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Before the First Incision

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How much information does an experienced surgeon actually gather before making the very first incision?

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HODA-A™ Clinical Insight Series · Publication 012

Before the First Incision

Why better assessment matters more than better instruments

Dr Jo Abbott, PhD — Clinical Biomechanist · Anatomist · Clinical Nutritionist · Independent Musculoskeletal Researcher

How much information does an experienced surgeon actually gather before making the very first incision? Every profession that opens the human body carries responsibility of the sharpest kind, and surgery has always known it: the most consequential decisions are often made before theatre — whom to operate on, when, and whether to operate at all.

Imaging and robotics have transformed what happens inside the incision. Yet surgeons still describe tissue by feel, judge planes by resistance, and know within moments when what the scan promised is not what the body presents. Surgery’s own human-factors literature has reached the conclusion this series is built on: adverse events are rarely just a question of technique. In this twelfth publication of the HODA-A™ Clinical Insight Series, Dr Jo Abbott draws on eight years of doctoral research into how skilled hands and trained eyes become a measurement instrument.

Written for surgeons, surgical trainees, surgical care practitioners and perioperative teams, Before the First Incisionexamines the clinician as instrument — how attention, expectation and context shape what we find on examination and at the table; why experience alone is not calibration; and why the quality of the perception-and-reasoning chain is what separates a considered intervention from a routine one. Its central argument: before we test reliability, we must stabilise the instrument.

Includes written feedback from HODA-A™ participants across the hands-on professions, selected further reading, and an introduction to the Level 1 Perceptual Calibration Certification — including private team cohorts for groups of eight or more.

Format: Free PDF download · 10 pages · may be shared in full and unaltered
Series: HODA-A™ Clinical Insight Series, Publication 012
Published: July 2026 · © 2026 Dr Jo Abbott

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Dr Jo Abbott Ph.D
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