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What Makes A Great Surgeon?

Discussion in 'General Surgery' started by Dr.Scorpiowoman, Nov 28, 2017.

  1. Dr.Scorpiowoman

    Dr.Scorpiowoman Golden Member

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    I asked twitter yesterday what qualities a great surgeon should possess. I have given this quite a lot of thought over the years, particularly what differentiates the qualities required for a great surgeon from those required by a great anaesthetist, or for that matter a great doctor of any sort.

    I think most of the tweets you see below here are quite self explanatory. I'd like to summarise to begin with, and add a few of my own.

    Summary
    Most of the tweets related to the way the surgeon communicates with their team and their patients. Some mentioned the need to be able to operate well, and I started the ball rolling by saying that to be an excellent surgeon you must have finely honed manual dexterity. There were a few disagreements, making the point that you can operate quite safely with average dexterity, but I'm looking for the qualities that separate an excellent surgeon from an average surgeon. The other qualities mentioned were communication skills, decision making skills, and empathy for their patient.

    Attributes

    Knowledge: A surgeon has to know their stuff. There is a lot of anatomy, physiology and pathology to go through. This is a given really, and also applies to every doctor in every specialty.

    Manual dexterity/economy of movement:

    The 'feel' of your surgical instruments in/on the patient cannot be taught except by experience. Some people may wonder how an anaesthetist can comment on a surgeon's technical ability? Remember I watch surgeons operate every day. I watch them carefully, I analyse their movements, whether they're careful and gentle when handling the tissues, if they use a lot of unnecessary manoeuvres, if they cause injury by carelessness or inattention. If you want to know which of your surgeons are truly excellent, ask your anaesthetist.

    Considering many of my followers are anaesthetists (or anesthesiologists if you're American), I was expecting more people to say that a fast surgeon is an excellent surgeon. I think every surgeon has a natural pace, and that varies from person to person. I think the quality we should actually be looking for is an efficient surgeon, who operates at his own pace, but when you examine what they do, you see that every movement has a purpose. Nothing is wasted. It looks pretty much effortless, like a world-class dancer who makes moves that you know are fiendishly difficult look as easy as a walk in the park.

    Communication/team behaviour

    The ability to communicate effectively with the team and with your patients/relatives was a common theme to many of the tweets. A successful operation is very much of a team effort between the surgeon, anaesthetist, scrub staff and anaesthetic assistant. Great communication inspires your team to work at their peak, often in difficult circumstances. Beforehand they know what the task in hand is, the equipment required is available, and any patient issues are discussed beforehand so there are no surprises when we get to the operating theatre.

    The ability to speak clearly becomes an important issue intraoperatively. There is a lot of background "white" noise (suction, warmer, diathermy etc.) and a large visual aid is removed by wearing a surgical mask. Speaking out loud clearly helps everyone do their job better.

    Being part of the team (helping get the patient off the table etc.) was mentioned, and I wholeheartedly agree. Also it increases the enjoyment of the day if everyone helps each other out. Most days I love my job because of this team spirit. You work with great people to make a difference to someone's life - it's a brilliant feeling.

    Insight/analysis

    To learn effectively from experience you need to be able to analyse your performance, benchmark it against others, and institute changes in what you do to improve. People with no insight don't progress, and people who think they're already brilliant, or are content with a job "just good enough" don't become excellent. An excellent doctor is never satisfied with an average job.

    Decision making skills

    Preoperatively the decision not to operate is often much more difficult than the decision to proceed, even if it's not necessarily in the patient's best interests.

    Equally during the operation there is occasionally a need to bail out, where the risk of proceeding with the operation becomes too great - again another difficult decision.

    Empathy

    A great surgeon doesn't just think of a patient as "a difficult hernia" but has the patient in their mind while they're operating. This is another quality that applies to a great doctor of any discipline, but it's easier to detach yourself when the patient is unconscious and draped up with only the operative site visible. An excellent doctor treats their patient as they would want their own nearest and dearest treated.

    Example

    I'm extremely lucky that in the institution I work in there are some outstanding surgeons, many of them internationally renowned, and I could choose any number of them as my example. I'm choosing a surgeon I've been working with for the last four years once a week. To my great distress she is retiring this year. She is still at the top of her game in every way, and I want to analyse some of what she does to illustrate my point.

    She has all the knowledge and manual dexterity qualities mentioned above. If she sees a difficult patient in clinic she texts/calls me to discuss how we're going to get them through the operation, and we come up with a plan between us.

    She has an absolute passion for her patients and their best interests. She cares for all of them, even if they're demanding, difficult, unpleasant, indecisive or if they don't care for themselves. She communicates well intraoperatively, takes on some difficult cases and is a delight to work with. I'll miss her when she goes.

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