Good Surgeon – Excellent Surgeon – Great Surgeon!!!

Good surgeon means good education and good training. The education and training should fulfil two main objectives. The first one is to develop good manual dexterity. A surgeon without adequate manual skills is not a surgeon. He should also acquire a wide range of clinical and scientific knowledge relevant to the chosen specialty. Not every trainee who develops high technical skills and acquires sound theoretical knowledge becomes a truly good surgeon. He should have high intellectual potential and good communication skills. He should participate in scientific research with regular publications which is one of the ways of self-improvement and of keeping up-to-date.

Surgeons – particularly those who are in the early stages of their career – might emulate to become truly excellent surgeons. The best surgeons have mentors (Gurus). Mentors guide us through a career path. They provide sage advice, personal counselling and support our growth. Mentors go beyond teaching; they impart wisdom. A good mentor sees the potential in the mentee and facilitates his development. Achieving excellence, becoming the best, is almost always associated with outstanding mentorship. My teacher (my Guru) used to say everyone should have Guru in ones life. Guru does not mean religious leader but a person who leads your life, in addition to surgery, even hand holding in surgery. Surgeons often equate excellence with the mastery of surgical technique, accompanied by other attributes, such as knowledge, poise, and common sense. These virtues separate a good technician from a good surgeon. Excellent surgeons know when to operate and when not to operate. They understand that decisions are more important than incisions of surgery. The ultimate goal of an operation is to benefit the patient, not the surgeon. Excellent surgeon does not believe in the narcissistic concept. “I have done, what others could not,” Excellent surgeons follow the principle “first, do no harm”, Henri Bismuth, an expert in the hepatobiliary field, said when talking about reckless surgeons, “I have never seen a surgeon dying in the operating room as a result of his reckless performance. But I have seen patients die, or feel pain, or undergo complications because of these reckless surgeons. “Excellent surgeons are not the ones who fight cancer regardless of the consequences brought about by this fight and who justify their decisions as necessary to eradicate a disease, even at the expense of their patients’ lives. These surgeons know that a thorough informed consent does not equal the right to carry out procedures that can lead to serious complications for their patients.

Excellent surgeons may operate slowly, but think quickly. Excellent surgeons never seem to be in a hurry. Deliberate, precise movements, without any wasted motions and following the right planes, usually result in a faster conclusion of the procedure. Time should not be the driver; perfection should be. An excellent surgeon’s ego should not be bruised when there is a need to stop, move back, and rethink when the patient’s best interests are at stake. Such surgeons make operation look effortless. They do not seem rushed. Excellent surgeons are patient.

Complications worry all the surgeons but do not become an obsession. Excellent surgeon try to sort them out, learn from them, and avoid future ones. They generously share their knowledge. At the same time, they are aware that their knowledge is limited and are willing to study and learn from others. They are constantly learning and investigating, and transmit their knowledge to future generations. People who have nothing to learn from others have nothing to teach.

More than first-class technical skill, an excellent judgement is always required when performing an operation. Even the best surgeons can have operations go unexpectedly wrong leading to disaster. Calmness of the mind is then required, not rising panic, not blaming your assistant, not shouting at the scrub nurse. Such events may occasionally require humility and moral courage, by the need to call for further skilled assistance rather than pressing on with perhaps inadequate or inexperienced assistance. Massive bleeding is an example. However senior, however experienced, the great surgeon will feel no loss of face in asking for help from a colleague. Rightly, there is now great emphasis on the importance of team working. Team working in the operating room is the norm. A good team of a surgeon may have the same scrub nurse and the same anaesthetist and an assistant who had been attached to the him for several months, may be longer.

Few surgeons are great masters! Great surgeons lead the surgical procedure and support all the members of the surgical team. In this collaborative setting, team members feel protected amid the stress and empowered to speak up and contribute. Respect and mutual support for every member of the team brings out the best in every member. The great surgeons, as leaders of their team, will take full responsibility for the actions of their team when things go wrong. When things go right, excellence in leadership requires that surgeons identify those who made “the right thing” happen. Never miss an opportunity for public praise. Such surgeons enjoy their work. Passion for a profession is like falling in love. For them surgery is not a job that must be done to survive. It is a choice. The great surgeons know their limits. Experiencing fear before a complex procedure is a normal and helpful feeling. Fear keeps you focused and alert. Only the reckless feel no fear. Managing fear when facing risks is key to excellent performance in surgery. The great surgeons realize that fear is part of a surgeon’s life. The great surgeons consistently audit their results. They are fully aware of both their abilities and limitations. Through introspection, they are motivated to seek continuous self-improvement. The relentless pursuit of perfection in everything we do is the hallmark of a surgeon.

The mature and great surgeons establish trusting relationships with their patients and their families.  Patients are people – people with needs that extend beyond the mere treatment of a physical illness. The great surgeons feel the pain of their patients and the concern of their relatives as if it were their own. The great surgeons listen more than talk. The great surgeons are grateful and humble. The great surgeons do not know that they are the “best” and do not strive to be considered the best. Rather, they know they can always improve and are receptive to knowledge that will benefit their future patients. These surgeons are grateful to their mentors and constantly honour their memory by passing on their example to future generations. Once surgeons have lived a life in surgery and reach a certain age, it can be difficult to humbly accept retirement. The great surgeons know when to leave the operating room for good. It is always better to do so one year too early than one day too late. Great surgeons find ways to balance two important aspects of life, focusing on their patients while at work and living lives of fulfilment with family and friends when out of the hospital. The nourishment of the soul provided by these moments will be reflected at work, yielding excellence.

The ability to communicate with patients and their relatives in a quietly confident way, at all times being honest and understandable is part of the hallmark of a master surgeon. Arrogance or seeming superiority should be abhorred. Communication and team working are necessary components of good leadership, a quality which is also part of the persona of the master surgeon, who is also likely to be a good teacher – avoiding humiliation of a student or trainee in front of others.

Knowledge has been handed to us, and we must pass it on. Taking time to pass it on is the rent that we pay for the privilege of being here.You may be a technically very good surgeon; an excellent surgeon but try to be a great surgeon and a master teacher!!

Pahle Sajjan Bano, Phir Surgeon Bano!

Dr. A.K. Dewan
Director – Surgical Oncology