The biggest lessons a physician learns in the beginning of their career can influence how they practice years later.
Seven spine surgeons share what they learned early on in their time working in the field.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker's invites all spine surgeon and specialist responses.
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Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CST Wednesday, August 14.
Editor's note: Responses were lightly edited for clarity and length.
Question: Early in your career, what was the first big lesson you learned as a spine surgeon?
Rachel Bratescu, MD. George Washington University (Washington, D.C.): One of the first big lessons I learned is the difference between what you could do versus what you should do for a patient. This is a challenging and subjective balance. Born out of necessity and part of the education process as a trainee is a heightened emphasis on developing a surgical plan independently, preceded by questions from mentors like, "What would you do?" We often find ourselves thinking about a variety of surgical approaches and in some cases of increasing morbidity as we perform this exercise when the key is listening to the patient, their goals and also considering the psychosocial and medical impacts of an intervention.
Thomas Errico, MD. Nicklaus Children’s Hospital (Miami): Early in my career, due to the good results I was getting with my patients, I was asked by colleagues to operate on family members. Over time, the requests came in for surgery on colleagues. Some of these did not go as planned fitting in the aforementioned maxim about operating on doctors or their families. This resulted in a great deal of self reflection. I wasn’t "nervous" or didn’t carry out the "plan" but I was not getting my usual results.
Over time, I came to realize my problem. The request for care came because of the results I got with my usual "standard of care." Either consciously or unconsciously, however, I was not giving my doctor patients my "standard of care." I would deviate from my fundamental routines to do something "extra" for them. After all they were valued colleagues, and I was honored by their putting their faith in me.
This was misguided. By doing something "extra" for them I was deviating from the routine that brought my usual good results. Sometimes the "extra" change was because they requested I do something "their way." That is a huge mistake. Doing it "their way" is something that should happen if I went to them! If I try to do it "their way" in my hands the results will be unpredictable. "Special patients" should be treated as you treat the rest of your practice. Don’t deviate or give them special exceptions. This will help ensure you both get the results that brought them to you in the first place.
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: Perhaps one of the biggest lessons I learned was hubris is the enemy of humility. I think most of us have had a case where every up was a down, and every left was a right and all the things you learned in residency and fellowship did not work.
You learn to be very humble when modifying such important structures in the human body such as the brain or the spine. We all learn the most from the hardest lessons.
The other lesson was, when a payer promises they will pay you on such and such a date, and such and such amount, no matter how iron-clad the contract is, expect skullduggery on their part.
Kamran Khan, MD. Endeavor Health Neurosciences Institute (Naperville and Woodridge, Ill.): Just because you can doesn't mean you should. Coming out of fellowship, you learn amazing skills and know about great technologies, but it's important to understand where you are when practicing.
Sometimes even though you may have the necessary skills, the location in which you are practicing may not be able to support all those skills. But know the institution eventually will be able to support those skills.
Yu-Po Lee, MD. UCI Health (Orange, Calif.): There are some truisms in medicine. One of which is "always listen to the patient" and another would be "if you did not chart it, then it did not happen." One that is not really mentioned is that "we are part of a community." Spine surgeons, like all physicians, are part of a very small community. It is important to keep in mind how important it is to be respectful and considerate to others in our community.
As spine surgeons, we are often placed in an environment where we compete for patients, compete for better payors, and compete for hospital resources. In such a competitive environment, it is not always easy to be considerate to others. But it is important to keep in mind that we create the type of community that we live in. If we see a patient from another surgeon for a second opinion, we can influence how that patient perceives that other surgeon and that can have significant consequences.
Early in my career, a patient to whom I had recommended surgery went to seek a second opinion from another local surgeon. The other surgeon explained to the patient that he agreed with my decision and expressed confidence in me. Because of that, the patient felt much more comfortable with me and it made the rest of my interactions with that patient much easier. I was very grateful to that other surgeon, even though I had never met him. We only knew of each other by reputation. But I was also very mindful of extending him the same courtesy whenever I saw any of his patients for a second opinion.
One of the biggest lessons that I learned early on was that it is important to be respectful and courteous when speaking of other surgeons when you see their patients.
Marc Levine, MD. RWJBarnabas Health Medical Group (Hamilton, N.J.): Although perhaps a statement of the obvious, young spine surgeons should understand that we/they are in the business of taking care of patients. Before the first day of starting a new practice, a surgeon should create pathways and systems that provide care to patients and lead their care team.
From the office to the operating room, developing the resources to deliver the expertise of a young surgeon will allow for a more seamless transition. Young surgeons need to stay committed early on to strive for excellence and act as role models for others on their care team. A great chef has the skills/knowledge to deliver a great meal, but only if their kitchen has the right ingredients and support team to serve the meal. Whether it is in the office or hospital, or your kitchen(s), be prepared.
Noam Stadlan, MD. Endeavor Health Neurosciences Institute (Skokie and Highland Park, Ill.): My first big lesson as an attending was responsibility for my patients, especially the ones I operated on. It is easy to take credit when patients do well. It is much more difficult to acknowledge when patients have a less-than-optimal result, even when technically the surgery was perfect. Early recognition, acknowledgement, workup and treatment of patients can only happen when the surgeon takes responsibility for the outcomes, both great and (rarely) not so great.