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From the Editors: Querencia
In the flood of emails, periodicals, Twitter, Facebook, Doximity, Medscape, and other information that washes over surgeons every day, why should they use their precious time to read ACS Surgery News? That question is foremost in the minds of the editors of this publication as we consider news stories and commentaries for inclusion. Is this an article our readers are going to find informative, pertinent, and stimulating? We want ACS Surgery News to be a querencia: a source of reliable, vetted information that gives surgeons a place of intellectual security along the information highway.
The editors of ACS Surgery News understand surgery from the scrub sink up. While our mission includes keeping our readers informed about these looming thunderstorms, we are also privileged to report progress and innovations that keep coming no matter how the forces of red tape and commerce play against our profession. Bringing news of both challenges and beacons of hope for our profession with commentary and perspective from our colleagues is our objective. For the editors, this is both a mission and a pleasure. Since most of the editors and our Editorial Advisory Board (EAB), like our readers, must focus primarily on our jobs as surgeons, teachers, and researchers, we cannot read every journal or attend every meeting. The role of ACS Surgery News is to find the relevant news of interest and importance to surgeons, wherever it may be found, and to report it succinctly and accurately in a readable form. Before an article appears in ACS Surgery News, it is reviewed by the author of the paper or presentation for accuracy and reviewed by the most appropriate member of the EAB as well as by both Co-Editors for importance and relevance to our surgeon readers. We do not want to shy away from controversial topics, but endeavor to present such topics with balance and sensitivity, just as the ACS itself always attempts to do: to shed light, rather than merely heat, on all subjects that we cover in our pages.
The editors of ACS Surgery News hope that in the months and years to come, this publication can be a querencia for the surgeon: a safe and secure place to engage all the forces that a surgeon must confront to be successful. In these pages we hope you will find knowledge, wisdom, camaraderie, and support for your practice, whatever that may be.
Surgery is a life of great joy and great sorrow, sometimes happening all within the same hour. We hope to be part of the joy and to soften the sorrow by being a publication you look forward to reading and wherein you find those things that contribute to your being a great surgeon and human being.
Dr. Deveney is professor of surgery and vice chair of education in the department of surgery, Oregon Health & Science University, Portland. She is the Co-Editor of ACS Surgery News.
Dr. Hughes is clinical professor in the department of surgery and director of medical education at the Kansas University School of Medicine, Salina Campus, and Co-Editor of ACS Surgery News.
In the flood of emails, periodicals, Twitter, Facebook, Doximity, Medscape, and other information that washes over surgeons every day, why should they use their precious time to read ACS Surgery News? That question is foremost in the minds of the editors of this publication as we consider news stories and commentaries for inclusion. Is this an article our readers are going to find informative, pertinent, and stimulating? We want ACS Surgery News to be a querencia: a source of reliable, vetted information that gives surgeons a place of intellectual security along the information highway.
The editors of ACS Surgery News understand surgery from the scrub sink up. While our mission includes keeping our readers informed about these looming thunderstorms, we are also privileged to report progress and innovations that keep coming no matter how the forces of red tape and commerce play against our profession. Bringing news of both challenges and beacons of hope for our profession with commentary and perspective from our colleagues is our objective. For the editors, this is both a mission and a pleasure. Since most of the editors and our Editorial Advisory Board (EAB), like our readers, must focus primarily on our jobs as surgeons, teachers, and researchers, we cannot read every journal or attend every meeting. The role of ACS Surgery News is to find the relevant news of interest and importance to surgeons, wherever it may be found, and to report it succinctly and accurately in a readable form. Before an article appears in ACS Surgery News, it is reviewed by the author of the paper or presentation for accuracy and reviewed by the most appropriate member of the EAB as well as by both Co-Editors for importance and relevance to our surgeon readers. We do not want to shy away from controversial topics, but endeavor to present such topics with balance and sensitivity, just as the ACS itself always attempts to do: to shed light, rather than merely heat, on all subjects that we cover in our pages.
The editors of ACS Surgery News hope that in the months and years to come, this publication can be a querencia for the surgeon: a safe and secure place to engage all the forces that a surgeon must confront to be successful. In these pages we hope you will find knowledge, wisdom, camaraderie, and support for your practice, whatever that may be.
Surgery is a life of great joy and great sorrow, sometimes happening all within the same hour. We hope to be part of the joy and to soften the sorrow by being a publication you look forward to reading and wherein you find those things that contribute to your being a great surgeon and human being.
Dr. Deveney is professor of surgery and vice chair of education in the department of surgery, Oregon Health & Science University, Portland. She is the Co-Editor of ACS Surgery News.
Dr. Hughes is clinical professor in the department of surgery and director of medical education at the Kansas University School of Medicine, Salina Campus, and Co-Editor of ACS Surgery News.
In the flood of emails, periodicals, Twitter, Facebook, Doximity, Medscape, and other information that washes over surgeons every day, why should they use their precious time to read ACS Surgery News? That question is foremost in the minds of the editors of this publication as we consider news stories and commentaries for inclusion. Is this an article our readers are going to find informative, pertinent, and stimulating? We want ACS Surgery News to be a querencia: a source of reliable, vetted information that gives surgeons a place of intellectual security along the information highway.
The editors of ACS Surgery News understand surgery from the scrub sink up. While our mission includes keeping our readers informed about these looming thunderstorms, we are also privileged to report progress and innovations that keep coming no matter how the forces of red tape and commerce play against our profession. Bringing news of both challenges and beacons of hope for our profession with commentary and perspective from our colleagues is our objective. For the editors, this is both a mission and a pleasure. Since most of the editors and our Editorial Advisory Board (EAB), like our readers, must focus primarily on our jobs as surgeons, teachers, and researchers, we cannot read every journal or attend every meeting. The role of ACS Surgery News is to find the relevant news of interest and importance to surgeons, wherever it may be found, and to report it succinctly and accurately in a readable form. Before an article appears in ACS Surgery News, it is reviewed by the author of the paper or presentation for accuracy and reviewed by the most appropriate member of the EAB as well as by both Co-Editors for importance and relevance to our surgeon readers. We do not want to shy away from controversial topics, but endeavor to present such topics with balance and sensitivity, just as the ACS itself always attempts to do: to shed light, rather than merely heat, on all subjects that we cover in our pages.
The editors of ACS Surgery News hope that in the months and years to come, this publication can be a querencia for the surgeon: a safe and secure place to engage all the forces that a surgeon must confront to be successful. In these pages we hope you will find knowledge, wisdom, camaraderie, and support for your practice, whatever that may be.
Surgery is a life of great joy and great sorrow, sometimes happening all within the same hour. We hope to be part of the joy and to soften the sorrow by being a publication you look forward to reading and wherein you find those things that contribute to your being a great surgeon and human being.
Dr. Deveney is professor of surgery and vice chair of education in the department of surgery, Oregon Health & Science University, Portland. She is the Co-Editor of ACS Surgery News.
Dr. Hughes is clinical professor in the department of surgery and director of medical education at the Kansas University School of Medicine, Salina Campus, and Co-Editor of ACS Surgery News.
Sic transit gloria mundi
The email came with the words, “It is with sadness we report that Frank Moody died. …” I was instantly transported to the last time I saw the man and a flood of emotions swept over me. The name Frank Moody will ring a distant bell or none at all to some in our profession. Like many of the greats of surgery, he belongs to the ages.
I remember the first time I asked a student, “Who is Michael DeBakey?” I was dumbfounded to be greeted with a blank stare. How could a student of medicine not know of Dr. DeBakey? A few years later, the same question prompted a smart aleck reply that he was the man who invented DeBakey forceps. Well, of course he did invent the forceps, but to know nothing further of the man who was the world’s expert on ulcer disease in the 1940s, the progenitor of the National Medical Library, and among the foremost pioneers of heart surgery seemed beyond belief.
My mentor, Ernest Poulos, has long since left the active surgical scene. At times he would note the passing of one of his heroes like Carl Moyer (look it up!) and say, “Sic transit gloria mundi.” At 27 and anxious to get the right to cut into my fellow human beings, I would cock my head like a confounded puppy and wonder what that meant. I looked up the translation and meaning long ago, but now with age I understand the phrase in my bones.
I have long been a hanger-on at surgical meetings, hoping to meet those mighty figures that shaped surgical history. I saw W. Dean Warren once and had a very long hour with the great Mark Ravitch. Oliver Beahrs once performed magic tricks at a dinner I attended. At every surgical meeting there is an old guy (and now occasionally with the change in our profession, an elderly lady) getting on the bus to go to the reception or dinner dance. Often they are alone, their spouses having departed before them. As a young man, I wondered why the heck they came to the meetings. Just like every generation before, ours was eager to grab the reins, and in our ardor for future glory, we were polite but also restless for them to move aside. I hadn’t yet learned the importance of history and of listening.
What I missed while carousing with my young colleagues was an opportunity to hear history first hand and to learn that, what we thought was so cutting edge, these men and women had long ago considered. Many of our living legends imagined some of today’s innovations but they lacked the technology to bring their dreams to fruition, or time and age defeated them before they reached the final chapter of their research. It was when I was about 50 that I wised up and began seeking out living legends like Frank Moody and Frank Spencer.
In the case of Frank Moody, he was quite elderly when I first met him. For some reason, he knew who I was and shook my hand softly. I didn’t recognize him initially, but at the sound of his name, I knew I was in the presence of a major figure in 20th century gastrointestinal surgery. He had been at the University of California, San Francisco, during an historic time when George Sheldon, Donald Trunkey and other great surgeons trained there with J. Englebert Dunphy as their chief. Dr. Moody’s CV lists 141 articles in basic and clinical science that have had a profound impact on how we view the gastrointestinal tract. He was Chief at the University of Utah and the University of Alabama and finished his career as professor at the University of Texas-Houston. His awards and achievements were legion.
Parkinson’s had only recently really begun to affect him when I met him, and as the years went by his voice became so very faint that I had to lean in to hear him. We would sit together at the back of the dinner dance room so that we could hear each other. And while the other guests entertained themselves, Dr. Moody and I would discuss his life, scientific method and philosophy as well as his insights into his own case of Parkinsonism. I would see him at meetings, making his way slowly but steadily along a corridor while others briskly walked by, unaware that the man they just passed was among the most important surgical pioneers of our time. It was not sad that Dr. Moody was elderly and unrecognized, but that we younger surgeons missed knowing a great man in our tendency to rush past history.
History is not facts and dates, but rather, it is people and their lives. Yes, the history of our profession is embodied by pioneers like Frank Moody and the others I’ve mentioned.
We have many Fellows among us who are living history, still contributing – maybe not at the dais but at the dinner table, speaking softly and walking a bit slower than their juniors. Thanks to LaMar McGinnis who started it and Don Nakayama who continues it, the College has a History Community on the ACS Communities, an active Surgical History Group, and a will to acknowledge the history that lives and breathes among us. The Surgical History Group has organized a full program of events at the Clinical Congress and I hope many attendees take the opportunity to attend.
Take a moment at your next meeting or at the Clinical Congress and look for those historic surgeons still with us. Be smarter than I was at a young age and get to know them. You may learn something from them you can’t learn anyplace else.
Dr. Hughes is clinical professor in the department of surgery and director of medical education at the Kansas University School of Medicine, Salina Campus, and Co-Editor of ACS Surgery News.
The email came with the words, “It is with sadness we report that Frank Moody died. …” I was instantly transported to the last time I saw the man and a flood of emotions swept over me. The name Frank Moody will ring a distant bell or none at all to some in our profession. Like many of the greats of surgery, he belongs to the ages.
I remember the first time I asked a student, “Who is Michael DeBakey?” I was dumbfounded to be greeted with a blank stare. How could a student of medicine not know of Dr. DeBakey? A few years later, the same question prompted a smart aleck reply that he was the man who invented DeBakey forceps. Well, of course he did invent the forceps, but to know nothing further of the man who was the world’s expert on ulcer disease in the 1940s, the progenitor of the National Medical Library, and among the foremost pioneers of heart surgery seemed beyond belief.
My mentor, Ernest Poulos, has long since left the active surgical scene. At times he would note the passing of one of his heroes like Carl Moyer (look it up!) and say, “Sic transit gloria mundi.” At 27 and anxious to get the right to cut into my fellow human beings, I would cock my head like a confounded puppy and wonder what that meant. I looked up the translation and meaning long ago, but now with age I understand the phrase in my bones.
I have long been a hanger-on at surgical meetings, hoping to meet those mighty figures that shaped surgical history. I saw W. Dean Warren once and had a very long hour with the great Mark Ravitch. Oliver Beahrs once performed magic tricks at a dinner I attended. At every surgical meeting there is an old guy (and now occasionally with the change in our profession, an elderly lady) getting on the bus to go to the reception or dinner dance. Often they are alone, their spouses having departed before them. As a young man, I wondered why the heck they came to the meetings. Just like every generation before, ours was eager to grab the reins, and in our ardor for future glory, we were polite but also restless for them to move aside. I hadn’t yet learned the importance of history and of listening.
What I missed while carousing with my young colleagues was an opportunity to hear history first hand and to learn that, what we thought was so cutting edge, these men and women had long ago considered. Many of our living legends imagined some of today’s innovations but they lacked the technology to bring their dreams to fruition, or time and age defeated them before they reached the final chapter of their research. It was when I was about 50 that I wised up and began seeking out living legends like Frank Moody and Frank Spencer.
In the case of Frank Moody, he was quite elderly when I first met him. For some reason, he knew who I was and shook my hand softly. I didn’t recognize him initially, but at the sound of his name, I knew I was in the presence of a major figure in 20th century gastrointestinal surgery. He had been at the University of California, San Francisco, during an historic time when George Sheldon, Donald Trunkey and other great surgeons trained there with J. Englebert Dunphy as their chief. Dr. Moody’s CV lists 141 articles in basic and clinical science that have had a profound impact on how we view the gastrointestinal tract. He was Chief at the University of Utah and the University of Alabama and finished his career as professor at the University of Texas-Houston. His awards and achievements were legion.
Parkinson’s had only recently really begun to affect him when I met him, and as the years went by his voice became so very faint that I had to lean in to hear him. We would sit together at the back of the dinner dance room so that we could hear each other. And while the other guests entertained themselves, Dr. Moody and I would discuss his life, scientific method and philosophy as well as his insights into his own case of Parkinsonism. I would see him at meetings, making his way slowly but steadily along a corridor while others briskly walked by, unaware that the man they just passed was among the most important surgical pioneers of our time. It was not sad that Dr. Moody was elderly and unrecognized, but that we younger surgeons missed knowing a great man in our tendency to rush past history.
History is not facts and dates, but rather, it is people and their lives. Yes, the history of our profession is embodied by pioneers like Frank Moody and the others I’ve mentioned.
We have many Fellows among us who are living history, still contributing – maybe not at the dais but at the dinner table, speaking softly and walking a bit slower than their juniors. Thanks to LaMar McGinnis who started it and Don Nakayama who continues it, the College has a History Community on the ACS Communities, an active Surgical History Group, and a will to acknowledge the history that lives and breathes among us. The Surgical History Group has organized a full program of events at the Clinical Congress and I hope many attendees take the opportunity to attend.
Take a moment at your next meeting or at the Clinical Congress and look for those historic surgeons still with us. Be smarter than I was at a young age and get to know them. You may learn something from them you can’t learn anyplace else.
Dr. Hughes is clinical professor in the department of surgery and director of medical education at the Kansas University School of Medicine, Salina Campus, and Co-Editor of ACS Surgery News.
The email came with the words, “It is with sadness we report that Frank Moody died. …” I was instantly transported to the last time I saw the man and a flood of emotions swept over me. The name Frank Moody will ring a distant bell or none at all to some in our profession. Like many of the greats of surgery, he belongs to the ages.
I remember the first time I asked a student, “Who is Michael DeBakey?” I was dumbfounded to be greeted with a blank stare. How could a student of medicine not know of Dr. DeBakey? A few years later, the same question prompted a smart aleck reply that he was the man who invented DeBakey forceps. Well, of course he did invent the forceps, but to know nothing further of the man who was the world’s expert on ulcer disease in the 1940s, the progenitor of the National Medical Library, and among the foremost pioneers of heart surgery seemed beyond belief.
My mentor, Ernest Poulos, has long since left the active surgical scene. At times he would note the passing of one of his heroes like Carl Moyer (look it up!) and say, “Sic transit gloria mundi.” At 27 and anxious to get the right to cut into my fellow human beings, I would cock my head like a confounded puppy and wonder what that meant. I looked up the translation and meaning long ago, but now with age I understand the phrase in my bones.
I have long been a hanger-on at surgical meetings, hoping to meet those mighty figures that shaped surgical history. I saw W. Dean Warren once and had a very long hour with the great Mark Ravitch. Oliver Beahrs once performed magic tricks at a dinner I attended. At every surgical meeting there is an old guy (and now occasionally with the change in our profession, an elderly lady) getting on the bus to go to the reception or dinner dance. Often they are alone, their spouses having departed before them. As a young man, I wondered why the heck they came to the meetings. Just like every generation before, ours was eager to grab the reins, and in our ardor for future glory, we were polite but also restless for them to move aside. I hadn’t yet learned the importance of history and of listening.
What I missed while carousing with my young colleagues was an opportunity to hear history first hand and to learn that, what we thought was so cutting edge, these men and women had long ago considered. Many of our living legends imagined some of today’s innovations but they lacked the technology to bring their dreams to fruition, or time and age defeated them before they reached the final chapter of their research. It was when I was about 50 that I wised up and began seeking out living legends like Frank Moody and Frank Spencer.
In the case of Frank Moody, he was quite elderly when I first met him. For some reason, he knew who I was and shook my hand softly. I didn’t recognize him initially, but at the sound of his name, I knew I was in the presence of a major figure in 20th century gastrointestinal surgery. He had been at the University of California, San Francisco, during an historic time when George Sheldon, Donald Trunkey and other great surgeons trained there with J. Englebert Dunphy as their chief. Dr. Moody’s CV lists 141 articles in basic and clinical science that have had a profound impact on how we view the gastrointestinal tract. He was Chief at the University of Utah and the University of Alabama and finished his career as professor at the University of Texas-Houston. His awards and achievements were legion.
Parkinson’s had only recently really begun to affect him when I met him, and as the years went by his voice became so very faint that I had to lean in to hear him. We would sit together at the back of the dinner dance room so that we could hear each other. And while the other guests entertained themselves, Dr. Moody and I would discuss his life, scientific method and philosophy as well as his insights into his own case of Parkinsonism. I would see him at meetings, making his way slowly but steadily along a corridor while others briskly walked by, unaware that the man they just passed was among the most important surgical pioneers of our time. It was not sad that Dr. Moody was elderly and unrecognized, but that we younger surgeons missed knowing a great man in our tendency to rush past history.
History is not facts and dates, but rather, it is people and their lives. Yes, the history of our profession is embodied by pioneers like Frank Moody and the others I’ve mentioned.
We have many Fellows among us who are living history, still contributing – maybe not at the dais but at the dinner table, speaking softly and walking a bit slower than their juniors. Thanks to LaMar McGinnis who started it and Don Nakayama who continues it, the College has a History Community on the ACS Communities, an active Surgical History Group, and a will to acknowledge the history that lives and breathes among us. The Surgical History Group has organized a full program of events at the Clinical Congress and I hope many attendees take the opportunity to attend.
Take a moment at your next meeting or at the Clinical Congress and look for those historic surgeons still with us. Be smarter than I was at a young age and get to know them. You may learn something from them you can’t learn anyplace else.
Dr. Hughes is clinical professor in the department of surgery and director of medical education at the Kansas University School of Medicine, Salina Campus, and Co-Editor of ACS Surgery News.
Introducing Dr. Karen Deveney
As Layton “Bing” Rikkers leaves his post as Editor of ACS Surgery News, it has fallen to Karen Deveney and me to shepherd the paper forward as co-Editors. Dr. Rikkers felt that a combination approach of an academic surgeon and a community surgeon would bring balance to ACS Surgery News that would be representative of the nature of the American College of Surgeons (ACS).
In Karen Deveney we have an accomplished academic surgeon who has wide ranging interests in and out of surgery. Karen was raised in rural Oregon, went to Stanford for undergraduate education, and did her medical school and residency at University of California, San Francisco. Among her cohort in those times of training and her early academic career were Donald Trunkey, George Sheldon, and Brent Eastman, all of whom, like Karen, went on to have a major impact in the world of surgery.
After a stint in the military serving in Germany with her surgeon husband Cliff, Karen eventually landed at Oregon Health and Science University where she went on to serve as Program Director for 20 years at one of the best general surgery training programs in the country. She served as Second Vice-President of the ACS and is the immediate past-President of the Pacific Coast Surgical Association.
Her CV reflects varied academic interests and activities. So, Karen’s contributions to academic surgery are outstanding. But in Karen we also get a person who is alive to the needs of the population beyond the walls of her major medical center. Karen has been a leader in the march to save surgical access for rural populations. She is a founding member of the ACS Advisory Council for Rural Surgery, serving as the Education Pillar Chair of that Council. In her own institution, Karen is a pioneer in developing a model rural surgery track for general surgery residents – first in Grants Pass, Ore. and then in Coos Bay, Ore.
She has been a hardworking general and colorectal surgeon for over 30 years. And, like almost all dedicated surgical educators, she has taken call – enduring the long call schedule of her residents throughout her career.
Karen and I hope to make a good team in this new effort. We are different in many ways, but very much the same in others. We plan a synergy that will unflinchingly recognize the challenges in surgery and facilitate positive discussion and reporting of the solutions for those challenges. Among those challenges are the changing economic structure of surgery, the facilitation of useful quality efforts, and most importantly, the rapid dissemination of significant clinical and scientific information vital to surgeons everywhere.
Dr. Hughes is an ACS Fellow with the department of general surgery, McPherson Hospital, McPherson, Kan., and is the Editor in Chief of ACS Communities. He is also Associate Editor for ACS Surgery News.
As Layton “Bing” Rikkers leaves his post as Editor of ACS Surgery News, it has fallen to Karen Deveney and me to shepherd the paper forward as co-Editors. Dr. Rikkers felt that a combination approach of an academic surgeon and a community surgeon would bring balance to ACS Surgery News that would be representative of the nature of the American College of Surgeons (ACS).
In Karen Deveney we have an accomplished academic surgeon who has wide ranging interests in and out of surgery. Karen was raised in rural Oregon, went to Stanford for undergraduate education, and did her medical school and residency at University of California, San Francisco. Among her cohort in those times of training and her early academic career were Donald Trunkey, George Sheldon, and Brent Eastman, all of whom, like Karen, went on to have a major impact in the world of surgery.
After a stint in the military serving in Germany with her surgeon husband Cliff, Karen eventually landed at Oregon Health and Science University where she went on to serve as Program Director for 20 years at one of the best general surgery training programs in the country. She served as Second Vice-President of the ACS and is the immediate past-President of the Pacific Coast Surgical Association.
Her CV reflects varied academic interests and activities. So, Karen’s contributions to academic surgery are outstanding. But in Karen we also get a person who is alive to the needs of the population beyond the walls of her major medical center. Karen has been a leader in the march to save surgical access for rural populations. She is a founding member of the ACS Advisory Council for Rural Surgery, serving as the Education Pillar Chair of that Council. In her own institution, Karen is a pioneer in developing a model rural surgery track for general surgery residents – first in Grants Pass, Ore. and then in Coos Bay, Ore.
She has been a hardworking general and colorectal surgeon for over 30 years. And, like almost all dedicated surgical educators, she has taken call – enduring the long call schedule of her residents throughout her career.
Karen and I hope to make a good team in this new effort. We are different in many ways, but very much the same in others. We plan a synergy that will unflinchingly recognize the challenges in surgery and facilitate positive discussion and reporting of the solutions for those challenges. Among those challenges are the changing economic structure of surgery, the facilitation of useful quality efforts, and most importantly, the rapid dissemination of significant clinical and scientific information vital to surgeons everywhere.
Dr. Hughes is an ACS Fellow with the department of general surgery, McPherson Hospital, McPherson, Kan., and is the Editor in Chief of ACS Communities. He is also Associate Editor for ACS Surgery News.
As Layton “Bing” Rikkers leaves his post as Editor of ACS Surgery News, it has fallen to Karen Deveney and me to shepherd the paper forward as co-Editors. Dr. Rikkers felt that a combination approach of an academic surgeon and a community surgeon would bring balance to ACS Surgery News that would be representative of the nature of the American College of Surgeons (ACS).
In Karen Deveney we have an accomplished academic surgeon who has wide ranging interests in and out of surgery. Karen was raised in rural Oregon, went to Stanford for undergraduate education, and did her medical school and residency at University of California, San Francisco. Among her cohort in those times of training and her early academic career were Donald Trunkey, George Sheldon, and Brent Eastman, all of whom, like Karen, went on to have a major impact in the world of surgery.
After a stint in the military serving in Germany with her surgeon husband Cliff, Karen eventually landed at Oregon Health and Science University where she went on to serve as Program Director for 20 years at one of the best general surgery training programs in the country. She served as Second Vice-President of the ACS and is the immediate past-President of the Pacific Coast Surgical Association.
Her CV reflects varied academic interests and activities. So, Karen’s contributions to academic surgery are outstanding. But in Karen we also get a person who is alive to the needs of the population beyond the walls of her major medical center. Karen has been a leader in the march to save surgical access for rural populations. She is a founding member of the ACS Advisory Council for Rural Surgery, serving as the Education Pillar Chair of that Council. In her own institution, Karen is a pioneer in developing a model rural surgery track for general surgery residents – first in Grants Pass, Ore. and then in Coos Bay, Ore.
She has been a hardworking general and colorectal surgeon for over 30 years. And, like almost all dedicated surgical educators, she has taken call – enduring the long call schedule of her residents throughout her career.
Karen and I hope to make a good team in this new effort. We are different in many ways, but very much the same in others. We plan a synergy that will unflinchingly recognize the challenges in surgery and facilitate positive discussion and reporting of the solutions for those challenges. Among those challenges are the changing economic structure of surgery, the facilitation of useful quality efforts, and most importantly, the rapid dissemination of significant clinical and scientific information vital to surgeons everywhere.
Dr. Hughes is an ACS Fellow with the department of general surgery, McPherson Hospital, McPherson, Kan., and is the Editor in Chief of ACS Communities. He is also Associate Editor for ACS Surgery News.
Down Under
If you want to know how big the world really is, I suggest you take a trip from McPherson, Kansas, to Sydney, Australia, in one day. You won’t be able to do it, by the way. The construct of days prohibits you from doing this from East to West. Your vessel will pass the International Date Line and you will lose the day (sort of the opposite of seizing the day). Don’t worry. You’ll get it back on the return trip. In this way, the universe seems to enjoy a certain symmetry. But even by first class in a “Sky Couch,” your body will understand how far 8,666 miles is. Trust me: The world is a big place.
There is something unsettling about stepping out of a metal tube that was going Mach 0.7 for 13 hours into a world with “mates” and where the bathtub water drains out the “wrong” way. It’s a little like a “Twilight Zone” episode in which the guest star notes everything in this world is familiar except just different enough to make all the difference.
I entered this zone because I have the great good fortune to know John Kyngdon, MD, FRACS. Dr. Kyngdon was the convener for this year’s Rural Surgery Section of the Royal Australasian College of Surgeons, aka, RACS. I was delighted to attend the 2016 RACS annual meeting, which had the theme of technology and communication.
We Americans can be pretty smug when it comes to our health care system, our training, and our outcomes. Traveling to the other side of the world and spending time with surgeons working in Australia and New Zealand can take the smug right off one’s face. Australia is a land of immense distances and minuscule population for such a large land mass. The challenge of providing care across this gigantic continent, the center of which contains an immense desert filled with some of this most deadly insects, snakes and other creatures on the planet, is epic for sure. Yet, where an American baby boomer like me might decry the hopelessness of such a task, the Australians smile and carry on. These people just don’t understand that their task is nigh on impossible, so they succeed to a large degree against the odds.
RACS, of course, does not just include Australia and New Zealand but the South Pacific and Southeast Asia as well. It was formed in part from the efforts of Dr. Will Mayo, who supported the effort of an ACS-like organization for this part of the world. RACS members seem to have a special affection for Americans, consequently, and one feels entirely at home with them. While ACS has many more members, the quality of the presentations given at the RACS annual meeting is certainly on par with much of what one would see in October at the ACS Clinical Congress. American surgeons commonly attend, and I was delighted to see ACS Vice President Ron Maier, MD, there, as well as Gary Timmerman, MD, of South Dakota and Nathaniel Soper, MD, of Northwestern.
The striking point for me is the commonality we surgeons share worldwide. Whether trained under a UK, Australian, or American-type system, the problems we face are similar. For RACS members, the challenge of managing the EHR is about the same, and as would be expected, interoperability is a huge problem for them! Because of the distances involved in Australia, they are much more involved in telemedicine than are US surgeons, but they are just beginning to deal with privacy issues that come with the technology. They are haunted by quality metrics just as we are. Malpractice is quite different from the US in that, at least in New Zealand, surgeons are not sued for compensation, but they can lose their professional credentials over a bad outcome attributed to them. Burnout among surgeons is a problem Down Under, just as it is here. Governmental intrusions and misadventures, ditto.
I had the opportunity to observe teaching of anatomy at a medical school and learned about dissecting electronically as well as in the flesh. One of the keynote speakers at the RACS meeting was an Australian dotcom entrepreneur. From him and his cohorts on the panel I learned that, in the very near future, over 90% of health care data will likely be gathered not in medical offices but from patient-worn devices. I saw apps based on patient-generated data claiming over 97% accuracy.
Of course, I got to spend a few days touring. Who wouldn’t? I got to see animals such as kangaroos that had been just pictures to me before. By the way, have you ever noticed those sharp claws on the “cuddly” koala? Eventually, I had to return and endure the jet lag that is always worse going West to East. Naturally, my first night on call kept me up most of 30 hours. Jet lag and call lag have the same effect. You just want to get some sleep but don’t know how.
RACS and ACS have been closely aligned for decades. I cannot think of a better mind-expanding view of the surgical world than to join them at one of their meetings. Like so many surgeons, I’ve always thought I just couldn’t take so much vacation at once. Nonsense. You can’t afford not to do so. And there’s nothing like patting the head of a kangaroo to help cure burnout.
Dr. Hughes is an ACS Fellow with the department of general surgery, McPherson Hospital, McPherson, Kan., and is the Editor in Chief of ACS Communities. He is also Associate Editor for ACS Surgery News.
If you want to know how big the world really is, I suggest you take a trip from McPherson, Kansas, to Sydney, Australia, in one day. You won’t be able to do it, by the way. The construct of days prohibits you from doing this from East to West. Your vessel will pass the International Date Line and you will lose the day (sort of the opposite of seizing the day). Don’t worry. You’ll get it back on the return trip. In this way, the universe seems to enjoy a certain symmetry. But even by first class in a “Sky Couch,” your body will understand how far 8,666 miles is. Trust me: The world is a big place.
There is something unsettling about stepping out of a metal tube that was going Mach 0.7 for 13 hours into a world with “mates” and where the bathtub water drains out the “wrong” way. It’s a little like a “Twilight Zone” episode in which the guest star notes everything in this world is familiar except just different enough to make all the difference.
I entered this zone because I have the great good fortune to know John Kyngdon, MD, FRACS. Dr. Kyngdon was the convener for this year’s Rural Surgery Section of the Royal Australasian College of Surgeons, aka, RACS. I was delighted to attend the 2016 RACS annual meeting, which had the theme of technology and communication.
We Americans can be pretty smug when it comes to our health care system, our training, and our outcomes. Traveling to the other side of the world and spending time with surgeons working in Australia and New Zealand can take the smug right off one’s face. Australia is a land of immense distances and minuscule population for such a large land mass. The challenge of providing care across this gigantic continent, the center of which contains an immense desert filled with some of this most deadly insects, snakes and other creatures on the planet, is epic for sure. Yet, where an American baby boomer like me might decry the hopelessness of such a task, the Australians smile and carry on. These people just don’t understand that their task is nigh on impossible, so they succeed to a large degree against the odds.
RACS, of course, does not just include Australia and New Zealand but the South Pacific and Southeast Asia as well. It was formed in part from the efforts of Dr. Will Mayo, who supported the effort of an ACS-like organization for this part of the world. RACS members seem to have a special affection for Americans, consequently, and one feels entirely at home with them. While ACS has many more members, the quality of the presentations given at the RACS annual meeting is certainly on par with much of what one would see in October at the ACS Clinical Congress. American surgeons commonly attend, and I was delighted to see ACS Vice President Ron Maier, MD, there, as well as Gary Timmerman, MD, of South Dakota and Nathaniel Soper, MD, of Northwestern.
The striking point for me is the commonality we surgeons share worldwide. Whether trained under a UK, Australian, or American-type system, the problems we face are similar. For RACS members, the challenge of managing the EHR is about the same, and as would be expected, interoperability is a huge problem for them! Because of the distances involved in Australia, they are much more involved in telemedicine than are US surgeons, but they are just beginning to deal with privacy issues that come with the technology. They are haunted by quality metrics just as we are. Malpractice is quite different from the US in that, at least in New Zealand, surgeons are not sued for compensation, but they can lose their professional credentials over a bad outcome attributed to them. Burnout among surgeons is a problem Down Under, just as it is here. Governmental intrusions and misadventures, ditto.
I had the opportunity to observe teaching of anatomy at a medical school and learned about dissecting electronically as well as in the flesh. One of the keynote speakers at the RACS meeting was an Australian dotcom entrepreneur. From him and his cohorts on the panel I learned that, in the very near future, over 90% of health care data will likely be gathered not in medical offices but from patient-worn devices. I saw apps based on patient-generated data claiming over 97% accuracy.
Of course, I got to spend a few days touring. Who wouldn’t? I got to see animals such as kangaroos that had been just pictures to me before. By the way, have you ever noticed those sharp claws on the “cuddly” koala? Eventually, I had to return and endure the jet lag that is always worse going West to East. Naturally, my first night on call kept me up most of 30 hours. Jet lag and call lag have the same effect. You just want to get some sleep but don’t know how.
RACS and ACS have been closely aligned for decades. I cannot think of a better mind-expanding view of the surgical world than to join them at one of their meetings. Like so many surgeons, I’ve always thought I just couldn’t take so much vacation at once. Nonsense. You can’t afford not to do so. And there’s nothing like patting the head of a kangaroo to help cure burnout.
Dr. Hughes is an ACS Fellow with the department of general surgery, McPherson Hospital, McPherson, Kan., and is the Editor in Chief of ACS Communities. He is also Associate Editor for ACS Surgery News.
If you want to know how big the world really is, I suggest you take a trip from McPherson, Kansas, to Sydney, Australia, in one day. You won’t be able to do it, by the way. The construct of days prohibits you from doing this from East to West. Your vessel will pass the International Date Line and you will lose the day (sort of the opposite of seizing the day). Don’t worry. You’ll get it back on the return trip. In this way, the universe seems to enjoy a certain symmetry. But even by first class in a “Sky Couch,” your body will understand how far 8,666 miles is. Trust me: The world is a big place.
There is something unsettling about stepping out of a metal tube that was going Mach 0.7 for 13 hours into a world with “mates” and where the bathtub water drains out the “wrong” way. It’s a little like a “Twilight Zone” episode in which the guest star notes everything in this world is familiar except just different enough to make all the difference.
I entered this zone because I have the great good fortune to know John Kyngdon, MD, FRACS. Dr. Kyngdon was the convener for this year’s Rural Surgery Section of the Royal Australasian College of Surgeons, aka, RACS. I was delighted to attend the 2016 RACS annual meeting, which had the theme of technology and communication.
We Americans can be pretty smug when it comes to our health care system, our training, and our outcomes. Traveling to the other side of the world and spending time with surgeons working in Australia and New Zealand can take the smug right off one’s face. Australia is a land of immense distances and minuscule population for such a large land mass. The challenge of providing care across this gigantic continent, the center of which contains an immense desert filled with some of this most deadly insects, snakes and other creatures on the planet, is epic for sure. Yet, where an American baby boomer like me might decry the hopelessness of such a task, the Australians smile and carry on. These people just don’t understand that their task is nigh on impossible, so they succeed to a large degree against the odds.
RACS, of course, does not just include Australia and New Zealand but the South Pacific and Southeast Asia as well. It was formed in part from the efforts of Dr. Will Mayo, who supported the effort of an ACS-like organization for this part of the world. RACS members seem to have a special affection for Americans, consequently, and one feels entirely at home with them. While ACS has many more members, the quality of the presentations given at the RACS annual meeting is certainly on par with much of what one would see in October at the ACS Clinical Congress. American surgeons commonly attend, and I was delighted to see ACS Vice President Ron Maier, MD, there, as well as Gary Timmerman, MD, of South Dakota and Nathaniel Soper, MD, of Northwestern.
The striking point for me is the commonality we surgeons share worldwide. Whether trained under a UK, Australian, or American-type system, the problems we face are similar. For RACS members, the challenge of managing the EHR is about the same, and as would be expected, interoperability is a huge problem for them! Because of the distances involved in Australia, they are much more involved in telemedicine than are US surgeons, but they are just beginning to deal with privacy issues that come with the technology. They are haunted by quality metrics just as we are. Malpractice is quite different from the US in that, at least in New Zealand, surgeons are not sued for compensation, but they can lose their professional credentials over a bad outcome attributed to them. Burnout among surgeons is a problem Down Under, just as it is here. Governmental intrusions and misadventures, ditto.
I had the opportunity to observe teaching of anatomy at a medical school and learned about dissecting electronically as well as in the flesh. One of the keynote speakers at the RACS meeting was an Australian dotcom entrepreneur. From him and his cohorts on the panel I learned that, in the very near future, over 90% of health care data will likely be gathered not in medical offices but from patient-worn devices. I saw apps based on patient-generated data claiming over 97% accuracy.
Of course, I got to spend a few days touring. Who wouldn’t? I got to see animals such as kangaroos that had been just pictures to me before. By the way, have you ever noticed those sharp claws on the “cuddly” koala? Eventually, I had to return and endure the jet lag that is always worse going West to East. Naturally, my first night on call kept me up most of 30 hours. Jet lag and call lag have the same effect. You just want to get some sleep but don’t know how.
RACS and ACS have been closely aligned for decades. I cannot think of a better mind-expanding view of the surgical world than to join them at one of their meetings. Like so many surgeons, I’ve always thought I just couldn’t take so much vacation at once. Nonsense. You can’t afford not to do so. And there’s nothing like patting the head of a kangaroo to help cure burnout.
Dr. Hughes is an ACS Fellow with the department of general surgery, McPherson Hospital, McPherson, Kan., and is the Editor in Chief of ACS Communities. He is also Associate Editor for ACS Surgery News.
Commentary: Bones
I’ve always thought that “Bones” of the “Star Trek” series is the sort of surgeon I want to be. He is a treasure trove of wisdom that anyone worth their Federation credits who aspires to be a surgeon should study. Here are some of his truths we should follow in these primitive times, long before surgery becomes the ideal profession it is in the 23rd century (obviously it takes us a little time to solve universal health access).
“Permission to speak freely?” he asks the captain. “Are you out of your mind?” Even in the future, the ship’s surgeon is the one who sees clearly the hazards ahead with oblivious leadership at the helm. It is our job to point out the obvious and the dangerous and see the picture as clearly as possible – because if we don’t, bad things will happen. It seems that the good surgeon is the person who points out that ejecting the warp core of medicine might be the wrong move.
“I’d give a lot to see a hospital. I suppose they still cut and sew people like garments.” Since I cut and sew people like garments every day, one would think I would take offense at Dr. McCoy’s observation of 20th century medicine. But what would a surgeon do without the instruments of our originating profession, the barbers? No scissors and thread? It is now the 21st century, but we still use these basic tools and will probably do so for the foreseeable future.
Most good surgeons I know feel that we operate when it is the best option for our patients, and when that is not the case, we are pleased when a disease is best addressed by other means. Does anyone miss surgically putting sterile ping-pong balls into chests for TB? How about managing a leaking duodenum after an operation for a bleeding duodenal ulcer? That was a lot of fun, wasn’t it? I miss the excitement of operating on a perforated ulcer, an operation in which I could quickly take someone from agony and near death back to health. But I am glad that proton pump inhibitors and H. pylori were discovered. When I was a resident, esophageal cancer and rectal cancer were a death sentence. They are still ugly diseases; however, we now see people with no evidence of disease after chemoradiation. Will the world be a lesser place if esophagectomy and abdominal-perineal resection virtually disappear?
“Dammit Jim, I’m a surgeon not a …” This has to be the motto of every surgeon. We are a highly trained, highly strung set of individuals. In general, we were born to become surgeons, and I have no doubt that by the time Dr. McCoy is galloping about the cosmos, it will be common knowledge that the Cutter gene is found in people who become surgeons. Because this is true, society and surgeons make the mistake of thinking that being really good at surgery in some way equates to being an expert on business, health policy, home repair, or politics. The first thing a surgeon should do when asked to step outside the OR and begin messing with something he or she knows about only tangentially is to repeat Dr. McCoy’s mantra: I’m a surgeon, not an engineer. I’m a surgeon, not a CEO. I’m a surgeon, not a president. The surgeon, of course, can be all these things, but not until he or she has actually learned something in these areas. It would also be nice if nonsurgeons would refrain from posing as experts on surgery.
“He’s dead, Jim.” Dr. McCoy was great at being a realist and so should we surgeons. McCoy rarely made wildly ineffective attempts to save a life that was already gone. Surgeons have to be able to tell families and colleagues the truth about patients who are far beyond saving with today’s technology. It is often our role to do so, but sometimes we forget.
“I had to join Star Fleet – my wife took everything in the universe in the divorce. All I’ve got left is my bones.” This is the origin of Dr. McCoy’s nickname. I am grateful that this is one McCoy trait I’ve not emulated. Being married to one of the great creatures in the universe has made me a much better surgeon.
Sometimes when I look at how much has changed since I became a surgeon, I feel a little like Dr. McCoy. Even a country boy like me gets to work a miracle every now and then. I guess we may live long and prosper after all.
Dr. Hughes is an ACS Fellow with the department of general surgery, McPherson Hospital, McPherson, Kan., and is the Editor in Chief of ACS Communities. He is also Associate Editor for ACS Surgery News.
I’ve always thought that “Bones” of the “Star Trek” series is the sort of surgeon I want to be. He is a treasure trove of wisdom that anyone worth their Federation credits who aspires to be a surgeon should study. Here are some of his truths we should follow in these primitive times, long before surgery becomes the ideal profession it is in the 23rd century (obviously it takes us a little time to solve universal health access).
“Permission to speak freely?” he asks the captain. “Are you out of your mind?” Even in the future, the ship’s surgeon is the one who sees clearly the hazards ahead with oblivious leadership at the helm. It is our job to point out the obvious and the dangerous and see the picture as clearly as possible – because if we don’t, bad things will happen. It seems that the good surgeon is the person who points out that ejecting the warp core of medicine might be the wrong move.
“I’d give a lot to see a hospital. I suppose they still cut and sew people like garments.” Since I cut and sew people like garments every day, one would think I would take offense at Dr. McCoy’s observation of 20th century medicine. But what would a surgeon do without the instruments of our originating profession, the barbers? No scissors and thread? It is now the 21st century, but we still use these basic tools and will probably do so for the foreseeable future.
Most good surgeons I know feel that we operate when it is the best option for our patients, and when that is not the case, we are pleased when a disease is best addressed by other means. Does anyone miss surgically putting sterile ping-pong balls into chests for TB? How about managing a leaking duodenum after an operation for a bleeding duodenal ulcer? That was a lot of fun, wasn’t it? I miss the excitement of operating on a perforated ulcer, an operation in which I could quickly take someone from agony and near death back to health. But I am glad that proton pump inhibitors and H. pylori were discovered. When I was a resident, esophageal cancer and rectal cancer were a death sentence. They are still ugly diseases; however, we now see people with no evidence of disease after chemoradiation. Will the world be a lesser place if esophagectomy and abdominal-perineal resection virtually disappear?
“Dammit Jim, I’m a surgeon not a …” This has to be the motto of every surgeon. We are a highly trained, highly strung set of individuals. In general, we were born to become surgeons, and I have no doubt that by the time Dr. McCoy is galloping about the cosmos, it will be common knowledge that the Cutter gene is found in people who become surgeons. Because this is true, society and surgeons make the mistake of thinking that being really good at surgery in some way equates to being an expert on business, health policy, home repair, or politics. The first thing a surgeon should do when asked to step outside the OR and begin messing with something he or she knows about only tangentially is to repeat Dr. McCoy’s mantra: I’m a surgeon, not an engineer. I’m a surgeon, not a CEO. I’m a surgeon, not a president. The surgeon, of course, can be all these things, but not until he or she has actually learned something in these areas. It would also be nice if nonsurgeons would refrain from posing as experts on surgery.
“He’s dead, Jim.” Dr. McCoy was great at being a realist and so should we surgeons. McCoy rarely made wildly ineffective attempts to save a life that was already gone. Surgeons have to be able to tell families and colleagues the truth about patients who are far beyond saving with today’s technology. It is often our role to do so, but sometimes we forget.
“I had to join Star Fleet – my wife took everything in the universe in the divorce. All I’ve got left is my bones.” This is the origin of Dr. McCoy’s nickname. I am grateful that this is one McCoy trait I’ve not emulated. Being married to one of the great creatures in the universe has made me a much better surgeon.
Sometimes when I look at how much has changed since I became a surgeon, I feel a little like Dr. McCoy. Even a country boy like me gets to work a miracle every now and then. I guess we may live long and prosper after all.
Dr. Hughes is an ACS Fellow with the department of general surgery, McPherson Hospital, McPherson, Kan., and is the Editor in Chief of ACS Communities. He is also Associate Editor for ACS Surgery News.
I’ve always thought that “Bones” of the “Star Trek” series is the sort of surgeon I want to be. He is a treasure trove of wisdom that anyone worth their Federation credits who aspires to be a surgeon should study. Here are some of his truths we should follow in these primitive times, long before surgery becomes the ideal profession it is in the 23rd century (obviously it takes us a little time to solve universal health access).
“Permission to speak freely?” he asks the captain. “Are you out of your mind?” Even in the future, the ship’s surgeon is the one who sees clearly the hazards ahead with oblivious leadership at the helm. It is our job to point out the obvious and the dangerous and see the picture as clearly as possible – because if we don’t, bad things will happen. It seems that the good surgeon is the person who points out that ejecting the warp core of medicine might be the wrong move.
“I’d give a lot to see a hospital. I suppose they still cut and sew people like garments.” Since I cut and sew people like garments every day, one would think I would take offense at Dr. McCoy’s observation of 20th century medicine. But what would a surgeon do without the instruments of our originating profession, the barbers? No scissors and thread? It is now the 21st century, but we still use these basic tools and will probably do so for the foreseeable future.
Most good surgeons I know feel that we operate when it is the best option for our patients, and when that is not the case, we are pleased when a disease is best addressed by other means. Does anyone miss surgically putting sterile ping-pong balls into chests for TB? How about managing a leaking duodenum after an operation for a bleeding duodenal ulcer? That was a lot of fun, wasn’t it? I miss the excitement of operating on a perforated ulcer, an operation in which I could quickly take someone from agony and near death back to health. But I am glad that proton pump inhibitors and H. pylori were discovered. When I was a resident, esophageal cancer and rectal cancer were a death sentence. They are still ugly diseases; however, we now see people with no evidence of disease after chemoradiation. Will the world be a lesser place if esophagectomy and abdominal-perineal resection virtually disappear?
“Dammit Jim, I’m a surgeon not a …” This has to be the motto of every surgeon. We are a highly trained, highly strung set of individuals. In general, we were born to become surgeons, and I have no doubt that by the time Dr. McCoy is galloping about the cosmos, it will be common knowledge that the Cutter gene is found in people who become surgeons. Because this is true, society and surgeons make the mistake of thinking that being really good at surgery in some way equates to being an expert on business, health policy, home repair, or politics. The first thing a surgeon should do when asked to step outside the OR and begin messing with something he or she knows about only tangentially is to repeat Dr. McCoy’s mantra: I’m a surgeon, not an engineer. I’m a surgeon, not a CEO. I’m a surgeon, not a president. The surgeon, of course, can be all these things, but not until he or she has actually learned something in these areas. It would also be nice if nonsurgeons would refrain from posing as experts on surgery.
“He’s dead, Jim.” Dr. McCoy was great at being a realist and so should we surgeons. McCoy rarely made wildly ineffective attempts to save a life that was already gone. Surgeons have to be able to tell families and colleagues the truth about patients who are far beyond saving with today’s technology. It is often our role to do so, but sometimes we forget.
“I had to join Star Fleet – my wife took everything in the universe in the divorce. All I’ve got left is my bones.” This is the origin of Dr. McCoy’s nickname. I am grateful that this is one McCoy trait I’ve not emulated. Being married to one of the great creatures in the universe has made me a much better surgeon.
Sometimes when I look at how much has changed since I became a surgeon, I feel a little like Dr. McCoy. Even a country boy like me gets to work a miracle every now and then. I guess we may live long and prosper after all.
Dr. Hughes is an ACS Fellow with the department of general surgery, McPherson Hospital, McPherson, Kan., and is the Editor in Chief of ACS Communities. He is also Associate Editor for ACS Surgery News.
General surgery’s place in the world
I heard the expression, “This is the age of specialization” the other day and I winced. As a general surgeon, I understood the implicit corollary that I was not a specialist. I disagree, by the way. As a person interested in the public good, I winced because subspecialization is an oft-repeated mantra as a solution to all the surgical world’s problems. That just isn’t so, any more than that generalism is the solution. As my father used to say, “All generalizations are false – including this one.”
We have more than one issue in surgery today. Simply creating more and more subspecialists who do less and less of an area of surgery on the premise that high-volume repetitive practice creates the best public good is too narrow a view, because there is more to success in surgery than the simple performance of the procedure itself. Further, the definition of an outcome is becoming far too quantitative at the expense of an overall qualitative reality from the patient’s point of view.
The Lancet Global Surgery Commission reports that 1.5 billion people in the world have no access to surgical care when they need it and that 5 billion have no access to timely surgical care. As the Australians (presented at the Royal Australasian College of Surgeons) have found, the local conditions that result in delay in diagnosis (as well as treatment) play the major role in poor outcomes. We tend to think of the Lancet numbers as applying to underdeveloped countries, but even in the United States there are underserved areas. Successful solutions in developed countries may well mean templates for solutions in those less developed countries.
The point of this is to state that in our rush to improve the quantitative measurable results such as 30-day mortality, we find answers that lead us away from the qualitative results patients want and deserve. In relentlessly pursuing these results, we risk creating situations of inequality and unmet needs far greater than the risks to an individual patient vis à vis arbitrary definitions of outcome.
The specialty of general surgery can be described in this country as in decline. Over the past 50 years several core components of what a general surgeon did have been excised. Some of this has come through obvious advances, some through economics, and some through abdication of our surgical roles. In aggregate, this trend is leading to a further crisis that was no doubt unintended by those who made the individual decisions and changes.
Within very major training centers, the need for the general surgeon is eclipsed by the plethora of subspecialists available. Many of my academic friends at such institutions admit there really isn’t a job for the broad-based surgeon except for covering call (the acute care surgeon). The problem is that the model of a wonderful fully resourced major center doesn’t translate to suburbia, exurbias, and rural settings where most of the U.S. population resides.
We need a new definition and era of general surgery both for the United States and the rest of the world. Without it, I fear we will drift into a fragmented, patient-unfriendly, bankrupting system that treats late-diagnosed patients who travel at great personal pain to overloaded centers.
The new general surgeon I envision will not proudly proclaim that there is no operation he or she can’t do. That attitude is as outdated as resident work hours equal to the number of hours in the week, banning women from surgical careers, paying residents in room and board, or firing residents for getting married. The general surgery community must accept that times and science have changed for highly complex operations, but that the performance of “standard” and moderately complex operations must remain in the arsenal of the general surgeon. At the same time, subspecialists need to recognize that they must keep a “hands off” attitude toward these core general surgery cases and respect the obvious need throughout the world for the well-trained generalist.
Patients want a doctor they know who is close to home and who has surgical cognition of a wide nature with multiple skills to solve their problems. This local surgeon they know and trust needs to be part of a system that supports the local surgeon’s decision to send the patient to the “center” with neither economic penalty nor the implied message that the local surgeon isn’t quite up to the task.
To know everything about everything is as hard as knowing a lot about a relatively small body of knowledge, perhaps harder. To the patient, they want both – knowledgeable and dependable surgeons locally who can meet perhaps 80% of their surgical needs but also the subspecialist who can stop their heart for an hour, repair their liver or heart problem, and then reboot them. Ask yourself as a surgeon, isn’t that what you want as well for yourself? Would you really prefer to have your gall bladder out 70, 100, 400 miles away or 20 minutes from your home with equally good results?
The generalization I propose is that we need a more sensible approach than the big center vs. small center fight we have now. The Kansas City Royals shouldn’t ever win a World Series. They are a small-market team with a constrained budget, but they formed a mass of generalists and some spectacularly good specialists. That’s how they won in 2015 against the common wisdom of baseball and statistics.
I ask all to support the efforts of the American College of Surgeons, American Board of Surgery, Residency Review Committee, the Association of Program Directors in Surgery, the Accreditation Council of Graduate Medical Education, and the various subspecialty societies in supporting the growing effort to redesign general surgery education and establish its place in this century for the good of all those patients far and wide who cannot, will not, and should not be forced into an uncoordinated system of surgical care.
Dr. Hughes is an ACS Fellow with the department of general surgery, McPherson Hospital, McPherson, Kan., and is the Editor in Chief of ACS Communities. He is also Associate Editor for ACS Surgery News.
I heard the expression, “This is the age of specialization” the other day and I winced. As a general surgeon, I understood the implicit corollary that I was not a specialist. I disagree, by the way. As a person interested in the public good, I winced because subspecialization is an oft-repeated mantra as a solution to all the surgical world’s problems. That just isn’t so, any more than that generalism is the solution. As my father used to say, “All generalizations are false – including this one.”
We have more than one issue in surgery today. Simply creating more and more subspecialists who do less and less of an area of surgery on the premise that high-volume repetitive practice creates the best public good is too narrow a view, because there is more to success in surgery than the simple performance of the procedure itself. Further, the definition of an outcome is becoming far too quantitative at the expense of an overall qualitative reality from the patient’s point of view.
The Lancet Global Surgery Commission reports that 1.5 billion people in the world have no access to surgical care when they need it and that 5 billion have no access to timely surgical care. As the Australians (presented at the Royal Australasian College of Surgeons) have found, the local conditions that result in delay in diagnosis (as well as treatment) play the major role in poor outcomes. We tend to think of the Lancet numbers as applying to underdeveloped countries, but even in the United States there are underserved areas. Successful solutions in developed countries may well mean templates for solutions in those less developed countries.
The point of this is to state that in our rush to improve the quantitative measurable results such as 30-day mortality, we find answers that lead us away from the qualitative results patients want and deserve. In relentlessly pursuing these results, we risk creating situations of inequality and unmet needs far greater than the risks to an individual patient vis à vis arbitrary definitions of outcome.
The specialty of general surgery can be described in this country as in decline. Over the past 50 years several core components of what a general surgeon did have been excised. Some of this has come through obvious advances, some through economics, and some through abdication of our surgical roles. In aggregate, this trend is leading to a further crisis that was no doubt unintended by those who made the individual decisions and changes.
Within very major training centers, the need for the general surgeon is eclipsed by the plethora of subspecialists available. Many of my academic friends at such institutions admit there really isn’t a job for the broad-based surgeon except for covering call (the acute care surgeon). The problem is that the model of a wonderful fully resourced major center doesn’t translate to suburbia, exurbias, and rural settings where most of the U.S. population resides.
We need a new definition and era of general surgery both for the United States and the rest of the world. Without it, I fear we will drift into a fragmented, patient-unfriendly, bankrupting system that treats late-diagnosed patients who travel at great personal pain to overloaded centers.
The new general surgeon I envision will not proudly proclaim that there is no operation he or she can’t do. That attitude is as outdated as resident work hours equal to the number of hours in the week, banning women from surgical careers, paying residents in room and board, or firing residents for getting married. The general surgery community must accept that times and science have changed for highly complex operations, but that the performance of “standard” and moderately complex operations must remain in the arsenal of the general surgeon. At the same time, subspecialists need to recognize that they must keep a “hands off” attitude toward these core general surgery cases and respect the obvious need throughout the world for the well-trained generalist.
Patients want a doctor they know who is close to home and who has surgical cognition of a wide nature with multiple skills to solve their problems. This local surgeon they know and trust needs to be part of a system that supports the local surgeon’s decision to send the patient to the “center” with neither economic penalty nor the implied message that the local surgeon isn’t quite up to the task.
To know everything about everything is as hard as knowing a lot about a relatively small body of knowledge, perhaps harder. To the patient, they want both – knowledgeable and dependable surgeons locally who can meet perhaps 80% of their surgical needs but also the subspecialist who can stop their heart for an hour, repair their liver or heart problem, and then reboot them. Ask yourself as a surgeon, isn’t that what you want as well for yourself? Would you really prefer to have your gall bladder out 70, 100, 400 miles away or 20 minutes from your home with equally good results?
The generalization I propose is that we need a more sensible approach than the big center vs. small center fight we have now. The Kansas City Royals shouldn’t ever win a World Series. They are a small-market team with a constrained budget, but they formed a mass of generalists and some spectacularly good specialists. That’s how they won in 2015 against the common wisdom of baseball and statistics.
I ask all to support the efforts of the American College of Surgeons, American Board of Surgery, Residency Review Committee, the Association of Program Directors in Surgery, the Accreditation Council of Graduate Medical Education, and the various subspecialty societies in supporting the growing effort to redesign general surgery education and establish its place in this century for the good of all those patients far and wide who cannot, will not, and should not be forced into an uncoordinated system of surgical care.
Dr. Hughes is an ACS Fellow with the department of general surgery, McPherson Hospital, McPherson, Kan., and is the Editor in Chief of ACS Communities. He is also Associate Editor for ACS Surgery News.
I heard the expression, “This is the age of specialization” the other day and I winced. As a general surgeon, I understood the implicit corollary that I was not a specialist. I disagree, by the way. As a person interested in the public good, I winced because subspecialization is an oft-repeated mantra as a solution to all the surgical world’s problems. That just isn’t so, any more than that generalism is the solution. As my father used to say, “All generalizations are false – including this one.”
We have more than one issue in surgery today. Simply creating more and more subspecialists who do less and less of an area of surgery on the premise that high-volume repetitive practice creates the best public good is too narrow a view, because there is more to success in surgery than the simple performance of the procedure itself. Further, the definition of an outcome is becoming far too quantitative at the expense of an overall qualitative reality from the patient’s point of view.
The Lancet Global Surgery Commission reports that 1.5 billion people in the world have no access to surgical care when they need it and that 5 billion have no access to timely surgical care. As the Australians (presented at the Royal Australasian College of Surgeons) have found, the local conditions that result in delay in diagnosis (as well as treatment) play the major role in poor outcomes. We tend to think of the Lancet numbers as applying to underdeveloped countries, but even in the United States there are underserved areas. Successful solutions in developed countries may well mean templates for solutions in those less developed countries.
The point of this is to state that in our rush to improve the quantitative measurable results such as 30-day mortality, we find answers that lead us away from the qualitative results patients want and deserve. In relentlessly pursuing these results, we risk creating situations of inequality and unmet needs far greater than the risks to an individual patient vis à vis arbitrary definitions of outcome.
The specialty of general surgery can be described in this country as in decline. Over the past 50 years several core components of what a general surgeon did have been excised. Some of this has come through obvious advances, some through economics, and some through abdication of our surgical roles. In aggregate, this trend is leading to a further crisis that was no doubt unintended by those who made the individual decisions and changes.
Within very major training centers, the need for the general surgeon is eclipsed by the plethora of subspecialists available. Many of my academic friends at such institutions admit there really isn’t a job for the broad-based surgeon except for covering call (the acute care surgeon). The problem is that the model of a wonderful fully resourced major center doesn’t translate to suburbia, exurbias, and rural settings where most of the U.S. population resides.
We need a new definition and era of general surgery both for the United States and the rest of the world. Without it, I fear we will drift into a fragmented, patient-unfriendly, bankrupting system that treats late-diagnosed patients who travel at great personal pain to overloaded centers.
The new general surgeon I envision will not proudly proclaim that there is no operation he or she can’t do. That attitude is as outdated as resident work hours equal to the number of hours in the week, banning women from surgical careers, paying residents in room and board, or firing residents for getting married. The general surgery community must accept that times and science have changed for highly complex operations, but that the performance of “standard” and moderately complex operations must remain in the arsenal of the general surgeon. At the same time, subspecialists need to recognize that they must keep a “hands off” attitude toward these core general surgery cases and respect the obvious need throughout the world for the well-trained generalist.
Patients want a doctor they know who is close to home and who has surgical cognition of a wide nature with multiple skills to solve their problems. This local surgeon they know and trust needs to be part of a system that supports the local surgeon’s decision to send the patient to the “center” with neither economic penalty nor the implied message that the local surgeon isn’t quite up to the task.
To know everything about everything is as hard as knowing a lot about a relatively small body of knowledge, perhaps harder. To the patient, they want both – knowledgeable and dependable surgeons locally who can meet perhaps 80% of their surgical needs but also the subspecialist who can stop their heart for an hour, repair their liver or heart problem, and then reboot them. Ask yourself as a surgeon, isn’t that what you want as well for yourself? Would you really prefer to have your gall bladder out 70, 100, 400 miles away or 20 minutes from your home with equally good results?
The generalization I propose is that we need a more sensible approach than the big center vs. small center fight we have now. The Kansas City Royals shouldn’t ever win a World Series. They are a small-market team with a constrained budget, but they formed a mass of generalists and some spectacularly good specialists. That’s how they won in 2015 against the common wisdom of baseball and statistics.
I ask all to support the efforts of the American College of Surgeons, American Board of Surgery, Residency Review Committee, the Association of Program Directors in Surgery, the Accreditation Council of Graduate Medical Education, and the various subspecialty societies in supporting the growing effort to redesign general surgery education and establish its place in this century for the good of all those patients far and wide who cannot, will not, and should not be forced into an uncoordinated system of surgical care.
Dr. Hughes is an ACS Fellow with the department of general surgery, McPherson Hospital, McPherson, Kan., and is the Editor in Chief of ACS Communities. He is also Associate Editor for ACS Surgery News.
