Embora “Ortodoxia” seja uma obra filosófica e teológica escrita por G.K. Chesterton, suas ideias podem ter algumas aplicações interessantes e reflexivas no cotidiano da cirurgia. Claro que a relação direta pode não ser evidente, mas certos princípios filosóficos podem fornecer perspectivas valiosas para os cirurgiões. Aqui estão algumas maneiras pelas quais as ideias de “Ortodoxia” podem ser aplicadas no contexto cirúrgico:

1. Valorizar o pensamento paradoxal: A cirurgia é uma disciplina complexa e muitas vezes ambígua, onde os médicos devem tomar decisões cruciais em situações desafiadoras. Valorizar o pensamento paradoxal pode ajudar os cirurgiões a considerar opções diversas e até opostas antes de tomar decisões importantes.
2. Reconhecimento da complexidade humana: Chesterton destaca a importância de compreender a natureza complexa da realidade. No contexto cirúrgico, isso se traduz em tratar cada paciente como um indivíduo único, com suas próprias circunstâncias médicas, emocionais e sociais. Isso pode ajudar os cirurgiões a abordar cada caso com uma mente aberta e livre de preconceitos.
3. Equilíbrio entre tradição e inovação: Assim como Chesterton valoriza a tradição cultural, os cirurgiões podem se beneficiar de uma abordagem equilibrada entre as técnicas tradicionais e as inovações médicas. Combinar o conhecimento estabelecido com as mais recentes pesquisas e tecnologias pode levar a melhores resultados para os pacientes.
4. Enfrentar a incerteza: A cirurgia pode ser imprevisível, e os resultados nem sempre são garantidos. A ortodoxia de Chesterton nos encoraja a aceitar a incerteza e a enfrentar os desafios com coragem e confiança. Essa mentalidade pode nos ajudar a enfrentar situações complicadas e se adaptar a cenários imprevistos.
5. Importância da ética e moralidade: Chesterton enfatiza a importância da moralidade e da virtude. Na cirurgia, esses princípios são essenciais para garantir a melhor qualidade de atendimento ao paciente, respeitando sempre a dignidade e os direitos humanos.
6. Valorizar a imaginação: A imaginação é uma parte essencial do trabalho cirúrgico, permitindo aos médicos visualizar procedimentos, simular situações e pensar em soluções criativas. A capacidade de imaginar possibilidades pode ajudar os cirurgiões a planejar cuidadosamente cada intervenção.

Embora “Ortodoxia” não tenha sido escrito com o objetivo específico de se aplicar à cirurgia, as ideias e princípios contidos na obra podem inspirar uma reflexão mais profunda e nos guiar de forma mais consciente, sensível e equilibrada.

A prática cirúrgica é uma forma de arte que exige habilidade técnica e precisão, mas vai além disso. Os cirurgiões não apenas dominam as técnicas e procedimentos, mas também são desafiados a aplicar virtudes cardinais em cada etapa do ato operatório. A diérese, exérese, hemostasia e síntese, as quatro fases cruciais da cirurgia, podem ser vistas como um reflexo das virtudes cardinais: prudência, justiça, fortaleza e temperança. Vamos explorar como essas virtudes se manifestam na rotina de um cirurgião comprometido com o bem-estar dos pacientes.

Diérese (A Prudência como Guia) : A primeira etapa da cirurgia, a diérese, é o momento em que o cirurgião realiza uma incisão precisa para acessar o local a ser tratado. A prudência, virtude da sabedoria prática, entra em cena através do domínio da anatomia. O cirurgião deve avaliar cuidadosamente cada caso, analisar os riscos e tomar decisões fundamentadas. A prudência orienta a escolha das melhores abordagens cirúrgicas, levando em consideração a saúde geral do paciente, suas necessidades individuais e o objetivo final da intervenção.

Exérese (A Justiça na Busca pelo Equilíbrio): Na fase de exérese, o cirurgião remove tecidos ou estruturas comprometidas pela doença. Aqui, a justiça desempenha um papel essencial. O cirurgião deve agir com equidade, buscando remover apenas o que é necessário, sem excessos ou negligências. A justiça implica em tratar cada paciente com equidade, respeito e imparcialidade, levando em consideração os melhores interesses do indivíduo e buscando o bem comum. É um compromisso em garantir que o procedimento cirúrgico seja realizado com integridade e sempre em benefício do paciente.

Hemostasia (A Fortaleza para Enfrentar Desafios) : Durante a fase de hemostasia, o cirurgião aplica técnicas para controlar o sangramento e garantir um campo cirúrgico claro. Nesse momento, a fortaleza se faz presente. A cirurgia pode apresentar situações imprevistas, complicações ou momentos de grande pressão. A fortaleza permite ao cirurgião manter-se firme, agir com coragem diante de adversidades e tomar decisões rápidas, mas sábias, para proteger a vida e o bem-estar do paciente. A fortaleza é a virtude que impulsiona o cirurgião a enfrentar desafios com firmeza e superar obstáculos através de uma alma inabalável, mantendo durante todo o procedimento uma determinação com o melhor prognóstico do paciente.

Síntese (A Temperança na Busca do Equilíbrio Final) : A última etapa, a síntese, envolve a restauração da integridade do tecido por meio de suturas ou outros meios. Nesse momento, a temperança se revela. A temperança é a virtude que permite ao cirurgião exercer controle e moderação, evitando excessos e buscando a harmonia. A escolha adequada do material de sutura, a técnica precisa e o cuidado meticuloso são fundamentais. A temperança assegura que a finalização do ato operatório seja feita com prudência, justiça e fortaleza, considerando o bem-estar a longo prazo do paciente.

Logo, podemos concluir que a prática da cirurgia transcende a habilidade técnica e exige o cultivo das virtudes cardinais. A prudência, a justiça, a fortaleza e a temperança tornam-se guias éticos para o cirurgião comprometido com o cuidado ao paciente. A diérese, exérese, hemostasia e síntese, cada uma refletindo uma virtude cardinal, são etapas cruciais em busca da excelência médica. Quando o cirurgião incorpora essas virtudes em sua rotina, ele se torna não apenas um técnico habilidoso, mas um verdadeiro médico que busca o bem-estar e a cura integral do paciente. A arte da cirurgia, assim, se revela não apenas como uma expressão de destreza manual, mas como uma expressão do cuidado compassivo e virtuoso que o médico oferece ao paciente.

SURGERY, A NOBLE PROFESSION

Surgery is, indeed, one of the noblest of professions. Here is how Dictionary defines the word noble: 1) possessing outstanding qualities such as eminence, dignity; 2) having power of transmitting by inheritance; 3) indicating superiority or commanding excellence of mind, character, or high ideals or morals. These three attributes befit the profession of surgery. Over centuries, the surgical profession has set the standards of ethical and humane practice. Surgeons have made magnificent contributions in education, clinical care, and science. Their landmark accomplishments in surgical science and innovations in operative technique have revolutionized surgical care, saved countless lives, and significantly improved longevity and the quality of human life. Generations of surgeons have developed their craft and passed it on to succeeding generations, as they have to me and to each one of you, to take into the future.

Beyond its scientific and technical contributions, surgery is uniquely fulfilling as a profession. It has disciplined itself over the centuries and dedicated its practice to the best welfare of all human beings. In return, it has been accorded the respect of society, of other professions, and of policy makers. Its conservative stance has served it well and has been the reason for its constancy and consistency. At the beginning of the 21st century, however, profound changes are taking place at all levels and at a dizzying pace, providing both challenges and opportunities to the surgical profession. These changes are occurring on a global level, on the national level, in science and technology, in healthcare, and in surgical education and practice.

To retain its leadership position in innovation and its attractiveness as a career choice for students, surgery must evolve with the times. It is my belief that surgery needs to introduce changes to create new priorities in clinical practice, education, and research; to increase the morale and prestige of surgeons; and to preserve general surgery as a profession. I am reminded of a Chinese aphorism that says, “You cannot prevent the birds of unhappiness from flying over your head, but you can prevent them from building a nest in your hair.”

ADVANCES IN SCIENCE

The coalescence of major advances in science and technology made the end of the 20th century unique in human history. Notable among the achievements are the development of microchips and miniaturization, which fueled the explosion in information technology. The structure of the human genome is nearly completely elucidated, ushering in the genomic era in which genetic information will be used to predict, on an individual basis, susceptibility to disease and responsiveness to drug therapy. The field of nanotechnology allows scientists to work at a resolution of less than one nanometer, the size of the atom. By comparison, the DNA molecule is 2.5 nanometers.

In the last 50 years, biomedical research became increasingly reductionist, turning physiologists and anatomists into molecular biologists. As a result, two basic science fields—integrative physiology and gross anatomy—now have a lower standing in medical education and surgical science than they once did. Surgery and surgical departments can and possibly should claim these fields, but the window of opportunity is narrow. Research is now moving back from discipline-based reductionist science to multidisciplinary science of complexity, in which biomedical scientists work side by side with engineers, mathematicians, and bioinformatists. The ability of high-speed computers to quickly process tens of millions of pieces of data now allows for data-driven rather than hypothesis-based research. This collaboration among different disciplines has already been successful.

TRANSFORMATION OF HEALTHCARE SYSTEM

During the past 75 years, we have seen the entire healthcare system undergo a profound transformation. In the 1930s and for a considerable period thereafter, medical practice was fee-for-service, the doctor–patient relationship was strong, and the physician perceived himself or herself as being responsible nearly exclusively to his or her individual patients. The texture of medical practice started to change when the federal government became involved in the provision of healthcare in 1965. The committee on “Crossing the Quality Chasm” identified six key attributes of the 21st-century healthcare system. It must be:

1. Safe, avoiding injuries to patients;
2. Effective, providing services based on scientific knowledge;
3. Patient-oriented, respectful of and responsive to individual patients’ needs, values, and preferences;
4. Timely, reducing waits, eliminating harmful delays for both care receiver and caregiver;
5. Efficient, avoiding wasted equipment, supplies, ideas, and energy;
6. Equitable, providing equal care across genders, ethnicities, geographic locations, and socioeconomic strata;

No one knows at present what this 21st-century healthcare system will look like. While care in the old system was reactive, in the new system it will be proactive. The “find it, fix it” approach of the old system will be replaced by a “predict it, prevent it, and if you cannot prevent it, fix it” approach. Sporadic intervention, provided only when patients present with illness, will give way to a system in which physicians and other healthcare providers plan 1-, 5-, and 10-year care programs for each patient. Care will be more interactive, with patients taking a more important role in their own care. The technology-oriented system will become a system that provides graded intervention. Delivery systems will not be fractionated but integrated. Even more importantly, care will not be based simply on experience and clinical impression but on evidence of proven outcome measures. If the old system was cost-insensitive, the new system will be cost-sensitive.

SURGICAL PRACTICE

There are many reasons for the declining interest in general surgery, some of which parallel reasons for the drop in medical school applicants in general. One problem specific to surgery is that medical students are given less and less exposure to surgery, due to the shortening of required surgical rotations. Most important, however, is their perception that the life of the surgical resident is stressful, the work hours too long, and the time for personal and family needs inadequate. The workload of the surgical resident over the years has increased significantly both in amount and intensity, without concomitant increase in the number of residents and at a time when hospitals have significantly reduced the support personnel on the surgical ward and in the operating rooms. Students graduating with debts close to $100,000 simply find the years of training in surgery too long, followed by uncertain practice income after graduation.

From several recent studies, lifestyle is the critical and most pressing issue in surgical residency. Some studies have also shown that the best students tend to select specialties that provide controllable lifestyles, such as radiology, dermatology, and ophthalmology. We have a problem not only in the declining number of students applying for surgical training but also in the declining quality of those who do apply. In a preliminary survey of 153 responding general surgery programs, we found that attrition (i.e., categorical residents leaving the training programs) occurred at a rate of 13% to 19% in the last 5 years. In 2001, 46% of those leaving general surgery training programs cited lifestyle as the major reason.

Unless these trends are reversed, general surgery as a specialty is threatened, and a future shortage of general surgeons is inevitable. I know that the Council of the American Surgical Association is most concerned about the crisis in general surgery. We must do a better job of communicating to students and residents that the practice of surgery is as rewarding as ever and full of opportunities in this new era. Innovations in minimal access and computer-assisted surgery and simulation technology provide exciting new possibilities in surgical training. We must also look very carefully at the demands of surgical residency and improve the life of residents without compromising their surgical experience. Unless we deal with work hours and quality of life issues, we are likely to see continuing decline in the interest of medical students in surgical training.

CONCLUSIONS

In conclusion, the noble profession of surgery must rise to meet numerous challenges as the world in which it operates continues to undergo profound change. These challenges represent opportunities for the profession to develop an international perspective and a global outreach and to address the growing needs of an aging population undergoing major demographic and workforce shifts. The leadership of American surgery has a unique role to play in the formulation of a new healthcare system for the 21st century. This task will require commitment to quality of care and patient safety, and it will depend on harnessing the trust and support of the American public. Advances in science and technology—particularly in minimal access surgery, robotics, and simulation technology—provide unprecedented opportunity for surgeons to continue to make landmark contributions that will improve surgical care and the human condition. I believe it is also crucially important that we train surgeon-scientists who will keep surgery at the cutting edge in the genomic and bioinformatics era. Ours is a noble profession imbued with eminence, dignity, high ideals, and ethical values. It has a rich and proud heritage… and I quote, “The highest intellects, like the tops of mountains, are the first to catch and reflect the dawn.”

Source: Lecture from Haile T. Debas, MD (UCSF School of Medicine, San Francisco, California) Presented at the 122nd Annual Meeting of the American Surgical Association, April 25, 2002, The Homestead, Hot Springs, Virginia.

Complete references here