Doctor Left
Left-handed and training to be a surgeon? Welcome to the operating room, the live- or-die theater designed for right-handers
Aug. 13 was International Left Handers Day. It was also Tisha B’av, the Jewish fast day mourning the destruction of the first and second temples in Jerusalem and other historical tragedies. This piece only refers to the former holiday.
I’ve been left-handed for decades. With my left-handed scissors and left-handed can opener, and with the drum work of lefty Ringo Starr increasingly regarded, I recently conceded to someone that while we are a minority (about 10 percent of everyone) and an ignored minority, we are not a despised minority nor an endangered minority. There is no profiling known as “driving while left-handed.” College students have erected no tent cities to denounce left-handed colonialism.
We’ve made progress during my lifetime, the most important sign being that, while a woman’s right to choose is being rolled back, no one is trying to convert me to right handedness. No one is questioning the rest room I use. As someone must have said, “The arc of justice bends to the left.”
It turns out that I conceded too soon. Next time you’re in the hospital for a little elective surgery consider this as the anesthetic starts to work: that left-handed doctor hovering nearby was likely trained as a right-hander by a right-handed trainer and is working on right-handed equipment.
Having always been unconscious when I entered the operating room, I never considered this. But as we know from TV doctor shows, there’s a protocol, and speed and accuracy are crucial to the success of the surgery. So it’s disconcerting to read:
“Surgical instruments are designed to be used by the right-hand; theatre scrub staff will load needle holders for [right handed] surgeons, and pass instruments into the right-hand,” write Bushra Othman, Raaj Chandra and Debra Nestel in “Age of the Leftie,” a 2022 article containing the results of a study “to explore, describe and understand the lived experience of LH [left-handed for short] surgeons in relation to surgical education and training in Australia.”
As they do it in the Antipodes, “LH surgeons must reverse the usual motion to utilize instruments such as artery forceps and needle holders. Alternatively, they need to learn to use their right-hands thus cultivating ambidexterity,” they write. “Both these options are unnatural and fatiguing for the LH surgeon as they are forced to do manoeuvres that challenge their natural actions. This in theory can be dangerous for the surgeon, theatre nurse and patient, particularly when sharp instruments are involved.”
In other words, don’t point that thing at people with your left hand, you’ll poke somebody’s eye out.
The eye might belong to your trainer. Not only is training more difficult for left-handers than it is for right-handers, it’s hard on right-handed trainers, too, according to Madaliene E. Denison, Kyrillos Awad, Jacob R. Gillen, Michael S. Nussbaum and Bryan R. Collie in “Issues and Strategies in Training Left-Handed Surgeons” from 2023.
“Many believe that the disadvantages that LH surgeons face are due to barriers in teaching LH surgeons rather than deficiencies in their actual skill. This can have long-lasting effects not only on their training years but also on their future careers. These challenges are rarely discussed within surgical training programs, perpetuating the cycle of frustration with LH trainees,” they write.
There isn’t a lot of research about left-handed surgical training. But the little evidence there is points to the system as the exacerbator of left-handers’ difficulties, not the native abilities of the lefties.
A 2016 survey concluded that “the disadvantage LH surgical trainees face is due to barriers in training rather than inherent lesser ability. Nonetheless, minimal modifications are made to overcome these barriers,” write Maia Anderson, Erica Carballo, David Hughes, Christopher Behrer and Rishindra M. Reddy in “Challenges training left-handed surgeons.”
Left-handers make up about 10 percent of the medical world. And while being left- handed is an advantage in occupations that love a surprise factor — like baseball or hand-to-hand combat — the same can’t be said in an environment where there is a right way and a wrong way.
On the one hand, forcing left-handers into a right-handed gauntlet produces a lot of ambidextrous surgeons, which is good because it increases the body of flexible surgeons. On the other, according to Chloe Milton, who was a medical student when she wrote about her experiences as a left-hander, “lefthanded surgeons have reported stress, fatigue, and even physical pain from using righthanded equipment.”
Milton recalls a surgeon who found it “scary” that Milton used the “wrong” hand to cut sutures while assisting in an operation.
“What’s scary to me is how easily the challenges faced by lefthanded trainees are dismissed,” Milton writes. “Medicine needs to move away from the idea of ‘right’ and ‘wrong’ hands, so that lefthanded students learning examination and surgical skills are properly supported in caring for patients.
“From the beginning of my first year of medical school I noticed that the whole clinical environment was designed for righthanded use,” Milton continues. “Tradition dictates that you should stand on the right side of a patient when examining them, making it difficult — if not impossible — to use your left hand to do so. Moreover, the equipment used in clinical skills sessions and objective structured clinical examinations is almost always arranged with righthanded students in mind.
This is more serious than having to deal with those right-handed classroom desks where you have to pivot your body to be able to write without your left elbow dropping into your lap.
Othman, Chandra and Nestel write: “Endoscopes are designed to be held in the non-dominant left-hand with the controls being manipulated by the dominant right-hand. While there is little evidence in the literature regarding hand injuries and colonoscopy, LH surgeons have reported suffering neck, back and hand pain while using RH instruments.”
Oh, and “dials on a watch become almost inaccessible if worn on the right-hand by a left-hander.” I always thought you had to take off the watch to change the time.
“Left-Handed Med Students Still 'Left Out' in Surgery” is the clever headline in a 2024 article by Heidi Splete in Medscape. In it, she writes about a new study published in Academic Medicine.
“It was understandable that left-handed medical students feel stigmatized,” writes Splete, “a message for educators is to not presume right-handedness; instead, ask students about the hand preference on first meeting, and then training will be more inclusive.”
It’s a strange discovery, this Achilles left hand of the medical profession, like learning the Great Oz is just smoke and mirrors or the results of your genetic testing show that you’re more Ashkenazi Jewish and Neanderthal than Celtic.
Even now, a nurse somewhere is handing an instrument to the right hand of a left-handed surgeon whose left hand can’t find the instrument. Seconds tick by…
And speaking of stigmatized, while researching this piece, I came across “How to train a left-handed surgeon,” by Rishi Reddy, MD. Reddy’s credentials include FACS, indicating he is a fellow of the American College of Surgeons.
And his preferred pronouns are he / him / his.
Tucked in among Reddy’s credentials is the abbreviation (RH). I’m still trying to confirm what RH stands for. It could refer to training in rural hospitals. But until I hear differently, I’m going to believe it means right-handed.