Originally published in the December 2014 issue of Veterinary Practice News "A great surgeon is someone who makes a difficult surgery look easy," a colleague once told me. How do you know if you are a good surgeon? How do you know if you are a great one? What does it even mean to be good or great? Does it mean saving all your patients? Does it mean not shaking like a leaf while suturing? Does it mean being worshipped by your technicians? Does it mean knowing it all? Does it mean getting flowers from every pet owner? Trying to define which qualities we strive for, I submitted a challenging question to a number of board-certified surgeons, in the U.S. and abroad: What qualities does a great surgeon have? I heard so many excellent answers that I can share only the top 10—those mentioned the most frequently. 1. Be Ethical Ironically, the most important trait of a surgeon, based on the number of similar responses, is knowing when not to perform surgery. "A chance to cut may not be a chance to cure,” said Joe Harari. “Case selection is king; technique is the prince,” confirmed Steve Withrow. “Integrity goes beyond being honest with clients,” said Jennifer Wardlaw. “Honesty also applies to yourself and your team.” 2. Be Knowledgeable “Good judgment comes from experience; experience comes from poor judgment,” said Withrow. All of the surgeons insisted on the importance of knowing surgical anatomy. But being a great surgeon also requires being a good clinician, mastering other disciplines, such as physiology, pharmacology, pathology, anesthesia, radiology, medicine, etc., managing patients postoperatively, being aware of cutting edge and evidence-based therapies, keeping up-to-date with current literature, and so much more. Charles Kuntz calls this the “deliberate and continuous desire to improve.” He had a mentor who said that no matter how well a surgery went, you should come out with three things you could have done better. “Experience and repetition lead to surgical efficiency,” said Mike Pavletic. “This begins with an excellent foundation of training as an intern and surgical resident.” Yet Withrow reminds us that practice makes us better, not perfect. A great surgeon is always willing to be challenged by co-workers. They should be comfortable asking the surgeon, “Why?” “Because we’ve always done it that way” should never be the answer. 3. Be Sympathetic Let’s never forget that “surgery time is very stressful for pet owners,” Wardlaw said. This applies to any surgery, but particularly to cancer surgery because of the fear it can generate. In addition, we should remember that we don’t just treat a knee or a fracture, but an entire patient, who requires compassion and pain relief. 4. Be Adaptable “Experience allows having plans A, B and C in mind, as situations change or tissues are deemed suboptimal,” Wardlaw said. “For example, adaptability is required with fracture fixation, reconstructive procedures and oncologic surgery.” Mike Pavletic considers that innovation, creativity and thinking outside the box are important traits during challenging cases in which conventional surgical options are not sufficient. “Mobile surgeons are a breed apart, and they require an extra dose of adaptability to adjust to multiple environments,” said Justin Harper. 5. Be Atraumatic “Good hands make a good surgeon excellent,” Wardlaw said. In addition, holding instruments smoothly, gentle tissue handling to minimize trauma, good hand-eye coordination and delicate motor skills are all critical. “Be a thinking biologist and not a slashing technologist,” Withrow recommended. Don’t hesitate to practice on cadavers or to learn from more experienced surgeons. “The surgeon must pay attention to every aspect of atraumatic technique, from the first incision to the last suture,” Joe Bojrab said. 6. Be Humble “No screamin’ and throwin’ stuff,” Harari said. We are not here to save the world. “Let your hands do the talking, not your ego or your mouth.” Pavletic said, “A surgeon with the greatest talent in the world and a bad attitude is fully capable of destroying any practice.” “Confidence does not equal arrogance; arrogance does not equal ability,” Withrow said. We should be comfortable saying “I don’t know.” “Ask for help,” Pavletic advises. Turn to colleagues, mentors, journals, listservs and subspecialists. 7. Be a Communicator “Effective communication and interactive skills are paramount,” Pavletic said. This applies to pet owners, co-workers and referring veterinarians. The entire plan should be clear, beyond surgery, “including postop care, pain management, risks, complications, outcome, rechecks, test results and physical therapy,” Wardlaw said. 8. Be Prepared Whether before, during or after surgery, it is not a complication if you are prepared to handle it, Harari said. Dealing with it calmly and logically is the key, along with honesty and compassion. In addition, a commitment to resolving the complication is important for a successful resolution. 9. Be Accurate Accuracy does not apply only to cutting tissues. “It also involves attention to details with patient care and record keeping,” Pavletic said. 10. Be Super(wo)man All the surgeons suggested multiple other traits necessary to qualify as a well-rounded and charming surgeon. Justin Harper believes that persistence, wisdom, patience, efficiency, effectiveness and being outgoing all matter. Wardlaw added the capacity to multitask, in order to treat multiple complicated cases at once, be aware of anesthesia while focusing on surgery, and accept to be interrupted during surgery. Withrow describes the three H’s (head, heart and hands) and the three C’s (caring, competence and continuity of care). Pavletic values life-long learning, a good sense of humor and a willingness to help. Beware of loud music, insisted Harari. “The beeping of the monitors should be sweet music to our ears.” There are several benefits in carefully studying this list of attributes: It is always a good idea to know what great minds in the surgical world admire in their peers and mentors. It can guide you to mentor a young surgeon. It will help you to make the correct hiring (or firing) decision. It can help you assess your own greatness by taking a good look in the mirror—if you dare. It will help you to know what to strive for if you want to be one of the great ones. Acknowledgements Dr. Zeltzman thanks the surgeons in his poll: Joseph Harari, a surgeon in Spokane, Wash. Mike Pavletic, a surgeon in Boston n Jennifer Wardlaw, a mobile surgeon in the St. Louis area Justin Harper, a mobile surgeon around Boerne, Texas, and Joe Bojrab, a surgeon in Las Vegas He also thanks Julius Liptak, a surgeon in Ottawa, Ontario, Canada, and his generous international colleagues at the Veterinary Society of Surgical Oncology: Stephen Withrow, Jolle Kirpensteijn, Rod Straw, Robert Dudley, Sarah Boston, Sebastian Gordon, Charles Kuntz, William Eward, Daniel Ogden, Damiano Stefanello, Chad Devitt, Aylin Atilla and Cassie Prpich.
