At 35,000 feet, you can’t pull over to check the manual. In the operating room, you can’t pause the bleeding to Google the anatomy.
Both cockpit and OR demand the same superpower—knowing what matters before it’s too late.
Every pilot knows about the situational awareness scan—the continuous visual sweep. Altimeter. Airspeed. Engine instruments. Outside. Repeat.
Every surgeon knows it too. Vitals. Field. Team. Patient response. Repeat.
But here’s what they don’t teach you in flight school or medical school: Situational awareness isn’t about seeing everything. It’s about seeing what’s about to matter.
Invisible Threat
A patient’s blood pressure drops 10 points. A routine variation or the first domino? Your ground speed increases by 20 knots. Helpful tailwind or dangerous wind shear ahead? The answer isn’t in the number. It’s in the pattern.
Great pilots don’t just read instruments. They read trends. Great surgeons don’t just see anatomy. They see stories. Because catastrophe rarely announces itself. It whispers first.
Team Dynamic
In the cockpit, we have CRM—crew resource management, the radical idea that the captain isn’t always right.
In surgery, we have timeouts and briefings. Same principle, different altitude.
But protocols don’t count for awareness. They’re scaffolding. Real situational awareness means knowing when your first officer’s voice changes, when your scrub tech’s movements hesitate, when normal becomes not quite right.
The best outcomes happen when everyone feels safe to say, “Something’s wrong.”
Paradox of Experience
Experience is supposed to improve situational awareness. Sometimes it does the opposite.
There’s the 10,000-hour pilot who has “seen it all” stops seeing. Or the veteran surgeon who “could do it blindfolded” stops watching. We call this “normalization of deviance,” and the data is there to prove it happens. Expertise can go on autopilot—and autopilots don’t think.
The cure? Deliberate discomfort. Fly different aircraft. Operate different cases. Break your patterns before your patterns break you.
Three-Dimensional Chess Game
Aviation taught me something surgery couldn’t.
In the OR, threats are mostly linear. This leads to that. Cause creates effect.
In the cockpit, threats are three-dimensional. Weather above, traffic beside, terrain below—all moving, all changing, all interacting.
But here’s the insight: Every surgery is actually three-dimensional too. The patient’s physiology (your weather). The team dynamics (your traffic). The technical challenges (your terrain). We just pretend it’s linear because linear feels safer.
The Transfer
What transfers between the cockpit and OR isn’t technique—it’s temperament.
It’s the ability to be simultaneously relaxed and vigilant. to trust your training while questioning your assumptions, and to act decisively while staying open to new information.
This isn’t taught—it’s caught. Caught in those moments when everything goes sideways and you realize panic is a luxury you can’t afford.
Real Enemy
Complacency kills more pilots than weather. Assumptions kill more patients than complications.
The enemy isn’t the unexpected. It’s the expectation that you’ve seen it all.
The Question
They say the superior pilot uses superior judgment to avoid situations requiring superior skill. The superior surgeon? Same rule, different sky.
But here’s what matters: Situational awareness isn’t about perfection. It’s about perception. Not just seeing what is, but sensing what might be. Not just knowing where you are, but knowing where you’re headed.
Whether your altitude is measured in feet or millimeters, the principle remains: The best time to notice something’s wrong is before it is.
