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

Operating Room Demeanor: An Important Aspect of Surgical Leadership

Will Ferrell, the actor, is attributed to saying, “Before marrying someone, give them a slow internet connection to find out what kind of person they truly are.” I would expound on that principle and say, give a surgeon a poorly working laparoscope or an accidentally contaminated operative field to truly find out what kind of person they really are.

Most surgeons can immediately recall some significant emotional events of our teaching faculty from the operating room during our training. How many of those experiences modeled our own behavior and in doing so were then propagated down the line to more students that had the misfortune of working with us? Our operating room demeanor, actions, and how we treat those we work with on a daily basis says a great deal of what kind of physician we are, but I would argue that it says even more what kind of person that we are. Do we carry our frustrations, fears, and insecurities to our personal pulpit? Are those then combined with our interactions with the operating room staff, medical students, and residents that we work with because it’s an outlet that is available to us? What does an attending with a frenetic operative technique, constantly moving the lights, dropping a retractor to grab the suction, moving back and forth from opposite sides of the field, have going on in his or her life? Yelling, joking, sulking, sighing; all behaviors we have seen to some degree or another every day in the operating room may hint at more internal issues rather than external ones. I will be the first to admit, we all have bad days, and I am not without reproach, but I challenge us as surgeons to be present with our day, our actions, and ourselves. In addition to it just being the right thing to be courteous to those around us, demonstrating a positive model for those in training to emulate will ensure the continuation of the highest quality surgeons and physicians in the future.

There’s a fairly famous recent college commencement speech by Admiral William McCraven, former commander of United States Special Operations Command. To be successful in life, he challenged the graduates to change the lives of just ten people. And if those ten people change the lives of ten more people and so on and so forth, what an amazing world we would live in. It doesn’t require huge differences, such as providing financial aid to a medical student or funding a cancer center, although those are incredible endeavors. A simple way to start for all of us is modeling behavior as teachers and role models for those future surgeons training with us. The mentor-mentee model championed in the past few years by the American College of Surgeons lends a platform for us as surgeons to do just that. The demeanor in our practice, witnessed by those we work with, for, and above can have lasting effects, both positive and negative. An adage of a group that I had the privilege to work with while serving in the military was “Someone is always watching.” The layers of depth of this saying went beyond the mere acting professional, or being careful with actions and interactions as security and safety of your peers depended on it. It also meant despite reaching a certain level of seniority, there were no changes in expectations, if anything; the acuity of observation was sharper and less forgiving which in the surgical world is often not the case.

As a fourth year medical student, while on an elective rotation in my hometown, the surgeon addressed the scrub tech as we entered the operating room pointing to me, “This is Dr. Skroch’s grandson.” Even though she was wearing her surgical mask, I could see her eyes light up and hints of a smile. “Dr. Skroch was the kindest surgeon I’ve ever had the pleasure of working with.” At this time, my grandfather had been retired about twenty years from practice as a general surgeon. It was a powerful moment for me to see that his actions in the operating room removed so many years, still carried such a positive emotion with those he worked. Does it say something about my grandfather being exceptional in whom he was or does it say more about who we are as surgeons that a scrub tech with a career of over forty years of experience and exposure to countless surgeons singled him out even after twenty years of not practicing? Probably a little bit of both.

In an era of surgical education that far preceded the revisions of work hour restrictions and recognition of toxic work environments, my grandfather practiced as a surgeon as he lived his life, graciously and always with a smile. His smile was magical, always a hint of smirk demonstrating his intelligence and wry sense of wit. To say that my grandfather was a role model for me minimizes his impact on my life and my suspicion of many other of his grandchildren, colleagues, students, and most importantly his patients. In the digital era, could a web diagram be made with Eugene Skroch, MD FACS in the middle? What would it look like if the basis of the diagram were changing a life as charged by Admiral McCraven?

We are who we are and as we get older, fewer and fewer life events have the capacity to fundamentally change us in regards to our core values. For trainees, the chances are much higher and senior surgeons have the ability to be an influence in those changes. May it be for the betterment of our future surgeons and our profession that we answer the challenge of Admiral McRaven and model Dr. Skroch and change the lives of just ten people, above and beyond the numerous numbers of patients that we affect on a daily basis.