As AI Advances, What Defines a Surgeon?

Surgery has long defined itself through operative technique.

Yet as technological innovation—including robotics, advanced imaging, and artificial intelligence (AI)—rapidly reshapes how operations are performed, the enduring identity of the surgeon may lie not in the operations they perform, but in something older and more fundamental: The cultivated capacity to “see” through the lens of practiced perception and judgment.

Surgeons, much like Marines, believe in a “once a surgeon, always a surgeon” mentality.

But what, exactly, persists when operative practice ends? One advantage of retirement is the opportunity to reflect, without haste, on what gave one purpose and pride during a career. I was fortunate to have trained and practiced in an era when the scope of general surgical practice was remarkably broad and stimulating.

A single surgeon might perform operations involving the chest, vascular system, abdomen, breast, and thyroid, as well as treat patients suffering from traumatic injury, burns, and conditions affecting pediatric populations. Even urologic and gynecologic procedures occasionally fell within the domain of general surgery.

Identity Sustained by Purpose

By the time of my retirement, however, a gradual shift in operative repertoire had occurred. Many procedures that defined the early years of my career had been reduced, eliminated, or replaced.

Some cases migrated to subspecialists; others evolved into new open techniques. Increasingly, they were transformed by endoscopic, image-guided, and robotic approaches.

The arc of surgical innovation over the past half century has been extraordinary. Yet as I reflect on my career, it isn’t the memory of now mostly obsolete operations that gives me a sense of pride. Rather, during those 40 years, I retained a consistent identity as a surgeon despite the rapid pace of technical and scientific change.

That identity was not defined by specific procedures. Instead, it was sustained by purpose and by the impact of working with patients.

Early in my career, I realized that a procedural identity—defining professional worth by the operations performed—would inevitably prove transient. Surgical techniques evolve quickly, and operative repertoires change. Anchoring professional identity in particular procedures risks attaching meaning to something inherently temporary.

More unsettling still is the reality that surgeons may themselves undergo transformation. Advances in robotics, imaging, and AI suggest a future in which aspects of surgery may increasingly be performed or guided by machines.

If that occurs, what remains uniquely human about the practice of surgery?

Despite these changes, the qualities embodied by the most admired surgeons appear remarkably durable. Among them are compassion, disciplined technical skill, equanimity, and a commitment to care for the patient no matter the circumstances. These attributes transcend specific procedures and remain essential regardless of how surgical techniques evolve.

Power of Perception

Preparing for the future of surgery—including coexistence with increasingly powerful technologies—may require preserving something deeper than operative skill alone. It may require preserving the capacity to “see.”

Before entering medicine, I was an artist in training. That path changed when my instructor advised me to pursue medicine instead, but not before he offered a lesson that would later resonate with my surgical career.

“You’re not here to learn how to draw,” he told our class. “You’re here to learn how to see.”

He elaborated further by warning us not to become trapped by what he called “thingness.” The task of the artist, he explained, was not merely to copy objects but to perceive relationships—structure, balance, and meaning—and interpret them through a trained eye.

Looking back, it is perhaps not surprising that I eventually found my way into surgery, a discipline that is profoundly visual and interpretive. Surgery, like drawing, depends fundamentally on perception. To the novice, surgery appears to consist of a sequence of technical maneuvers. Yet experienced surgeons know that operative practice depends far less on memorized steps than on interpretation. No two operations are identical. Anatomy varies, pathology distorts expected planes, and unexpected findings frequently emerge.

Surgical judgment requires continuous interpretation of a complex and changing landscape. The experienced surgeon entering the OR does not rigidly adhere to a stepwise plan. Rather, the surgeon perceives patterns—delicate tissue planes, variations in vascular anatomy, or the significance of color, tension, and texture within living tissue.

These perceptual judgments often occur rapidly and are difficult to articulate. Philosopher Michael Polanyi described this phenomenon as tacit knowledge, which is the idea that we often know more than we can fully explain.

Much of surgical expertise belongs to this tacit domain.

Surgeons learn through experience to recognize the safe plane of dissection, the feel of tissue under tension, or the subtle cues that signal an impending complication.

Artistic perception operates in a strikingly similar way. Experienced artists recognize compositional relationships, spatial balance, and patterns of light that remain invisible to the untrained observer. In both art and surgery, mastery arises not only from technical repetition but from cultivated perception.

The relationship between surgery and the visual arts is not new. From the Renaissance onward, anatomical discovery depended on artists as much as physicians. The anatomical drawings of Andreas Vesalius and the observational studies of Leonardo da Vinci revealed structures that could not be fully understood through text alone. (To learn more about Vesalius’s human anatomy illustrations, read the February 2026 Bulletin article, “Vesalius’s Fabrica Transforms Medicine Through Observation and Illustration.”)    

Surgical knowledge advanced through the disciplined act of seeing. This visual tradition continued well into modern surgical education. For generations, surgeons were trained to sketch anatomical relationships and operative findings as part of the observational approach to surgical learning.

Drawing these likenesses required careful observation and enhanced spatial understanding of the human body. In an era before photography and advanced imaging, the act of drawing was itself a method of surgical thinking. In this sense, the surgeon’s eye has always been shaped not only by scientific knowledge but also by artistic habits of perception.

Perhaps most importantly, both forms of perception extend beyond the purely visual.

A great surgeon sees more than anatomy. A great surgeon sees the patient. The surgeon must recognize vulnerability, suffering, and the ethical responsibilities that accompany intervention. In this sense, surgery has always been more than a technical discipline. It is a moral practice grounded in human relationships.

The history of surgery includes moments in which the profession expanded its understanding of the responsibility to the surgical patient, with one such development being the emergence of surgical palliative care.

For much of modern surgical history, the profession focused primarily on cure through intervention. The recognition that surgeons also bear responsibility for alleviating suffering when a curative approach is no longer possible represented an important shift in surgical culture. It broadened the surgeon’s role from technical operator to the physician who is  responsible for the full trajectory of serious illness.

A different but related evolution may now be occurring as surgery enters an era of rapid technological transformation. If machines increasingly assist or perform aspects of operative execution, the defining characteristics of the surgeon may lie less in manual technique and more in perception, judgment, and an understanding of the human condition.

The surgeon of the future may therefore resemble an interpreter more than a technician.

In this context, the visual arts may have an unexpected role in surgical culture. In recent years, a small group of surgeons who maintain active artistic practices have begun exploring the relationship between artistic perception and surgical identity. These conversations have led to the formation of the Surgeon Artists League, an informal community intended to foster dialogue among surgeons who engage in visual art. At first glance, such a group might appear merely recreational—a gathering of surgeons who paint or draw. Yet the deeper significance of such a community lies elsewhere.

Artistic practice cultivates precisely those perceptual habits that underlie surgical judgment: Attentive observation, interpretive awareness, tolerance of ambiguity, and sensitivity to subtle relationships. Communities such as the Surgeon Artists League offer a space in which surgeons may continue to cultivate the perceptual and reflective capacities that sustain the deeper meaning of their profession.

Earlier in my career, I had the opportunity to participate in work that helped bring the principles of palliative care into surgical practice. That effort broadened the ethical responsibilities of surgeons in the care of patients facing serious illness. In a different way, the emergence of the Surgeon Artists League reflects another expansion—one concerned not with the limits of cure but with the enduring identity of the surgeon.

Both developments arise from a common recognition: that the practice of surgery cannot be defined solely by technique.

Many years ago, my art instructor told me that drawing was not about learning how to draw, but about learning how to see. After 40 years in surgery, I have come to believe that the future of our profession may depend on remembering that lesson.

Author’s Disclosure

AI was employed for referencing, formatting, and stylistic suggestions and improvements.

Dr. Geoffrey Dunn is a retired general surgeon based in Erie, PA, widely recognized as the father of the surgical palliative care movement. He has dedicated his career to integrating palliative principles into surgical practice and improving the end-of-life care and suffering of patients.

Bibliography

Card EB, Mauch JT, Lin IC. Learner drawing and sculpting in surgical education: A systematic review. J Surg Res. 2021; 267:577-585.

Polanyi, M. The Tacit Dimension. University of Chicago Press; 1966.