8 Neurosurgeons Share Their
Pre-Surgery Rituals
“Engaging in ritual acts gives people more perceived control over their environment and reduces their anxiety,” says Juliana Schroeder, a professor in the Management of Organizations group at the Haas School of Business, University of California Berkeley. “What we’ve found is when you randomly assign people to do pre-performance rituals, compared to those who do not, they feel more in control, display less anxiety and perform better in their tasks.”
Before each competition, swimmer Michael Phelps, the most decorated Olympic athlete to date, reportedly slapped himself on the back by swinging his arms exactly three times.
Certain pre-performance routines have an immediate physiological effect, while others offer a grounding effect that helps filter distractions, optimizes focus and primes one to perform at the highest possible level.
Below, 8 neurosurgeons share the habits, rituals and routines they turn to before (and sometimes, during) a high-pressure surgery:
Dr. Michael Schulder, MD, FAANS
Dr. Schulder is a neurosurgeon at the Zucker School of Medicine at Hofstra/ Northwell, where he serves as Director of the Brain Tumor Center, Residency Program Director, and Vice Chair of the Department of Neurosurgery.
“The way I prep my patients for surgery has become an important ritual. I like to do everything the same exact way every single time. When I’m getting them into a certain position, cleaning the patient’s scalp, and placing the sterile drapes—I do it the same way each time. These rituals create a rhythm that carries into the surgery, keeping the non-essentials from distracting me so I can focus all my energy on the important details.
My operating room needs to be quiet. I used to play music, but in the early 90s, my cassette player got stolen and I had to operate in silence. I realized I liked it better that way, and I find my whole team focuses better when we’re not distracted by music.”
Dr. Elad I. Levy,
MD, MBA, FACS, FAHA
Dr. Levy is a neurosurgeon and the chairman of the neurological surgery department at University at Buffalo Neurosurgery where he’s also a professor of neurosurgery and radiology.
“I rowed for Dartmouth as an undergrad and I really feel like my experience as a Division 1 athlete laid the foundation for the rituals I’ve developed as a surgeon. Although exercise helps me decompress, I never do a vigorous workout the morning of surgery because I don’t want to be fatigued going into work. But a long bike ride or an intense workout the night before surgery puts me into the right headspace. After exercising, when I’m calm and focused, I go through the next day’s procedure in my head, mapping out not just plan A, but plans B, C, and D, too.
During surgery, we’ll usually have a Spotify Chill House playing in the background. When it gets stressful in the O.R., I’ll usually turn the music down and dim the lights so I can direct all my attention to the task at hand. On the crew team, I spent so much time staring at a tiny screen on the ergometer or focusing on someone’s back during practice. Staying hyper-focused on a very specific point when I’m under pressure to perform has almost become part of my DNA.”
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Dr. Praveen Mummaneni, MD, MBA
Dr. Mummaneni is a neurosurgeon and the director of UCSF's cervical spine and minimally invasive spine surgery programs. He also serves as co-director of the UCSF Spine Center and vice chair of the neurosurgery department.
“The night before surgery, I call my patients. Right before the procedure, they’re busy with starting IVs and intake procedures, which limits my access to them. Chatting the night before helps both of us relax and feel ready for surgery. They get all their questions answered, and I wake up the next day knowing we won’t need to have a conversation at the last minute.
I started doing this during the pandemic because I was finding it stressful to wait until the morning of surgery to confirm that my patients had received their pre-op Covid-19 test results. Pretty quickly, I realized it was so much easier to talk about everything—not just Covid-19 testing. We’re not rushed, and distractions are at a minimum.”
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Dr. Ciara Harraher, MD, MPH, FRCSC
Dr. Harraher is a general neurosurgeon and clinical professor of neurosurgery at Stanford. She also serves as the Chief of Neurosurgery at Dominican Hospital in Santa Cruz and leads the Stanford Neurosurgery Outreach Clinic.
“Taking five minutes to systematically wash my hands has helped me mentally prepare for surgery ever since I started doing it as a resident.
Even though you have the option to do a very quick hand wash with a solution that you can just rub into your hands as you’re walking into the operating room, I prefer the traditional method, where you stand at the sink and use one of the single-use chlorhexidine sponges.
I do it the same way every time, starting with my fingernails and scrubbing each finger before moving on to my palms, the backs of my hands, and my forearms. I use that time to run through each step of the case in my head and think about any challenges or pitfalls that could arise.”
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Dr. Michael Haglund, MD, PhD, MEd
Dr. Haglund is a neurosurgeon at Duke Health, where he also serves as Division Chief of Duke Global Neurosurgery.
“Before we go back to the operating room, I ask every single one of my patients if they’d like to join me in prayer. I understand if it’s not their thing, but out of probably 10,000 patients, only two have turned me down.
Also, when I became an attending physician, I instituted a couple of policies in my O.R.: We play Christian gospel music during surgery, and we don’t tolerate cursing. This is the kind of environment that works best for me and more importantly, it’s best for my patients.”
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Dr. Philip Stieg, PhD, MD
Dr. Stieg is the chairman, founder, and neurosurgeon-in-chief at the Weill Cornell Brain and Spine Center.
“Not many people want to let you go into their brains, so you better be prepared. The night before a procedure, I always go through the imaging.
Then I play the surgery out in my head, from the time the patient walks into the room to the time we roll them out. I do this multiple times to make sure I’m confident about what I’m planning to do, every single step of the way.
When I notice my stress level rising, I hum an old Mountain Dew jingle. It’s stupid, but whenever I start humming some of the words, it calms me right down and lets my team know we’ve got things under control, and we’re going to fix the problem.”
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Dr. Richard W. Williamson Jr., MD, FAANS
Dr. Williamson is a neurosurgeon and the Director of the Allegheny Health Network Cerebrovascular Center.
“I always have a cup of black coffee and a small snack like a piece of fruit or a Power Bar before surgery. That gives me the energy I need to stay laser-focused until the job is done. Eating a heavy meal, on the other hand, can make you feel tired, which is definitely not what you want.
As far as staying focused during surgery, when my tension level starts to elevate, deep breathing really helps to re-center me. But honestly, the best tactic I’ve found for managing stress in the O.R. is to leave my work at work. It can be really hard to do, especially when the challenges are so grave, but having that ‘off switch’ is so important. When I’m at home, taking time to exercise and being present with my family help me to recharge—and be a better doctor.”
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Dr. John H. Sampson, MD, PhD, MBA, MHSc
Dr. Sampson is a neurosurgeon and spine surgeon who sees patients at the Duke Cancer Center and The Preston Robert Tisch Brain Tumor Center at Duke.
“On the morning of surgery, I have a strict ritual of asking patients their name, why they’re here, and where they expect their incision to be.
Once we’re in the operating room, in addition to doing the standard time-out, I ask multiple people to confirm which side we’re operating on.
I also feel that involving as many people as possible optimizes safety, so I invite my residents to call me the night before surgery so we can talk about the case. If that doesn’t end up happening, on the morning of surgery, I invite them to ask questions. Giving them the chance to ask questions that other people might not be thinking about—no matter how naive they might seem—adds another layer of safety and security.”
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Dr. Elad I. Levy
Dr. Michael Schulder
Dr. Ciara Harraher
Dr. Praveen Mummaneni
Dr. Philip Stieg
Dr. Michael Haglund
Dr. John H. Sampson
Dr. Richard W. Williamson Jr.
Dr. Michael Schulder, MD, FAANS
Dr. Schulder is a neurosurgeon at the Zucker School of Medicine at Hofstra/ Northwell, where he serves as Director of the Brain Tumor Center, Residency Program Director, and Vice Chair of the Department of Neurosurgery.
Dr. Ciara Harraher, MD, MPH, FRCSC
Dr. Harraher is a general neurosurgeon and clinical professor of neurosurgery at Stanford. She also serves as the Chief of Neurosurgery at Dominican Hospital in Santa Cruz and leads the Stanford Neurosurgery Outreach Clinic.
Dr. Praveen Mummaneni, MD, MBA
Dr. Mummaneni is a neurosurgeon and the director of UCSF's cervical spine and minimally invasive spine surgery programs. He also serves as co-director of the UCSF Spine Center and vice chair of the neurosurgery department.
Dr. Philip Stieg, PhD, MD
Dr. Stieg is the chairman, founder, and neurosurgeon-in-chief at the Weill Cornell Brain and Spine Center.
Dr. John H. Sampson, MD, PhD, MBA, MHSc
Dr. Sampson is a neurosurgeon and spine surgeon who sees patients at the Duke Cancer Center and The Preston Robert Tisch Brain Tumor Center at Duke.
Dr. Richard W. Williamson Jr., MD, FAANS
Dr. Williamson is a neurosurgeon and the Director of the Allegheny Health Network Cerebrovascular Center.
Dr. Michael Schulder, MD, FAANS
Dr. Schulder is a neurosurgeon at the Zucker School of Medicine at Hofstra/ Northwell, where he serves as Director of the Brain Tumor Center, Residency Program Director, and Vice Chair of the Department of Neurosurgery.
Dr. Michael Schulder, MD, FAANS
Dr. Schulder is a neurosurgeon at the Zucker School of Medicine at Hofstra/ Northwell, where he serves as Director of the Brain Tumor Center, Residency Program Director, and Vice Chair of the Department of Neurosurgery.
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Dr. Richard W. Williamson Jr., MD, FAANS
Dr. Williamson is a neurosurgeon and the Director of the Allegheny Health Network Cerebrovascular Center.