Surgery and Psychiatry. Though the two fields seem vastly different, a surprising number of people waffle between the two specialties when selecting a career. In my medical school class, there were at least three people who switched from one to the other at the very last second (i.e. before submitting applications for residency). Psychiatry residencies report accepting surgeons into their programs; sometimes, these surgeons have established notable careers within their fields… and something compels them to pursue psychiatry. (People in other medical specialties also switch into psychiatry; I’ve met obstetricians/gynecologists, internists, family practice physicians, pediatricians, ophthalmologists, and anesthesiologists who changed their minds.)

Surgeons, in my non-randomized experience, also comprise the medical population that consistently express interest in psychiatry. Sometimes, this interest manifests itself primarily through teasing (as a medical student, I knew several surgery attendings who would routinely “pimp” future psychiatrists—admittedly, not me—about defense mechanisms and medications while operating!). Most of the time, though, surgeons seem to display genuine interest in the field and its theories.

People have argued that the two fields aren’t as different as they seem. Some comment that both specialties are invasive and, sometimes, outright intrusive. Both fields can be extraordinarily paternalistic, tossing patient autonomy aside. Surgeons and psychiatrists can take themselves and their work waaaaay too seriously and both can be arguably more prone to God complexes (”my intervention saved the patient’s life!”).

The (amusing) irony is that, in training, surgeons and psychiatrists often interact with patients in nearly antithetical fashions. Surgeons are stereotypically too curt, too cool, and occasionally frankly rude to patients. Psychiatrists are stereotypically too chatty, too mushy, and occasionally just too weird to patients. Surgeons barge into a patient’s room and feel around for physical pathology without warning. Psychiatrists are hypervigilant about touching patients (”but how will the patient interpret it? what will it mean?”).

I recently read a thoughtful paper about boundaries (because psychiatrists like to think about these sorts of things to the nth degree) and I was struck with one of the arguments in the paper: Psychiatrists get all worked up about physical boundaries because rigid rules about external, tangible boundaries (limits, whatever) allow for more porous and relaxed emotional/mental boundaries. Similarly, it probably serves surgeons very well to remain emotionally and mentally distant from their patients because of their constant invasion of physical boundaries. I don’t know if any of these ideas are valid, but if they are, I’m not sure who we are really trying to protect. As much as physicians might like to think that we’re doing things to promote “safety” for patients, this may actually be (read: is probably) All About Us.

Dancing and Social Behavior. Along the same lines of invasion/intrusion as mentioned above, dancing nicely demonstrates it is difficult (and uncomfortable) to invade someone (whatever that means) without cooperation. We cannot control the behavior of others; we can only try to increase the likelihood that a behavior will happen. All we have are our powers of influence and persuasion.

A lead recently asked me to dance and had already taken my hand. A mutual friend of ours, a follow, scurried up and started talking to me (albeit quickly, as she knew that she was intruding upon our dance). The lead then took her hand as she finished up her speech.

He then started dancing with us both, leading turns… while she was still talking. He was doing this because he could and, admittedly, it was amusing. He eventually let go of her hand (once she was done talking!), sending her gracefully away, and continued to dance with me.

It was only afterwards that I felt impressed with what had happened. He had enough confidence that we would both follow his lead(s). The other follow and I easily agreed to be led, even though we were clearly engaged in a conversation. It would not have been difficult for us both to let go of him and refuse to cooperate with his shenanigans. Coercion was not involved. The entire episode was voluntary.

Context mattered, of course: The three of us were on the dance floor and music was playing. People dance in those situations. She and I were clearly not engaged in a conversation of grave importance. It’s considered bad form to not follow a lead; that’s part of the dancing social contract.

Follows agree to be influenced and persuaded and, in our own ways, we can influence and persuade our leads. Leads don’t have to take our cues to give us creative space, but they usually do… because it increases the likelihood that (1) we will continue to follow, (2) something novel and fun will happen as a result of the shared experience, and (3) we will dance together again in the future. Are any of us actively thinking about all of that in the moment? I’m not.

Sometimes, we’re just not aware of how much influence (and power) we actually have.