Doctor Strange

Doctor Strange is a 2016 feature-length film featuring Benedict Cumberbatch as the eponymous protagonist. Produced by Marvel Studios and based on a Marvel Comics character, the plot follows an acclaimed New York neurosurgeon. Severely injured in a road traffic accident on his way to a conference, Doctor Strange sets out on a search for healing and, as a Marvel superhero, naturally ends up defending the world against dark forces.

But let’s take a look at Marvel’s depiction of Doctor Strange as a neurosurgeon. How realistic is it, and what imagery is used to demonstrate surgery and surgical teamwork to the lay audience?

The surgery scene opens with Doctor Strange at a scrub sink; the water from the tap runs from his fingertips to his wrists. Scrub-up guidance worldwide recommends scrubbing from fingertips to elbows and Doctor Strange might, therefore, have had a suboptimal scrub. While there is no high-level evidence supporting a fingertip-to-elbows scrub, in the real world he may have found himself on the receiving end of stern words from a hawk-eyed theatre sister.

Doctor Strange then dries his hands, dons a gown and protrudes his bare hands fully from the cuffs of the gown. This might be considered acceptable practice if sterile gloves are donned immediately, covering the cuffs of the gown. However, Doctor Strange then places a paper mask on to his own face using his ungloved hands – this is completely unacceptable practice and would necessitate a re-scrub and re-gown using appropriate aseptic technique.

No re-scrub for Doctor Strange, however, who immediately appears masked and gloved, ready to perform surgery. His instrument handling is very good, with suction in his left hand and a bipolar diathermy in his right. Although his hands and wrists are not stabilised, he holds his instruments like a surgeon and not like a child using cutlery for the first time, which is often the case in TV and film. It is not clear what surgery he is performing through a large craniotomy but he is in a standing position, which does not offer optimal visualisation of his surgical field. 

With instruments inside his patient, Doctor Strange taps his foot (acceptable), dances a little (questionable) and looks to his left as a colleague moves across the room (completely unacceptable). As his surgical supervisor, I would most definitely offer feedback about his focus, in the context of patient safety.

His subsequent discussion with his colleague – a nuanced discussion about the release date of an album – demonstrates Doctor Strange’s excellent memory and attention to detail. 

As he removes something from his patient’s craniotomy using a crocodile forcep (more commonly used in otolaryngology than neurosurgery), he makes eye contact with an attractive woman behind a glass door. His scrub nurse notices this interaction and excuses him. She uses his first name – “I’ve got this, Stephen, you’ve done your bit” – which seems a little informal but is perhaps an insight to the real Doctor Strange, who, despite his superhero status, prefers first-name terms and a flat hierarchy in his operating room.

Cumberbatch is a convincing and engaging Doctor Strange. His attention to sterile fields requires some serious work and he needs to write a reflection or two on patient safety in the context of his distractibility in the operating room. But his human touch, his relaxed and confident demeanour and his positive relationship with his colleagues are an excellent basis for a strong surgical team… and defending the world against dark forces.