American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

For Our Patients: On Becoming the Surgeon Advocate, Leader, and Learner

On a simple search of the definition of Surgeon, google provides the answer “a medical practitioner qualified to practice surgery.”

When I walked into the operating room for the first time as an attending physician, I felt confident that having been through countless years of training, I was more than qualified, and what I would be doing would no longer be considered “practice.” I knew all of the things my mentors taught me, how to position the patient, gain exposure, minimize bleeding, and manage a patient’s medical conditions to help them recover after surgery. I knew that I had to continue reading all of the important medical journals, and attend the national meetings to stay up to date on the latest advancements. I assumed that I would come to the hospital and everyone would follow in step with what I learned in my residency and fellowship and I would move forward with the same strides as my mentors before me. What I realized after that first day through personal experiences both positive and negative, is that it takes a lifelong commitment to be a surgeon, and having the qualifications to practice surgery is just the first step.

Learner

The performance during surgery is a crucial step in the healing of a patient, with any misstep resulting in sometimes life altering or even life ending consequences. The decision-making during surgery and the technical skill of the surgeon can continue to improve over time. However, to see actual improvements, every case must be analyzed and critiqued in order to understand what could be done better for the next case. To critique oneself or allow a third party to analyze what you do and make a suggestion is not an easy task. As I said on my first day in the hospital, I thought the way I knew how to do surgery was the best and that was final. Now three years later, all of my first assistants in surgery, nurses and scrub techs as well as co-surgeons, know that I will always ask them at the end of the surgery, “what do you think we could have done better?” This process is something I look forward to. It is inclusive and allows the entire team to be engaged and invested in the patient’s outcome.

Advocate

As I began to see patient’s in my office, evaluating patient’s symptoms, diagnosing their cancers, and treating them with surgery, something I never fully felt during training was the impact of seeing them back 3 months, 6 months, 12 months and now 36 months after their initial surgery. It is an easy observation one can have after spending time in the hospital, the patient’s who have visitors nearly the entire stay whether it is at 6 am or 9 pm, the patient’s who have their friends and family supporting and encouraging their recovery seem to be happier and do improve faster than those who are alone. Similarly, it is the patient who has a positive outlook, no matter how dreadful the treatment course is or becomes, that takes every breath with happiness rather than despair who experiences a better quality of life before and after surgery. It is how your patient’s live 1 month and even 3 years after surgery that define how well you did for them. These observations, three years later, are as crucial as the actual surgery. A typical office visit now involves allowing myself to be a direct communication line for the patient to explain what they are afraid of and what their goals are. I will see the patient’s more often to gain their trust and at each visit reinforce the tools necessary to maintain a positive outlook and keep not only their physical but mental fitness in good shape. Through having my patient’s keep gratitude journals, frequent phone calls myself or my team will make, and listening to my patient’s I find myself personally more satisfied and my patient outcomes are improved whether it is a situation involving a cure or the end of life.

Leader

The post of a surgeon is naturally one of leadership. At every patient encounter, from the office, pre-operative area, surgical room, recovery and even the home, effective communication, organization and respect must be visible for the patient to have the best chance for success. This can be very difficult, especially when you look like you are in high school and the entire team of people you are working with are twice your age. Understanding what is good for your patient does not always translate into knowing how to get the most out of your team. Mentors who I consider gods of surgery led through intimidation and sarcastic outbursts of anger. This seemed to be the accepted paradigm for getting the most out of each member of the team. Of course, three years into practice, mutual respect, two-way communication and very clearly stated goals, along with consistent feedback have resulted in each team member working at their best to reach the stated goals for our patient. Leadership has been learned on the job through trial and error, along with many apologies and gift cards. As much as we should listen to our patient’s, we must listen to our team. Rather than intimidation, lead with admiration.

Now, more than 3 years after that first day in the new hospital, I am only starting to feel comfort in what I do, and even that is with caution. It is not a right but rather a privilege to be a surgeon and this should be sought after and earned on a daily basis.