At least that's the saying about us surgical types. We're denigrated as non-thinking monkeys, snap-decision makers who always KNOW what they plan to do.
But that's not the case.
We puzzle. I have many options that are non-surgical for multiple diseases. Patient may have PPP (piss-poor protoplasm) and surgery likely would have a prolonged aftermath. The more medical illnesses, the higher the risk of surgery. Chronic pain folks rarely have a good result from surgery...but I'm not going to feed strong pain meds for that. (let the flaming begin).
And that's just before the operating room. We get into a belly...and find stuff we weren't expecting. A hot appy in a person with chronic pelvic pain (call in general surgery). Omental caking in a person with a normal ultrasound (FUCK!). Adhesions everywhere so that we can't even put in our usual port sites (grumble, grumble). Aberrant anatomy so that we're mumbling under our breath "I'm not sure WHAT this is". It's times like these where we think...and then make a decision.
Easy to hard. That's the mantra of a difficult case...Dissect out what you know. Gain control of the anatomy slowly. Plus this gives you time to think and to plan the next step. It also gives the circulating nurse time to run and grab an instrument that you don't usually use, but want this time.
Almost anyone can do the technical part...the trick to being a good surgeon is
1. Knowing if surgery is a reasonable option and
2. Knowing which technical part to do when it's not a straight forward case.