Authors
Joseph Salem-Hernández, Roberto Cardona-Quiñones, Saidy A Salem-Hernández, Norman Ramírez, Rafael Fernandez-Soltero, Jose Bossolo-Flores
Published in
Cureus. Volume 18. Issue 8. Pages e115092. Epub Aug 24, 2026.
Abstract
Orthopedic surgeons dedicate their careers to treating musculoskeletal injury, yet when they become patients, professional culture discourages disclosure, treats help-seeking as weakness, and provides no structured pathway to care without career consequence. This narrative review examines the ethical dimensions of surgeon injury through two complementary concepts drawn from Jungian psychology: the wounded healer archetype and shadow integration. We searched PubMed, Scopus, and Google Scholar from January 1975 to May 2026 for literature on the physician as patient, occupational injury and burnout in orthopedic populations, help-seeking behavior, peer support after adverse events, and the wounded healer archetype, and we selected sources on the basis of relevance to the ethical questions addressed here rather than by formal quality appraisal. The literature describes two divergent trajectories. Where personal suffering is acknowledged and integrated, it is associated with higher measured empathy and with reported changes in how clinicians listen and tolerate uncertainty. Where it is suppressed, the pattern we describe as 'shadow projection' may follow, with distorted clinical judgment, reduced empathy toward patients reporting pain, and ethical failures that credentialing systems are not designed to detect. This second trajectory is offered as a conceptual interpretation and a hypothesis for testing, not as an empirically demonstrated causal pathway. Two fictional composite vignettes, constructed for illustration and not drawn from any identifiable surgeon, patient, or published case report, are used to make the two trajectories concrete. From this synthesis we derive an ethical framework addressing four domains: disclosure to patients and institutions, the duty to operate, the timing of return to the operating room, and the reciprocal obligations institutions owe their surgeons. We also propose practical recommendations for departments, training programs, and professional societies. The central argument is not that Jungian psychology replaces clinical judgment but that it provides a vocabulary for the conditions under which clinical judgment may fail silently.
PMID:
42781602
Bibliographic data and abstract were imported from PubMed on 25 Sep 2026.
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