20 General Surgeon Interview Questions & Answers
1. You are doing surgery alone with a technician assisting you when you start to feel faint. What should you do?
How to Answer
Questions like these are asked to make sure you have common sense, overtly, but covertly are really just trying to see how you think 'on the fly' when asked something unusual. Yes, this type of emergency could happen, but it is extremely rare and the question is just to feel you out. As a training exercise, you should be ready to verbalize conventional wisdom here, i.e., that common sense dictates that coverage for the patient have continuity either by terminating the procedure with stability or, ideally, finishing the procedure with stability.
Entry Level
"I would notify the circulator nurse of my problem and ask for backup."
Answer Example
"If I thought I were compromised to the point where I couldn't continue, I would ask the nurse to call an associate immediately."
Experienced Level
"If I couldn't finish or terminate the surgery with the patient in stable condition, I would instruct the circulator nurse to call an associate surgeon; if the crisis were more time-sensitive than that, I would tell her to call a code. I would also make sure the anesthesiologist had the help needed to keep the patient stable. Also, this is a reportable event, so I would report it according to hospital protocol."
2. You are consulted for an otherwise healthy patient with abdominal pain, bloody diarrhea, and high fevers, in spite of 72 hours of triple antibiotic treatment; how would you respond?
How to Answer
Like another question, the one about a difficult intubation, this is a question that serves as a barometer for clinical common sense and basic medical judgment. Therefore, show them that you have that judgment. It is conventional medical wisdom that when a patient fails to respond to treatment based on a certain diagnosis, that you should doubt that diagnosis. Don't be afraid to be bold here with a drastic mid-course correction, because this is going to be a dead patient very soon!
Entry Level
"I would check what cultures came back and compare them with the antibiotic selection. Based on that, I would probably prepare the patient for a colonoscopy to rule out necrotic bowel."
Answer Example
"I would consider the therapy with the antibiotics a failure, so I would prepare to do what I needed to establish a correct diagnosis, which means a colonoscopy."
Experienced Level
"I would prepare to get a definitive diagnosis via a colonoscopy, because after failure of powerful antibiotics, I would suspect necrotic bowel. However, in my experience, I know that any colon ravaged like this for three days presents a high risk of perforation, so I would make sure I emphasized that in the informed consent. I would also involve an anesthesiologist for both complete patient immobility to reduce the likelihood of perforation and to maintain a surgery readiness should the need for emergency surgery prove necessary, such as colon resection of necrotic bowel."
3. Your patient, a mother of an 8-year-old, wants to be discharged a day early post-op because of domestic problems like childcare, so her child won't be at home alone. How do you respond?
How to Answer
This questions highlights a conflict between compassion and medicolegal risk. You should include in your answer two things: 1. You understand how a patient can get into a jam like this and are sympathetic with her concerns enough to help; and 2. Safety first, for many reasons--medical, ethical, and legal. Both sensibilities are what are being sought from you.
Entry Level
"If it were safe to send her home, I would simply discharge her with follow-up instructions; if it weren't safe, I would look for some sort of hybrid services to make it safe, like home health nursing visits, etc. If I could not make it safe, I'd explain to her why I couldn't discharge her."
Answer Example
"If it were unsafe to do so, I would not discharge her; however, I would assure her I understand her position and if she were to leave, I would understand and be available to her if she needed me."
Experienced Level
"This pits sympathy for her plight against medical and medicolegal risks. As such, I would treat it like any risk-vs-benefit situation and write a lengthy note of the likelihood of some risks and the unlikelihood of others, and the complications that can arise from them. This would be an informed consent, like having the patient understand the risks vs benefits of any surgery. I would also document her understanding of it all. Then I would tell her signing out AMA will not negatively upset our patient-doctor relationship and I'd continue to be available for her if she were to need me."
4. During surgery you call for a certain instrument that you're told isn't available, and this adds time to the surgery that otherwise would have been much shorter; how would you address this problem?
How to Answer
This question is asking how you would go about solving a problem that affects your efficiency, such as going through central supply with specific requests, etc.. However, what it might really be trying to do is to discover whether you blame others for your setbacks. You'll want to answer this with the usual bureaucratic steps you'd take, but you also should include in your answer the sentiment that you and you alone are responsible for what happens in your surgeries.
1st Answer Example
"I would contact Central Supply and ask what such an instrument costs or--if it is available--why wasn't it available to me at the time. Since I take responsibility for my surgery, I want to strive to have the state-of-the-art equipment needed."
2nd Answer Example
"I would contact the person in charge of inventory and arrange a meeting with him or her to discuss purchasing the item if it's not available, with an offer to help write a letter to administration justifying it. In the meantime, I would just have to be patient in awaiting its arrival or, if refused, accepting the verdict from the financial people making the decision."
3rd Answer Example
"I would arrange a meeting with Administration about what I wanted, along with a request for representation from persons responsible for purchasing. Because I understand the value of a 'bottom line,' I would understand if the request were deemed extravagant, redundant, or unnecessary. In the meantime, such a denial would only make me alter how I do my surgery without the instrument, not whine about it and blame any shortcomings on having to do without it."
5. You see a patient who comes to you and reports that another surgeon had bad things to say about you; how do you respond?
How to Answer
Anyone can be a jerk, even a doctor. Yes, this is unethical, dirty politics, and an ugly side of competition. It may even be due to some personal issue you don't even know about. You can rest assured that you're not the only person on this doctor's 'hit' list. Hospitals don't want people like that on their staffs, but if you respond in kind, you'll be lumped together with the original culprit. You just can't go wrong being a gentleman (or a lady). It's not being a patsy, it's being smart, because the interviewer will see that you're above such things.
Entry Level
"I suppose I have some choices here. I could confront the person and ask for an explanation; I could report him or her to the state medical board; or I could ignore it. Of these the only smart choice is to ignore it. The other choices are emotional knee-jerk reactions fraught with downsides."
Answer Example
"That would be unfortunate, but there's really nothing I can do about it except carry on without reacting and continuing to do the best work I can."
Expert Level
"Such things are hard to prove, and I have also learned that patients sometimes distort their memory when angry with a previous doctor and don't present an accurate story. Sometimes they might even try to drag me into their disagreement with that doctor. Even if they are reporting something like this accurately, the fact that they're seeing me already means I have nothing more to gain by gainsaying against that doctor. My patient can only see that as my being professional and the bonus is that I am not dragged into some flame war where there are no winners."
6. How do you feel about medical, non-surgical treatment for appendicitis?
How to Answer
The advent of diagnosing appendicitis via CT has allowed some physicians to avoid surgery for their patients by treating appendicitis with antibiotics. Of course, this is only possible via strict criteria, such as unruptured, etc. It seems to have become a popular subject in Pediatrician circles, but it is assuredly unpopular in General Surgeon circles for a couple of reasons: 1) Surgery is what you do, and 2) Although unruptured appendicitis will probably respond to antibiotics when so treated according to the prerequisite criteria, the treatment of choice for appendicitis is still removal. Don't be afraid to side with your specialty on this one. Also, looking at it from the hospital's point of view, a 'negative app' is a lot easier to explain than a child who dies because of an overly conservative approach. Rest assured, hour hospital will side with your specialty, too.
Entry Level
"I'm a surgeon. If a patient comes to me with signs and symptoms suspicious for appendicitis, I see nothing to gain in waiting; I'm going to remove it. Even if it comes back negative on pathology, I have still followed the standard of care."
Answer Example
"I've been trained to know that removal of an appendix, even for something as isolated right lower quadrant pain, is acceptable and the proverbial abundance of caution."
Experienced Level
"I've heard of medically treated appendicitis, but if I'm involved, I'm going to perform an appendectomy. There's just too much at stake to avoid a simple procedure that has a low complication rate. I would never use anything other than the treatment of choice, only to have to worry for days about the patient. It stands against everything a General Surgeon represents in that it is heavily wieghted in the benefit zone of any risk-vs-benefit considerations."
7. Do you intend to have a call arrangement with another surgeon for vacation, time off, or illness?
How to Answer
This is a frequent question. A hospital does not like any patient feeling as if a doctor has deserted him or her. This is so important that continuity of care and coverage is written in hospital rules/regulations or staff bylaws. This means, then, that you should embrace the spirit of those rules/regs and/or bylaws by assuring the interviewer that--of course--you will maintain coverage no matter what takes you away.
Entry Level
"I plan to volunteer on committees related to General Surgery to meet my colleagues as soon as possible, because I realize until I have such an arrangement I will be 100% responsible."
Answer Example
"I realize that continuity of care is important, especially in General Surgery, which involves a major challenge to a patient's physical status. I will have a relationship--either on-going or as-needed, to make sure there is not disruption of this continuity."
Experienced Level
"I take the patient-doctor relationship seriously, and that means my patient needs to feel he or she can count on me, from pre-op through admission, surgery, and throughout the postoperative period. As an experienced surgeon, I have learned not to schedule any surgeries around the time of a planned time away. In fact, I make it a point to leave a generous window to avoid overlaps that can occur when a complication could conceivably drag on for an extended time."
8. How important is bedside manner for the General Surgeon?
How to Answer
Like it or not, true or not, General Surgeons have a reputation for being gruff, direct, and in too much of a hurry to get into lengthy interactions with their patients. Your answer about bedside manner should simply state how important it is and that none of the stereotypes apply to you.
Entry Level
"Since I'm early in my career, I fear my patient may wonder if I'm qualified. Therefore, bedside manner, besides being important for communication in the patient-doctor relationship, can also help very much in assuring my patient of my capabilities and give him or her confidence in me and my ability to give care surgically."
Answer Example
"Bedside manner is important for all specialties, especially General Surgery, when things can be dramatic, personal, or frightening. That's my policy, because my patient deserves nothing less."
Experienced Level
"I feel bedside manner is very important simply because of the fears a patient may be having or the intractable pain he or she may be experiencing. Therefore, I may be in a hurry to address the problem which may very well be life-threatening. But being in a hurry, as pre-op-to-surgery often is, is the natural enemy of good bedside manner, and it takes experience--which I have--to make sure it doesn't sour this important aspect of the patient-doctor relationship. Thereafter, there is post-op pain, which requires that the momentum won in my bedside manner not be allowed to diminish."
9. If you order a blood transfusion of two units of packed cells and your patient stabilizes after the first, should you or should you not give the second unit?
How to Answer
This is a trick question. It involves knowledge of transfusion strategies and, as such, it probably will never be asked. However, you might be asked a similar type of question that will challenge a particular protocol used that only has tangential relevance to your vocastion, so it is used here for practice.
Entry Level
"I would contact the blood bank and ask if there were specific policies at the hospital regarding conservation of valuable blood products."
Answer Example
"Yes, if I had ordered two units for a reason, I would feel that the reason hadn't really changed. Therefore, I would stick with my original order for transfusing two units."
Experienced Level
"I know that introducing any blood products tends to turn off erythropoiesis, the body's natural blood-making process in the bone marrow. Therefore, although my patient may be stable after only one unit, I know that his or her red blood count will fall again when natural erythropoiesis is temporarily suspended. This is the whole reason no one really orders just one unit of blood. If it's bad enough to require blood at all, the starting point is two units."
10. You are doing surgery on a Jehovah's Witness child who is in danger of vascular collapse from hemorrhage and are faced with the dilemma to either give blood or withold it for religious reasons; what would you do?
How to Answer
This is a famous dilemma seen in all surgical specialties. By law, a patient can establish a directive that forbids transfusion of any type of blood element, even if it were to mean certain death. Your doing this anyway is considered assault and criminal. The fact that the patient is a child is only there to make the interviewer's question even harder to answer, so it seems to be posed to see how you think on your feet and not necessarily to judge your knowledge of the law. You can never go wrong stating you would follow the law, but an answer that diffuses your responsibility by adding another more authoritative party is always a good call, e.g., Ethics Committee.
Answer Example
"An advanced directive is a legal instrument that must be obeyed. The fact that it is a child means mitigating circumstances, so I would place an emergency consult to the head of the hospital Ethics Committee and defer any decision to him or her."
Enry Level
"I would simply follow hospital policy on this, according to the legal criteria already in place."
Experienced Level
"Children do not have the maturity to understand others' life-and-death decisions about them. I would reach out to the parent and make sure he or she knows the gravity and lethality of the situation. If the parent(s) were to remain adamant against blood, still, I would have hospital counsel place an emergency call to a judge who could issue an order allowing it. Short of that, I'm in no position to force it."
11. What is it about surgery that called you to it as a vocation?
How to Answer
You can rest assured you're going to be asked a question similar to this. It's just an introductory exercise, so feel free to be pragmatic, philosophical, or both. As a therapy of last resort, surgery is a big deal. You should show the interviewer that you 'get it.'
Entry Level
"Surgery is a specialty in which a person can be normal one moment then dying the next; I am there for the moment after that, returning to normal. That's fulfilling."
Answer Example
"I find it fascinating, restoring function or preventing adverse events in a person; and, being that it's a person, the personal nature of it is part of my calling."
Experienced Level
"We all have to start somewhere, and I started a while back. Along the way I've picked up a lot of experience beyond just the mechanical actions I was trained to do. Now I find that surgery still calls to me as a specialty in which the outcome may very well depend on who is there doing it, and I find it thrilling when a good outcome is because it was me who was there."
12. You are asked to sign a chart for a patient for whom you had assisted the primary surgeon, and you see false statements in the operative dictation that obviously were written to mitigate medical malpractice liability. What would you do?
How to Answer
It is tempting to think that a surgeon dictating a false story that dismisses a mishap that could result in a suit would be a welcome tactic by the hospital. After all, if a doctor is sued, so will be the facility. But this is erroneous thinking. Getting caught doing something like this by opposing counsel or by a regulatory agency is a major mistake, much costlier than whatever financial damages would have been saved by sidestepping a possible suit. Even worse, most suits are only for the purpose of initiating discovery, and a complication that otherwise might have gone nowhere medicolegally may in fact gain momentum if a plaintiff's lawyer can demonstrate manipulation of evidence. Your answer should subscribe to law.
Entry Level
"There is no room for dishonesty. Such tactics don't prevent suits, since they are iniatiated to begin discovery anyway. Therefore, I would tell the surgeon to re-dictate it in a form I could honestly sign."
Answer Example
"I would not sign a chart that wasn't accurate. I would let the primary surgeon know this and the chart would be incomplete until this is done and I can sign with a good conscience."
Experienced Level
"I would not sign the chart as an assistant if there were such a thing going on. I would tell him or her to re-dictate the op note to reflect a more accurate version. I wouldn't have to pester him to do it, because without my signature, the chart is incomplete and bound to come to the attention of billing and further reveiw."
13. You are aware of a colleague who brags about his meticulous work, but takes on average three times longer to do the same surgery as you do, what would be your reaction?
How to Answer
This is tricky, because surgeons are allowed to have a certain amount of autonomy in how they practice their craft. However, you are obligated to report anything you feel could put a patient or your hospital in jeopardy, medically or medicolegally. There are complications that are more likely the longer a surgery lasts, such as blood loss, infection, delayed healing. or extra pain, so if there is a question of breaching a standard of care--in this case a judgment call--you are obligated to report it to the appropriate authority of the staff, such as Chief-of-Staff, Department Head, or Executive Committee.
Entry Level
"I would ask the hospital's internal committee that has authority in such matters to investigate if his or her complications, known to be caused by lengthy surgeries, fell out of the average incidence of his or her other peers, and if so. suggest he or she be called to that committee to explain."
Answer Example
"If I were concerned about the length of time a surgeon takes to do a procedure being inappropriate, I would mention it to the Department Head and let him or her take it from there. My responsibility is to speak up if I see something incorrect."
Experienced Level
"This is a possibly explosive situation, because it pits my obligation to report the danger to the patient against what will be seen as an offensive maneuver to make someone look bad for competitive reasons, especially since he or she touts the length of surgery with the excellent outcome, itself a competitive act. Thus, anything I do will have to be based on how his or her patients do in the long run with complications. Because of HIPAA, I cannot investigate that, and as a competitor I shouldn't. But the hospital's appropriate oversight committee, usually the Executive Committee, has the authority to compare and contrast patient outcomes among different doctors. If I've raised the concern, that's all I need do. It would be inappropriate for me to go beyond that."
14. If you were assisting a colleague on surgery for a gun shot wound and he set a removed bullet aside as a souvenir, how would you respond?
How to Answer
Believe it or not, these things actually happen. In surgery, you will see things every day most see only once (or never) in their lifetimes. Because of the notoriety that is inherent in the drama of surgery, it can be tempting to act in a way that you feel doesn't really matter. You should never be tempted to do anything that can be looked at as inappropriate. Champion the straight-and-narrow course--you just can't go wrong.
Entry Level
"I wouldn't have the authority to take something as a souvenir. That would require permission from too many people to do it right. The easiest--and most correct--thing is to just follow normal protocol and not take any chances."
Answer Example
"I don't think such actions are appropriate. Something like a bullet is really a part of the medical record, and any tinkering with it is like falsifying the medical record. I would tell him or her to replace the item or 'un-do' the indisretion immediately or I'll be obligated to follow official guidelines up the chain of command."
Experienced Level
"As an experienced surgeon, I know such things, when they involve a patient who was a participant or a victim of a crime, are evidence. Not only would it be unethical to take something like this, it would be illegal, which could jeopardize my license, my staff membership, and even my freedom. Sometimes a patient requests something like a gallstone, but that is even part of the pathology record, not to leave the premises. The fact that my colleague does it doesn't get me off the hook, if I allow it to happen without protest."
15. If you were preparing to do an elective surgery on a child who had some difficulty with intubation (with possible aspiration), how would you proceed?
How to Answer
Another in a series of common sense barometer questions. This, however, is basic medical judgment. Therefore, show them that you have that judgment. Don't be afraid to 'shut anything down' if you can throw patient safety into your answer.
Entry Level
"Safety first. I would stop the procedure immediately. It can always be rescheduled."
Answer Example
"Since this is an elective surgery and no one can know the full extent of the damage from the aspiration, I would say that since the surgery hasn't actually started, it can be aborted. That's the safest approach for the patient."
Additional Answer
"The possibility of aspiration is a deal-breaker for the surgery. Even if the anesthesiologist assures me that all is well, if there's the slightest chance of this as a complication, I would cancel the surgery. There's just too much at stake and I have a responsibility to my patient to act the most prudently, always."
Experienced Level
"Elective procedures are just that--elective. Therefore, everything should be perfect. Any surgery--even the simplest--is serious business, and there is no room for taking even the slightest chance. I would rather explain why I canceled a surgery due to safety concerns over possible aspiration than explain that the child had a worse outcome because of my insisting on completing a planned surgery."
16. Surgery is often a set of steps that are routine; do you see mediicne evolving to allowing technicians to do it?
How to Answer
The future of medicine is wide open, with a confluence of capitalism, socialism, evidence-based medicine, competition, and altruism. You can rest assured that the medical world will be quite different in 10 years than it is now. Whatever your thoughts, you want to come off as someone who is thoughtful, open-minded, and willing to go with the flow--that flow being, of course, what's best for the hospital: keep that in mind.
Entry Level
"As a newly practicing unsupervised physician, I recognize that my experience may be not much more than technicians who have assisted on more cases than I have done. There are midwives authorized to practice in the specialty of OBGYN, so it may not be a stretch to see 'mid-surgeons,' for example, doing appendectomies while supervised by a surgeon on premises, much like an anesthesiologist can supervise more than one room via the nurse anesthetists. As long as safety criteria are met, I would be willing to consider any advancements in the current way of doing things. It is helpful that we have the American College of Surgeons who can weigh in for us."
Answer Example
"Medicine is always changing, certainly. It's up to us as practicing physicians to assure safety with whatever comes long. I can see how it may be cost-effective to give technicians, nurse practitioners, and other ancillary persons more autonomy and responsibility, but that's agains the all-important barometer of patient safety. Always."
Experienced Level
"It all comes down to authority. Someone must be authorized to be the final arbiter of what is proper and correct when it comes to patient safety, medical ethics, and professional propriety. Sure, a technician could do a cholecystectomy under perfect circumstances, but there is still a need for supervision and direct involvement by the person who takes the responsibility for the outcome. As such, such 'surgeon-extenders' could creep into the current way of doing things, as long as it's a team approach involving physicians as those final arbiters."
17. How do you feel about purely elective cosmetic surgery?
How to Answer
Hardly controversial now, elective surgery--especially for cosmetic reasons alone--has earned a legitimate place only after a lengthy period of disapproval, historically. You'll be considered behind the times if you condemn plastic surgery, but this question allows you do do something else altogether: give your opinion on a patient's ability to make his/her own decisions, unless it involves illegitimate surgery, such as outdated procedures or bogus ones that are nothing more than profiteering.
Entry Level
"All decisions to undergo elective surgery should be based on risk vs benefit. If the patient understands this ratio and feels it is weighted to his or her benefit, it should be considered acceptable."
Answer Example
"As long as a patient understands the risks vs benefits of a planned procedure, and if that surgery were to benefit him or her in any way, even for self-esteem, I see no reason to object to it."
Experienced Level
"All surgeries should be based on risk vs benefit. The risk is for me to decide, but the benefit is for the patient to decide. For example, if a patient were getting a rhinoplasty to end years of social anxiety, that sensibility is in his or her eyes alone, not mine; however, if I felt a procedure was ill-advised on medical, ethical, or risk grounds, I would have no trouble objecting to it and educating the patient of this."
18. Is surgery, which usually means a therapy of last resort along with the associated pathos, enjoyable to you?
How to Answer
This is a tricky question that asks you to explain how someone can really enjoy something that is otherwise tragic or dire to the person being treated. It is a question that will show how well you reconcile two conflicting emotions. The trick to the question is that that enjoying what you do means, in a sense, that it's 'fun'; however, that doesn't mean that it is 'funny'! Thus, making that distinction is easier and not as frightening as the question seems at first.
Entry Level
"I like surgery. Like any aspect of medicine, I like making people better, and that is the hope for every surgery I do. I know that sometimes a patient may not get better, but I get satisfaction in trying my best even when things are their worst, even against formidable odds. That satisfaction is my enjoyment."
Answer Example
"There is a satisfaction in doing things well and that makes what you do, enjoyable. Even when the situation is tragic for my patient, I can enjoy doing my best as something that is on another level altogether."
Experienced Level
"Bad things can happen to people, and if I can change that with my skills, that's something that I find very enjoyable. The very nature of General Surgery is that these bad things will land in my lap. If I can do my best to reverse them, then although some may find it to be a strange sense of enjoyment, it's one of the things that inspires me to continue to be my best."
19. How would you feel being assigned a patient who required a difficult emergency surgery for which you won't collect any income?
How to Answer
All doctors do a lot of work for fee. It's just part of the profession, so your interviewer expects professionalism in your answer. You don't have to say that the money means nothing to you, because that's not true; but you should have a sensibility of medicine as 'the noble profession.'
Entry Level
"If it is I who is responsible for addressing a surgery emergency, that's what I have to do, first and foremost. If I get paid, great; if not, that's certainly going to happen, and I knew that when I chose to become a doctor. If it bothered me, becoming a doctor would have been a bad decision."
Answer Example
"I have to say that getting paid is my way to make a living, but the nature of emergency surgery is to treat first and everything else second. And if that means there is no second anything, including income, it's just part of the specialty. Accepting being a surgeon is accepting that."
Experienced Level
"Within every demographic are the indigent, and they have a right to expect the same treatment as any higher socioeconomic group; that is, just because patients may be indigent, that shouldn't equate to being underserved, and it is my responsibility to make sure of that ."
20. How important do you feel the art of triage is in General Surgery?
How to Answer
The interviewer doesn't just want you to answer, 'Very important.' This is a throwaway question asked only to see you start to think out loud for him or her. It deals with prioritization and perspective, so let him/her know that you're not blind to the big picture.
Entry Level
"Triage begins with the person of first contact--usually a receiving team--before it is handed to me. Therefore, my responsibility is to judge whether the triage is accurate by the time the decision-making gets to me. "
Answer Example
"By its very nature, triage gets the most important things done first, and that requires a perspective and an instantaneous grasp of the total situation. Therefore, if the most important things are to be done first, I need to be there with a thorough perspective in a timely manner. Surgery has this quality as a foundation for everything else a surgeon does."
Experienced Level
"Triage is as important as it is necessary. In General Surgery, there is a final triage which consists of my hierarchy of decision-making once I've opened someone and the surgery is in progress. All of the most effective preliminary triage in the world will do no good if triage excellence doesn't continue with me during the actual surgery. I, as the surgeon, am making all decisions--which is in a basic sense, triaging--within the actual scope of the surgery I'm performing."