Notice your current story — without trying to change it

Here is something no one told you in residency: the thoughts running through your head on OR day are not neutral. They are either working for you or against you. And most surgeons have no idea which one it is.

What are you telling yourself right now?

"I just need this one to go well." "Please don't let me hit that vessel." "I hope anesthesia isn't slow today." "Don't mess this up."

Those thoughts create feelings in your body — tension, urgency, contraction. And those feelings show up in your hands, your decisions, your team interactions, whether you know it or not.

The first step is not to fix the story. It's to notice it. That act of observation — without judgment, without trying to change anything — is the beginning of every elite surgeon's mental edge. It is not soft. It is not therapy. It is the same skill every high-performance athlete trains deliberately. You just were never taught it.

Generate the emotions that actually serve your patient

Here is what separates surgeons who thrive from surgeons who survive: the ones who thrive have learned to generate useful emotional states on purpose. Not by pretending everything is fine. By choosing the thought that creates the feeling they need.

The emotions that make you a better surgeon: confidence, curiosity, ease, non-resistance, service.

The thought that drops me into service instantly, even on my worst days: "It's not about me. It never was, and it never will be."

Other prompts that work: "What's fun about this case?" "What's working?" "How can I make this simple and easy?"

Your brain is not your enemy. But it will run on autopilot if you let it — defaulting to anxiety, perfectionism, and scarcity. The surgeon who directs their brain deliberately walks into that OR in a completely different state than the one who doesn't. That difference shows up in outcomes. It shows up in how your team responds to you. It shows up in how you feel at the end of the day.

This is a trainable skill. You can learn it. That is exactly what we do inside Empowered Surgeons Group.

Implement a ritual

Top performers across every high-stakes field — surgery, athletics, special operations, performance — use pre-performance rituals. Not because they are superstitious. Because the research is unambiguous: rituals reduce anxiety and increase perceived control before high-stakes performance.

Yours might be: visualizing the entire case at the scrub sink, step by step, before you gown. A quiet moment in your car. Three deliberate breaths before you pick up the first instrument. A wink at yourself in the mirror and the words "you've got this" — because you have.

The ritual is not magic. It is a signal to your nervous system that it is time to shift. Be consistent. Be intentional. And one warning: if you miss your ritual and the case feels wrong before it starts, the ritual has become a compulsion. The goal is a useful association, not a dependency. You are the one in control — not the ritual.

BONUS: Before you book the case — check your Belief Triad

Most surgical complications are not purely technical. They begin earlier — in the consultation room, in the moment you said yes to a case you had a quiet reservation about.

The Belief Triad is your internal quality check before you take anyone to the OR. It takes thirty seconds. It has saved patients from unnecessary surgery and surgeons from unnecessary complications. Run it every time.

• Belief in Self: How confident are you in this specific procedure, today, in this patient's anatomy? Is this something you have done so many times it is automatic — or are you at the edge of your comfort zone? Neither answer disqualifies you. But knowing the answer changes how you prepare.

  Belief in Surgery: On a scale of 1 to 10, how convinced are you — not your mentors, not the guidelines, not the referral source — that this surgery will genuinely help resolve this patient's problem? Do you have everything you need to execute the way you want to? If your honest answer is below a 7, that is information.

  Belief in Patient: What is your rapport with this person? Do they understand what is actually happening to their body, or are they working from a story they built themselves? Do you feel genuine ownership of their care, or does this feel like just another case on the schedule?

  A shaky answer on any one of the three is not a reason to panic. It is a reason to pause. The surgeon who checks in with their Belief Triad before every case is playing a different game than the one who doesn't.

  That game is called the infinite game. And it is the only one worth playing.

3 STEPS TO get into the right midset on your or days

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