Surprises are for children and philosophers

October 1, 2007

Peter J. McDonnell expresses his feelings about surprises, which is that surprises almost always are bad, and every effort should be made to avoid them. Good things occur as the result of hard work, careful planning, and attention to detail-not by surprise.

Key Points

"Surprises are foolish things. The pleasure is not enhanced, and the inconvenience is often considerable."

-Jane Austen (1775–1817), novelist

"Life is a series of surprises, and would not be worth taking or keeping if it were not."

"Eighty percent of all surprises are unpleasant. This includes bills, estimates, unkept promises, firings, birthday parties, and pregnancies."

-William Marstellar

Do you like surprises? When I was a little boy, surprises seemed wonderful. As a 5-year-old, I remember, my sisters and I were determined to stay awake so we could catch Santa Claus coming down the chimney (with no success), and then were excited and delighted while opening presents the next morning. In those days, surprises were welcomed and wonderful. But now, in the words of the character Borat, not so much.

Think about it. Do you really want to be surprised the next time you are in the operating room? When patients are examined the day after surgery, is it better to have everything check out just the way it should, or would you rather be surprised?

If you make the correct diagnosis and start your patient on the correct medicine, when you see him or her in follow-up, the result should be predictable and the patient improved. A surprise at the time of the examination is much more likely to be bad (e.g., an adverse event from therapy, worsening of the condition, discovery that the initial diagnosis was incorrect) than good (such as a miraculous cure).

When talking with the family after performing your next phaco or LASIK procedure, do you want to describe the procedure with words such as "standard," "routine," and "uneventful," or do you want to say, "Wow, what a surprise we had"?

Is my aversion to surprise the consequence of getting older or of being a physician (many of us are accused of being control freaks)? Are people who like surprises (such as Ralph Waldo Emerson) more fun than those who don't like surprises (such as Jane Austen and William Marstellar)? I think not.

It's not just those who work in the field of medicine who should try to minimize surprises. Airline pilots, car dealers, financial planners, plumbers, house painters, accountants, and others should want their customers to have predictable, positive experiences with as few surprises as possible. Surfers, as everyone knows, are really fun people and are great to be around, but they become accomplished surfers by practice and by planning where to be on each wave, not by luck or surprise. Could Ralph Waldo Emerson surf?

My latest surprise on an airline flight occurred earlier this year. The pilot announced that a warning light indicated that the front landing wheels of the jet would not lock in the "down" position. That meant the landing could be exciting, with the nose of the jet scraping along the runway if the landing gear collapsed. After pulling up from the runway at the last minute twice, flying around Baltimore/Washington International Airport for about an hour to burn off fuel, and having the flight attendants review emergency procedures, the pilot committed us to landing on a runway lined with emergency response vehicles with flashing lights. The hour-long episode was interesting and memorable and it made the local TV news. Although things turned out okay, my preference remains boring, routine landings.