of potential surgeons.

“Shaky hands” mostly fits into a broader category called “technical mastery” (or something similar). It’s usually a five-point scale people are graded on (0-5 ranging from inept to proficient). But this is mainly in the U.S. (other countries have different measurements).

The vast majority of residency programs don’t look at this, however. General coordination (or a lack of it) is considered far more important to a potential career in surgery than nervous hands!

What about essential tremors or other conditions?

Of course, if you have something like an essential tremor (uncontrollable shaking) then surgery is most likely off the table. Being unable to control your hands (despite practice or stability aids) only puts patients at risk.

Other conditions that might make it difficult include:

1. Hyperhydrosis (sweaty palms)
2. Scleroderma (thickened skin)
3. Arthritis

But even in these circumstances technique can override mobility or stability shortcomings. Especially in the case of the very experienced.

Check out this video from Medschool Insiders if you need more confirmation…

Is this true for all surgery?

Another important thing to note is that not all surgery requires human hands (or the precision that comes with them).

A lot of modern surgery, especially in fields like neurosurgery and plastics, is done via machine. That takes away the threat of unsteady hands!

But surgeons are still needed for support in such operations. And hand stability is something they’ve likely developed through years of training anyway.

Good news if the machinery malfunctions and they suddenly need to jump in!

So, do surgeons drink coffee?

A well-known side effect of caffeine is that it can sometimes cause mild shaking.

Surgeons still drink it, however, especially orthopedics.

On average orthopaedic surgeons purchased the most coffee per person per year (mean 189, SD 136) followed by radiologists (177, SD 191) and general surgeons (167, SD 138).

So obviously they’re pretty confident it doesn’t impact their work!

Surgeons Hands

Obviously the bigger the hand, the more damage that can potentially be done.

Especially if the hand is less than steady.

So can surgeons have big hands?

Yes, surgeons can have big hands. There is no scientific proof that suggests any link between hand size and a lack of dexterity.

It could of course make doing “fine” work (precise incisions, sutures, etc.) a little more challenging, but it’s definitely not a reason for anyone not to pursue surgery.

Again technique and practice are what it really comes down to.

Do surgeons get their hands insured?

Surgeons can get their hands insured via Individual Disability Insurance.

Usually, they’ll take out this insurance at the beginning of their careers. There will be checks concerning their arms, back, neck, and musculo-neural system as well as their medical history.

This insurance, in most cases, lasts their whole career.

What’s interesting is that the number of surgeons actually doing this is actually quite small though. The survey reported on in this NBC article, which asked 100 surgeons across the U.S., found that only 1 in 4 actually took out such insurance.

The same article also reports that one surgeon, Dr. Joseph Colella, insured his hands for about $8 million.

So you can see the potential importance!

How do surgeons get steady hands?

As previously mentioned, steady hands are something that comes with time, practice, and technique.

Would-be surgeons will pick up these skills in their residency placements and under the instruction of more experienced surgeons.

Med students can also work on developing steady hands (as well as hand-eye coordination) by practicing common surgical techniques.

Hand exercises for surgeons

As for improving dexterity and hand stability, there are a couple of things surgeons can do.

Here are a few popular tools:

• Finger strength trainers (such as this item designed for musicians and physical therapists)
• Hand grippers
• Specialized suturing skill trainers

Keck Medicine of USC has also lots of good pointers. Here are a few of my favorites:

1. Squeeze ball sets: 10-12 reps squeezing a ball as tightly as you can for 3-5 seconds
2. Range of motion: make a fist, wrap your thumb over the fingers, hold then spread your fingers as wide as you can. Repeat.
3. Wrist stretches and finger lifts

The last one is very similar to a favorite wrist routine of mine created by Tom Merrick. You can check this out in the video below…

Final Thoughts

You don’t need incredibly steady hands to become a surgeon. Technique and practice over time can help your control.

Unless you have a condition impacting your motor control, these things can be worked on and improved.

Don’t let your self-perceived clumsiness put you off the idea!

If you liked this article, you might find the following useful:

Can You Be A Surgeon With Shaky Hands

A surgeon’s story – dealing with tremor

Ashwinikumar Pawade, retired surgeon talks about his experience with tremor, the impact that it has had on his career and the journey that has led to something entirely different.

I remember the day I noticed it first. It was on a teaching video I had prepared which showed me performing a complex operation on the heart of a new born child; I noticed a peculiar, almost a pill rolling, movement of my left thumb on the screen. The movement was being magnified by the pair of forceps I was holding. I had not been aware of it before. I also noticed that the right hand was perfectly steady.

I was then working as a consultant paediatric cardiac surgeon at Bristol Children’s Hospital. I had been appointed in 1995, in the wake of the “Bristol Heart Scandal’ – the public outcry when it was discovered that a large number of children undergoing complex heart surgery in Bristol were dying. My job was to turn the unit around and I was the only surgeon left as the others were stopped from working. Fortunately, the performance of the unit improved in my care and we were soon regarded as the best in the country; the tremor obviously had not affected my dexterity.

Over this period, I had been under intense scrutiny from various quarters including the media, the parents, the management and the government. I also went through a divorce, and changed my house twice staying in temporary rental accommodation. Stress had therefore been a part of my life, although there was some mild exacerbation of my tremor with stress. Some of it was borne out by my impatient nature; but it was always mild and did not affect my performance. I had developed an art of shutting out all my problems outside the operating theatre, concentrating on the job at hand.

Soon after the first series of events, I noticed that my tremor had worsened enough to worry me when performing operations on small babies. I felt obliged to address my tremor immediately lest I should harm my patients. I saw a number of experts and underwent a series of investigations. The final verdict was – Benign Hereditary Tremor. Although I was concerned only about my left thumb, the neurologists could detect a generalised tremor including titubation of my head. I rang my younger brother in India (my father had died young); and he told me that he had suffered from it for a decade. Propranolol did not agree with me as it made me feel giddy and this was a particular problem when operating on babies. We have to alter the ambient temperature of the operating theatre during these operations and I was comfortable while it was cool but I would feel faint as the theatre was rewarmed. In the best interest of all concerned, especially my patients, I decided to stop operating on babies below the age of 1 year. I had a feeling that the external exacerbating factors would not change, if anything, they would worsen with time – unfortunately I was to be proved correct.

According to the new job plan, I continued to operate on older children and adults with congenital heart disease and I also took on the responsibility of mentoring the newly appointed consultant. I took Propranolol when I was assisting him but would leave the table when the theatre was being rewarmed because by then most of the delicate part of the operation was usually over. I started reading for MBA to prepare me for a change of career to medical management at a later date.

I was in this new steady state for a year when there was another avalanche of problems but this time they broke my back. I remember the day vividly. I was shaking like a leaf. I could actually feel the titubation and my daughter noticed twitching of my face. I was in no fit state to operate and I cancelled my next operating list. My GP felt very strongly that I should distance myself from the damaging stimuli and he gave me time off work. The processes which designed to help me come to terms with the events in question only made my tremors worse. I was referred to a neurologist who stopped me from operating altogether. I decided to leave the NHS although by that time I had completed two thirds of my MBA modules – most of them with distinctions – I retired on health grounds in April 2008.

I am now a part of a charity programme. We go around the villages on the fringes of the Tiger reserves in central India and teach the local school children the importance of forest conservation. Thankfully my tremors are now minimal; I am not on any medication and I have never operated again.

Upon reflection, I would have chosen another career had I known about the existence of this problem in my family. I am certainly dissuading my doctor daughter from any career requiring fine manual dexterity. I had managed to find a state of equilibrium where ‘normal’ professional stresses did not affect me. I believe that I could have carried on for years had it not been for the avalanche of ‘abnormal stresses’. Having moved away from the offending stimuli, I have now reverted, to what for me is a ‘normal’ state.

Besides charity work, I am now a full time kept man – hard work that – but something I regard as a ‘normal stress’!