Specific Competence of Surgical Leadership
Surgeons are uniquely prepared to assume leadership roles because of their position in the operating room (OR). Whether they aspire to the title or not, each and every surgeon is a leader, at least within their surgical team. Their clinical responsibilities offer a rich variety of interpretations that prepare them for a broader role in health care leadership. They deal directly with patients and their families, both in and out of the hospital setting, seeing a perspective that traditional health care administrative leaders rarely experience. They work alongside other direct providers of health care, in varied settings, at night, on weekends, as well as during the typical workday. They understand supply-chain management as something more than lines on a spreadsheet.
The Challenges for a Surgical Leader
Surgeons prefer to lead, not to be led. Surgical training has traditionally emphasized independence, self-reliance, and a well-defined hierarchy as is required in the OR. However, this approach does not work well outside the OR doors. With colleagues, nurses, staff, and patients, they must develop a collaborative approach. Surgeons are entrusted with the responsibility of being the ultimate decision maker in the OR. While great qualities in a surgeon in the OR, it hinders their interactions with others. They have near-absolute authority in the OR, but struggle when switching to a persuasive style while in committees and participating in administrative activities. Most surgeons do not realize they are intimidating to their patients and staff. With patients, a surgeon needs to be empathetic and a good listener. A surgeon needs to slow the pace of the discussion so that the patient can understand and accept the information they are receiving. As perfectionists, surgeons demand a high level of performance of themselves. This sets them up for exhaustion and burnout, becoming actively disengaged, going through the motions, but empty on the inside. Given the many challenges surgeons face, it is difficult for them to understand the leadership role, given its complex demands.
Although teams and all team members provide health care should be allowed input, the team leader makes decisions. The leader must accept the responsibility of making decisions in the presence of all situations. They will have to deal with conflicting opinions and advice from their team, yet they must accept that they will be held accountable for the performance of their team. The surgeon–leader cannot take credit for successes while blaming failures on the team. Good teamwork and excellent communication do not relieve the leader of this responsibility.
A surgeon often has a position of authority based on their titles or status in an organization that allows them to direct the actions of others. Leadership by this sort of mandate is termed “transactional leadership” and can be successful in accomplishing specific tasks. For example, a surgeon with transactional leadership skills can successfully lead a surgical team through an operation by requesting information and issuing directives. However, a leader will never win the hearts of the team in that manner. The team will not be committed and follow through unless they are empowered and feel they are truly heard. A transformational leader is one who inspires each team member to excel and to take action that supports the entire group. If the leader is successful in creating a genuine atmosphere of cooperation, less time will be spent giving orders and dealing with undercurrents of negativity. This atmosphere can be encouraged by taking the time to listen and understand the history behind its discussion. Blame should be avoided. This will allow the leader to understand the way an individual thinks and the group processes information to facilitate the introduction of change. While leadership style does not guarantee results, the leader’s style sets the stage for a great performance. At the same time, they should be genuine and transparent. This invites the team members to participate, creating an emotional connection. Leaders try to foster an environment where options are sought that meet everyone’s desires.
Conflict is pervasive, even in healthy, well-run organizations and is not inherently bad. Whether conflict binds an organization together or divides it into factions depends on whether it is constructive or destructive. A good leader needs to know that there are four essential truths about conflict. It is inevitable, it involves costs and risks, the strategies we develop to deal with the conflict can be more damaging than the conflict itself, and conflict can be permanent if not addressed. The leader must recognize the type of conflict that exists and deal with the conflict appropriately. Constructive discussion and debate can result in better decision making by forcing the leader to consider other ideas and perspectives. This dialog is especially helpful when the leader respects the knowledge and opinions of team members with education, experience, and perspective different from the leader’s. Honesty, respect, transparency, communication, and flexibility are all elements that a leader can use to foster cohesion while promoting individual opinion. The leader can create an environment that allows creative thinking, mutual problem solving, and negotiation. These are the hallmarks of a productive conflict. Conflict is viewed as an opportunity, instead of something to be avoided.
Communication is the primary tool of a successful leader. On important topics, it is incumbent on the leader to be articulate, clear, and compelling. Their influence, power, and credibility come from their ability to communicate. Research has identified the primary skills of an effective communicator. They are set out in the LARSQ model: Listening, Awareness of Emotions, Reframing, Summarizing, and Questions. These are not set in a particular order, but rather should move among each other freely. In a significant or critical conversation, it is important for a leader to listen on multiple levels. The message, body language, and tone of voice all convey meaning. You cannot interrupt or over-talk the other side. They need an opportunity to get their entire message out. Two techniques that enhance listening include pausing and the echo statement. Pausing before speaking allows the other conversant time to process what they have said to make sure the statement is complete and accurate. Echo statements reflect that you have heard what has been said and focuses on a particular aspect needing clarification. Good listening skills assure that the leader can get feedback that is necessary for success.
Vision, Strategy, Tactics, and Goals
One of the major tasks of a leader is to provide a compelling vision, an overarching idea. Vision gives people a sense of belonging. It provides them with a professional identity, attracts commitment, and produces an emotional investment. A leader implements vision by developing strategy that focuses on specific outcomes that move the organization in the direction of the vision. Strategy begins with sorting through the available choices and prioritizing resources. Through clarification, it is possible to set direction. Deficits will become apparent and a leader will want to find new solutions to compensate for those shortfalls. For example, the vision of a hospital is to become a world class health care delivery system. Strategies might include expanding facilities, improving patient satisfaction, giving the highest quality of care, shortening length of hospital stay with minimal readmissions, decreased mortality, and a reduction in the overall costs of health care. Tactics are specific behaviors that support the strategy with the aim to achieve success. Tactics for improving patient satisfaction may include reduced waiting time, spending more time with patients, taking time to communicate in a manner that the patient understands, responding faster to patient calls, etc. These tactics will then allow a leader to develop quantitative goals. Patient satisfaction can be measured. The surgical leader can then construct goals around each tactic, such as increasing satisfaction in specific areas. This information allows a surgical leader to identify barriers and they can take steps to remedy problem areas. This analysis helps a leader find the weakest links in their strategies as they continue toward achieving the vision.
The world of health care is in continuous change. The intense rate of political, technical, and administrative change may outpace an individual’s and institution’s ability to adapt. Twenty-first century health care leaders face contradictory demands. They must navigate between competing forces. Leaders must traverse a track record of success with the ability to admit error. They also must maintain visionary ideas with pragmatic results. Individual accountability should be encouraged, while at the same time facilitating teamwork. Most leaders do not understand the change process. There are practical and psychological aspects to change. From an institutional perspective, we know that when 5% of the group begins to change, it affects the entire group. When 20% of a group embraces change, the change is unstoppable.
Succession Planning and Continuous Learning
An often-overlooked area of leadership is planning for human capital movement. As health care professionals retire, take leaves of absences, and move locations, turmoil can erupt in the vacuum. Leaders should regularly be engaging in activities to foster a seamless passing of institutional knowledge to the next generation. They also should seek to maintain continuity to the organization. Ways to accomplish this include senior leaders actively exposing younger colleagues to critical decisions, problem solving, increased authority, and change management. Leaders should identify promising future leaders, give early feedback for areas of improvement, and direct them toward available upward career tracks. Mentoring and coaching help prepare the younger colleagues for the challenges the institution is facing. Teaching success at all levels of leadership helps create sustainable high performance.
Aprendendo a Aprender
As oportunidades de aprendizado nos são oferecidas a cada momento, o tempo todo. Aprendemos toda vez que nos damos ao trabalho de pensar sobre o que determinado momento nos trouxe, o que nos ensinou que ainda não sabíamos, o que nos mostrou a respeito dos outros e de nós mesmos, e que antes ignorávamos. E esse processo é tão longo quanto a vida.
O caminho mais curto e certo para a estagnação é perder a disposição de aprender, seja pela arrogância de achar que já sabe tudo, seja pela enganosa convicção de que é cedo demais para adquirir tal conhecimento. A acomodação é outra inimiga do aprendizado, pois paralisa o segundo requisito necessário para que ele ocorra: o esforço. É preciso esforçar-se para manter a mente aberta ao novo, para não se deixar limitar pelos preconceitos e opiniões preconcebidas. E também é preciso esforço para ampliar as oportunidades de aprendizado, reservando tempo para as leituras, para as conversas e atividades instrutivas, para se atualizar e aprofundar seu conhecimento.
Não refiro apenas ao conhecimento necessário à sua profissão, mas a todos os aspectos de sua vida, por exemplo, conhecer mais a fundo sua família – acreditar que já sabemos tudo sobre nossos familiares é um erro fatal em qualquer tipo de relacionamento. Outro equívoco é negligenciar o autoconhecimento: uma série de frustrações, angústias e motivações. Conhecê-las também é um aprendizado constante, talvez o mais árduo de todos.
“Todas me pareceram tão cheias de si”, contou Sócrates, “tão seguras de suas verdades e certezas que, se sou de fato mais sábio do que elas, é pela simples razão de que sei de que não sei aquilo que elas acham que sabem”. Como nos sugere o filósofo com toda a sua perspicácia e sabedoria, a admissão de que ainda temos muito a aprender é o primeiro passo para transformarmos nossa vida em um constante aprendizado. A consciência desse fato enriquece nossas vidas, ampara nossas escolhas e direciona nossas ações. A importância de aprender sempre é tamanha que Stephen R. Covey, autor do best-seller Os 7 Hábitos das Pessoas Altamente Eficazes e 8° Hábito, a coloca entre as quatro necessidades básicas do ser humano – as demais serão afetadas.
O aprendizado, porém, está presente em todas: aprendemos a viver, a amar, a deixar um legado e, até mesmo, aprendemos a aprender.
Surgeons and Performance
SURGEONS ARE HIGH PERFORMANCE ATHLETES
In a 2011 New Yorker article, Dr. Atul Gawande explored the idea that surgeons should consider a performance coach. Like athletes, he reasons, surgeons rely on complex physical movements to achieve their goals. Guidance and refinement by a trained eye could improve their performance.
Surgical coaching is a controversial topic (one which colleagues and I are actively investigating). But in the years following Dr. Gawande’s article, this idea opened the door to a broader concept: the “surgeon athlete.” An “athlete” is one whose performance depends on a carefully choreographed interplay between mind and body: heightened focus and anticipation along with quick decision-making and coordination. Combined with the reliance on teamwork and requisite stamina, this is wholly within the job description of a surgeon. Many surgeons are likely to find this concept silly. But our profession has imprudently encouraged surgical trainees to disregard the critical fine-tuning of their minds and bodies. We demand perfection, stamina, and encyclopedic knowledge, while discouraging the healthy habits that improve performance. Ironically, the sports world is more advanced in applying science to their training. And by ignoring this indisputable science, we are really hurting our patients. Because in order to best take care of them, we need to first take care of ourselves.
The GOOD SURGEON
Surgery is an extremely enjoyable, intellectually demanding and satisfying career, and many more people apply to become surgeons each year than there are available places.
Those who are successful have to be ready not just to learn a great deal, but have the right kind of personality for the job.
Is a surgical career right for you?
Read the link…
THE GOOD SURGEON
Centro Cirúrgico: O TEMPLO DO CIRURGIÃO.
Templo (do latim templum, “local sagrado”) é uma estrutura arquitetônica dedicada ao serviço religioso. O termo também pode ser usado em sentido figurado. Neste sentido, é o reflexo do mundo divino, a habitação de Deus sobre a terra, o lugar da Presença Real. É o resumo do macrocosmo e também a imagem do microcosmo: ‘o corpo é o templo do Espírito Santo’ (I, Coríntios, 6, 19).
Dos locais especiais, O corpo humano (morada da alma), a Cavidade Peritoneal e o Bloco Cirúrgico, se bem analisados, são muito semelhantes e merecem atitudes e comportamentos respeitáveis. O Templo, em todos os credos, induz à meditação, absoluto silêncio tentando ouvir o Ser Supremo. A cavidade peritoneal, espaço imaculado da homeostase, quando injuriada, reage gritando em dor, implorando uma precoce e efetiva ação terapêutica.
O Bloco Cirúrgico, abrigo momentâneo do indivíduo solitário, que mudo e quase morto de medo, recorre à prece implorando a troca do acidente, da complicação, da recorrência, da seqüela, da mutilação, da iatrogenia e do risco de óbito pela agressiva intervenção que lhe restaure a saúde, patrimônio magno de todo ser vivo.
O Bloco Cirúrgico clama por respeito ao paciente cirúrgico, antes mesmo de ser tomado por local banal, misturando condutas vulgares, atitudes menores, desvio de comportamento e propósitos secundários. Trabalhar no Bloco Cirúrgico significa buscar a perfeição técnica, revivendo os ensinamentos de William Stewart Halsted , precursor da arte de operar, dissecando para facilitar, pinçando e ligando um vaso sangüíneo, removendo tecido macerado, evitando corpos estranhos e reduzindo espaço vazio, numa síntese feita com a ansiedade e vontade da primeira e a necessidade e experiência da última.
Mas, se a cirurgia e o cirurgião vêm sofrendo grande evolução, técnica a primeira e científica o segundo, desde o início do século, a imagem que todo doente faz persiste numa simbiose entre mitos e verdades. A cirurgia significa enfrentar ambiente desconhecido chamado “sala de cirurgia” onde a fobia ganha espaço rumo ao infinito. O medo prepondera em muitos.
A confiança é um reconhecimento e um troféu que o cirurgião recebe dos pacientes e seus familiares. Tanto a CONFIANÇA quanto a SEGURANÇA têm que ser preservadas a qualquer custo. Não podem correr o risco de serem corroídas por palavras e atitudes de qualquer membro da equipe cirúrgica. Não foi tarefa fácil transformar, para a população, o ato cirúrgico numa atividade científica, indispensável, útil e por demais segura. Da conquista da cirurgia, como excelente arma terapêutica para a manutenção de um alto padrão de qualidade técnica, resta a responsabilidade dos cirurgiões, os herdeiros do suor e sangue, que se iniciou com o trabalho desenvolvido por Billroth, Lister, Halsted, Moyniham, Kocher e uma legião de figuras humanas dignas do maior respeito, admiração e gratidão universal.
No ato operatório os pacientes SÃO TODOS SEMELHANTES EM SUAS DIFERENÇAS, desde a afecção, ao prognóstico, ao caráter da cirurgia e especialmente sua relação com o ato operatório. Logo o cirurgião entra no bloco cirúrgico com esperança e não deve sair com dúvida. Nosso trabalho é de equipe, cada um contribui com uma parcela, maior ou menor, para a concretização do todo, do ato cirúrgico por completo, com muita dedicação e sabedoria. Toda tarefa, da limpeza do chão ao ato de operar, num crescendo, se faz em função de cada um e em benefício da maioria, o mais perfeito possível e de uma só vez, quase sempre sem oportunidade de repetição e previsão de término.
O trabalho do CIRURGIÃO é feito com carinho, muita dignidade, humildade e executado em função da alegria do resultado obtido aliado a dimensão ética do dever cumprido que transcende a sua existência. A vida do cirurgião se materializa no ato operatório e o bloco cirúrgico, palco do nosso trabalho não tolera e jamais permite atitudes menores, inferiores, ambas prejudiciais a todos os pacientes e a cada cirurgião. Como ambiente de trabalho de uma equipe diversificada, precisa manter, a todo custo, o controle de qualidade, por lidar com o que há de mais precioso na Terra: o ser humano.
7 MOST QUESTIONS ABOUT THE SURGEON PROFESSION
What is a Surgical Profession?
The professions are the means by which the complex services needed by society are organized. A profession has been defined by the American College of Surgeons as: an occupation whose core element is work that is based upon the mastery of a complex body of knowledge and skills. It is a vocation in which knowledge of some department of science or learning, or the practice of an art founded upon it, is used in the service of others. Its members are governed by codes of ethics and profess a commitment to competence, integrity and morality, altruism and to the promotion of the public good within their domain. These commitments form the basis of a social contract between a profession and society, which, in turn, grants the profession a monopoly over the use of its knowledge base, the right to considerable autonomy in practice and the privilege of self-regulation. Professions and their members are accountable to those served and to society.
1. What are the core elements of a profession? All professions are characterized by four core elements: (1) a monopoly over the use of specialized knowledge; (2) in return for that monopoly that we enjoy, relative autonomy in practice and the responsibility of self-regulation; (3) altruistic service to individuals and society; and (4) responsibility for maintaining and expanding professional knowledge and skills.
3.What is professionalism? Professionalism describes the cognitive, moral, and collegial attributes of a professional. Ultimately, it is all the reasons that your mother is proud to say that you are a doctor and a surgeon.
4. Why do physicians need a code of professional conduct? Trust is integral to the practice of surgery. The Code of Professional Conduct clarifies the relationship between the surgical profession and the society it serves. This is often referred to as a social contract. For patients the code of professional conduct crystallizes the commitment of the surgical community toward individual patients and their communities. Trust is built brick by brick.
5. What is the Code of Professional Conduct ? The Code of Professional Conduct takes the general principles of professionalism and applies them to surgical practice. The code is the foundation on which we earn our professional privileges and the trust of patients and the public. It is our job description. During the continuum of the preoperative, intraoperative, and postoperative care surgeons have the responsibility to:
5.1 Serve as effective advocates for our patients’ needs.
5.2 Disclose therapeutic options including their risks and benefits.
5.3 Disclose and resolve any conflict of interest that might influence the decisions of care.
5.4 Be sensitive and respectful of patients, understanding their vulnerability during the perioperative period.
5.5 Fully disclose adverse events and medical errors.
5.6 Acknowledge patients’ psychological, social, cultural and spiritual needs.
5.7 Encompass within our surgical care the special needs of terminally ill patients.
5.8 Acknowledge and support the needs of patients’ families and
5.9 Respect the knowledge, dignity, and perspective of other healthcare professionals.
6. Why do surgeons need their own code of professionalism? A surgical procedure is an extreme experience. We impact our patients physiologically, psychologically, and socially. When patients submit themselves to a surgical experience, they must trust that the surgeon will put their welfare above all other considerations. The written code helps to reinforce these values.
7. What are the fundamental principles of the Code of Professional Conduct and the codes of other professional societies?
7.1 The primacy of patient welfare.
This means that the patient’s interests always come first. Altruism is central to this concept, and it is the surgeon’s altruism that fosters trust in the physician-patient relationship.
7.2 Patient autonomy.
Patients must understand and make their own informed decisions about their treatment. This is tricky. As physicians we must be honest with our patients so that they make educated decisions. At the same time, we must make sure that their decisions are consistent with ethical practices and do not lead to demands for inappropriate care.
7.3 Social justice.
As physicians we must advocate for our individual patients while at the same time promoting the health of the healthcare system as a whole. We must balance our patient’s needs (autonomy) and not misdirect scarce resources that benefit society (social justice).
Leadership in SURGICAL TEAM
Leadership is a process of social inﬂuence in which one person can enlist the aid and support of others in the accomplishment of a common task. Successful leaders can predict the future and set the most suitable goals for organizations. Effective leadership among medical professionals is crucial for the efﬁcient performance of a healthcare system. Recently, as a result of various events and reports such as the ‘Bristol Inquiry’, and ‘To Err is Human’ by the Institute of Medicine, the healthcare organizations across different regions have emphasized the need for effective leadership at all levels within clinical and academic ﬁelds. Traditionally, leadership in clinical disciplines needed to display excellence in three areas: patient care, research and education.
Within the ﬁeld of surgery, the last decade has seen various transformations such as technology innovation, changes to training requirements, redistribution of working roles, multi-disciplinary collaboration and ﬁnancial challenges. Therefore, the current concept of leadership demands to set up agendas in line with the changing healthcare scenario. This entails identifying the needs and initiating changes to allow substantive development and implementation of up-to-date evidence. This article delineates the deﬁnition and concept of leadership in surgery. We identify the leadership attributes of surgeons and consider leadership training and assessment. We also consider future challenges and recommendations for the role of leadership in surgery.
PRINCIPLES OF LEADERSHIP FOR GENERAL SURGEONS
Not only SURGEONS
VALORES ÉTICOS DOS ESTAGIÁRIOS DA CLÍNICA CIRÚRGICA
Nunca baixar os seus padrões pessoais e profissionais. Fazer sempre o melhor, NÃO SOMENTE O POSSÍVEL.
Fazer sempre a coisa certa, mesmo quando ninguém está olhando.
Cumprir rigorosamente as atribuições em relação aos cuidados com os pacientes do serviço.
Ser uma força positiva com comprometimento na melhor assistência ao paciente.
É a construção diária do seu objetivo.
O sucesso vem um pequeno passo de cada vez. O amanhã começa agora.
Turma 02 de RM Cirurgia Geral (HTLF)
Dr Antonio Filho (UEMA)
Dr Arimatéia Morales (UESPI)
Dra Livia Andrade (UFMA)
Dra Maura Calazeiras (UNICEUMA – APROVADA EM COLOPROCTOLOGIA NA UFCE)
Dr Igor Neiva (UNICEUMA – APROVADO EM ONCOLOGIA CIRÚRGICA NO INCA – RJ)
A todos os ex-residentes desejamos boa sorte e muitas realizações nesta nova etapa profissional.
Surgical Rotation: 5 PRINCIPLES
1.Getting along with the nurses.
The nurses do know more than the rest of us about the codes, routines, and rituals of making the wards run smoothly. They may not know as much about pheochromocytomas and intermediate filaments, but about the stuff that matters, they know a lot. Acknowledge that, and they will take you under their wings and teach you a ton!
2. Helping out.
If your residents look busy, they probably are. So, if you ask how you can help and they are too busy even to answer, asking again probably would not yield much. Always leap at the opportunity to shag x-rays, track down lab results, and retrieve a bag of blood from the bank. The team will recognize your enthusiasm and reward your contributions.
3. Getting scutted.
We all would like a secretary, but one is not going to be provided on this rotation. Your residents do a lot of their own scut work without you even knowing about it. So if you feel like scut work is beneath you, perhaps you should think about another profession.
4. Working hard.
This rotation is an apprenticeship. If you work hard, you will get a realistic idea of what it means to be a resident (and even a practicing doctor) in this specialty. (This has big advantages when you are selecting a type of internship. Staying in the loop. In the beginning, you may feel like you are not a real part of the team. If you are persistent and reliable, however, soon your residents will trust you with more important jobs. Educating yourself, and then educating your patients. Here is one of the rewarding places (as indicated in question 1) where you can soar to the top of the team. Talk to your patients about everything (including their disease and therapy), and they will love you for it.
5. Maintaining a positive attitude.
As a medical student, you may feel that you are not a crucial part of the team. Even if you are incredibly smart, you are unlikely to be making the crucial management decisions. So what does that leave: attitude. If you are enthusiastic and interested, your residents will enjoy having you around, and they will work to keep you involved and satisfied. A dazzlingly intelligent but morose complainer is better suited for a rotation in the morgue. Remember, your resident is likely following 15 sick patients, gets paid less than $2 an hour, and hasn’t slept more than 5 hours in the last 3 days. Simple things such as smiling and saying thank you (when someone teaches you) go an incredibly long way and are rewarded on all clinical rotations with experience and good grades.
Having fun! This is the most exciting, gratifying, rewarding, and fun profession and is light years better than whatever is second best (this is not just our opinion).
By: Alden H. Harken MDProfessor and Chair, Department of Surgery, University of California, San Francisco–East Bay, Oakland, California, Chief of Surgery, Department of Surgery, Alameda County Medical Center, Oakland, California
SOMOS poderosos além de qualquer medida…
Nosso medo mais profundo não é o de sermos inadequados. Nosso medo mais profundo é que somos poderosos além de qualquer medida. É a nossa luz, não nossa escuridão, que mais nos assusta. Nós nos perguntamos: Quem sou eu para ser brilhante, maravilhoso, talentoso e fabuloso? Na verdade, quem não quer que você seja? Você é um filho de Deus. Seu papel pequeno não serve ao mundo. Não há nada de iluminado em se encolher, para que outras pessoas não se sintam inseguros ao seu redor. Estamos todos feitos para brilhar, como as crianças. Nascemos para manifestar a glória de Deus que está dentro de nós. Não é apenas em alguns de nós, está em todos. E conforme deixamos nossa própria luz brilhar, inconscientemente damos às outras pessoas permissão para fazer o mesmo. Como estamos libertamos do nosso medo, nossa presença, automaticamente, libera os outros.
World’s Greatest Surgeon
On July 12, 2008, the world lost an incredible talent. A renegade physician, a pioneer, the father of open-heart surgery, and perhaps the best surgeon who ever lived, Dr. Michael DeBakey died of natural causes at 99. Because of his groundbreaking research, cutting-edge medical devices and maverick approach to cardiac surgery, DeBakey literally changed the rules of the game and thousands of lives are saved each day.
What can we learn from Michael DeBakey’s life and career?
1. Build your brand.
With a career that spanned more than 70 years, DeBakey built a reputation for being indispensable. His patients included everyone from the ordinary person next door and people with no means to a list of Who’s Who among world leaders. Presidents Kennedy, Johnson and Nixon, President Boris Yeltsin, King Hussein of Jordan, the Shah of Iran, Turkish President Turgut Ozal, just to name a few, engaged DeBakey because they knew he was the best. The Journal of the American Medical Association said in 2005, “Many consider Michael E. DeBakey to be the greatest surgeon ever.” Is your personal brand strong enough that if you left your company, colleagues and customers would have a difficult time getting along without you?
2. Be a guru, thought leader, industry expert.
Dr. DeBakey published more than 1,000 medical reports, research papers, chapters and books on topics related to cardiovascular medicine. He helped establish the National Library of Medicine, the world’s largest and most prestigious repository of medical archives. DeBakey played a key role in organizing a specialized medical center system to treat soldiers returning from the war. This system is now the Veterans’ Administration Medical Center System. For his numerous contributions Dr. DeBakey was awarded the Presidential Medal of Freedom, the Congressional Gold Medal, Congress’ highest civilian honor, the National Medal of Science, the country’s highest scientific award, and The United Nations Lifetime Achievement Award. Do people see you as a guru in your field? How distinctive is your knowledge base? How well do you garner, contribute and leverage knowledge?
3. Never quit learning.
As a child, DeBakey was required to borrow a book from the library each week and read it. He read the entire Encyclopedia Britannica before entering high school. Overseeing cases, consulting with colleagues and mentoring younger surgeons, he made his mark on the world right up to the end. DeBakey performed his last surgery at age 90 and continued to travel the globe giving lectures. Perhaps you’re thinking, “Who would want a 90-year-old surgeon operating on them?” The answer could be, “Someone who’s performed more than 60,000 cardiovascular procedures in his career.” Do you have a reputation for lifelong learning, for continually adding value? When we stop bringing something new to the game, the game is over.
4. Risk more, gain more.
DeBakey took risks others weren’t willing to take to advance medicine. Tubing, clamps, pumps, protocols all bear the mark of DeBakey’s passion for innovation. Yet, product and process innovations often pull people out of their comfort zones and some of DeBakey’s early breakthroughs weren’t accepted initially—in fact they were ridiculed. For example, in 1939, when Drs. DeBakey and Alton Ochsner linked cigarette smoking to lung cancer, many in the medical community derided it. Then in 1964, the Surgeon General confirmed their findings and documented the cause and effect. There was also skepticism when DeBakey discovered that he could substitute parts of diseased arteries with synthetic (Dacron) grafts—a procedure that enables surgeons to repair aortic aneurysms in the chest and abdomen. He initially figured out how to stitch synthetic blood vessels on his wife’s sewing machine. Now the procedure is widely used. DeBakey was also the first to perform bypass surgery and the first to perform a successful removal of a blockage of the carotid (main) artery of the neck, a procedure that has become the standard protocol for treating stroke. The world is not changed by those who are unwilling to take risks. Is your passion for advancing your field by taking a risk bigger than your fear of rejection or making a mistake?
5. Refuse to sell out on your dream.
DeBakey developed an interest in medicine in his father’s pharmacy where he listened to physicians talk shop. The vision to become a doctor was clear, the question was, “what kind?” In 1932, there simply wasn’t anything you could do for heart disease, if a patient had a heart attack the long-term prognosis wasn’t good. While he was still in school in 1932, DeBakey invented the roller pump—a critical part of the heart-lung machine that takes over the functions of the heart and lungs during open-heart surgery. This not only created the era of open-heart surgery, it cemented DeBakey’s passion to make a mark in the world of cardiovascular medicine. Engagement is about pouring your heart, mind and soul into a dream that causes you to fire on all cylinders. Does your career fulfill your desires? Or, have you sacrificed a dream that could make you come alive for a life of duty and routine that simply “works”?
6. Play to your genius.
DeBakey said, “I like my work, very much. I like it so much that I don’t want to do anything else.” Most people who are happy in life spend time doing what they love. This usually makes them extremely good at what they do. Dr. DeBakey exemplified the power of what can happen when our work requires what we are good at and passionate about. Playing to your genius is about using your gifts and talents to pursue a passion that makes a significant contribution to the people and the world you serve. Playing to your genius also promotes autonomy and self-direction, cultivates commitment, stimulates personal growth and makes work fun. Are you engaged in work you’re good at and passionate about—work that makes a contribution and needs to be done? Or are you just biding time?
7. Balance passion with discipline and focus.
With regard to his patients, the indefatigable DeBakey had an uncompromising dedication to perfection. He was known as a taskmaster who set very high standards, yet he never demanded more from others than he demanded from himself. Heart surgeons who trained under DeBakey say he was hard to keep up with when making patient rounds. They joked that he was from another world because he could maintain his focus and intensity for hours. In a world of competing priorities and information overload it’s easy to lose focus and get distracted. But, if you are playing to your genius and doing what you love, it’s easier to be disciplined and maintain a maniacal focus. Are you disciplined? Do you have a maniacal focus? Would your customers (internal and external) say you are relentless when it comes to pursuing perfection?
8. Find a void and figure out how to fill it.
Michael DeBakey’s innovations are on par with the likes of Thomas Edison, Alexander Graham Bell, Jonas Salk, Henry Ford and Alfred Nobel. During World War II, he helped establish the mobile army surgical hospitals or MASH units. He was a key player in the development of artificial hearts, artificial arteries and bypass pumps that help keep patients alive who are waiting for transplants. He was among the first to recognize the importance of blood banks and transfusions. He also helped create more than 70 surgical instruments that made procedures easier and clinical outcomes more effective. If something couldn’t be done, DeBakey found a way to do it. In 1967, Dr. Christiaan Barnard performed the first human heart transplant in South Africa. Dr. DeBakey was among the first to begin doing the procedure in the United States. The problem was that recipients’ bodies rejected the new organs and death rates were high. In the 1980s cyclosporine, a new anti-rejection drug paved the way for organ transplants. Again, DeBakey was among the first to develop new protocols and advance the field of heart transplants. Where are the gaps in your organization or industry? What would happen if you developed a reputation for filling these voids?
9. Show people that their work matters.
Michael DeBakey is known not only for his prolific contributions to the medical field, but also as a symbol of hope and encouragement to his colleagues. Many years ago a colleague of ours shadowed Dr. DeBakey for a day at The Methodist Hospital in Houston, Texas. He was struck by DeBakey’s capacity to affirm each person he saw in the course of the day. In one particular encounter, DeBakey began chatting with an elderly janitor who was sweeping the floor. DeBakey asked the man about his wife and children. He told the older man, obviously not for the first time, that the hospital couldn’t function without the janitor because germs would spread, increasing the chances of infection in the hospital. Later in the day, our colleague tracked down the janitor and asked him, “What exactly do you do? Tell me about your job.” With pride, the janitor replied: “Dr. DeBakey and I? We save lives together.” He’s right. After all, consider what would happen to our healthcare systems if the cleaning crews went on strike. DeBakey understood that showing the janitor exactly how he contributes to a larger, more heroic cause is crucial. This creates a powerful dynamic. Realizing that he is working toward a worthy goal, the janitor’s perceptions about his work changed. It had new meaning and his enthusiasm for the job was rejuvenated. Great leaders make time to help people see how their work is connected to something bigger. For a surgeon like DeBakey, those five or ten minutes each day were costly, unless, of course, you consider the productivity generated by a janitor whose work has been transformed. Right now, how many people in your organization are engaged in work that five years from today no one will give a rip about? Can you make the link between what you do and a noble or heroic cause? Can you make this link for others?
10. Be generative—inspire others to pursue the cause.
Generativity is the care and concern for the development of future generations through teaching, mentoring, and other creative contributions. It’s about leaving a positive legacy. All great leaders are generative and Michael DeBakey was no exception. He inspired many medical students to pursue careers in cardiovascular surgery. His reputation brought many people to Baylor College of Medicine and helped transform it into one of the premier medical institutions in the world. DeBakey trained and mentored almost 1,000 surgeons and physicians. In 1976, his students founded the Michael E. DeBakey International Surgical Society. Many of his residents went on to serve as chairpersons and directors of their own successful academic surgical programs in the United States and around the world. Are the people you’ve touched in your career learning, growing and making a difference as a result of your influence? Have they been inspired to build a better world than the world they inherited? Michael DeBakey applied his problem-solving skills to many parts of medicine that have changed our way of life. Timothy Gardner, M.D., president of the American Heart Association said it well, “DeBakey’s legacy will live on in so many ways—through the thousands of patients he treated directly and through his creation of a generation of physician educators, who will carry his legacy far into the future. His advances will continue to be the building blocks for new treatments and surgical procedures for years to come.”
Michael DeBakey’s life and legacy proves that one person who chooses to play to their genius can change the world and make it a better place for all. What legacy will you leave behind?
O CIRURGIÃO (POEMA)
Um corpo inerte aguarda sobre a mesa
Naquele palco despido de alegria.
O artista das obras efêmeras se apresenta.
A opereta começa, ausente de melodia
E o mascarado mudo trabalha com presteza.
Sempre começa com esperança e só términa com certeza.
Se uma vida prolonga, a outra vai-se escapando.
E nem sempre do mundo o aplauso conquistando
Assim segue o artista da obra traiçoeira e conquistas passageiras.
Há muito não espera do mundo os louros da vitória
Estudar, trabalhar é sua história, e a tua maior glória
Hás de encontrar na paz do dever cumprido.
Quando a vivência teus cabelos prateando
E o teu sábio bisturi, num canto repousando
Uma vez que sua missão vai terminando
Espera do bom Deus por tudo, a ti, seja piedoso.
SOIS VÓS INSTRUMENTO DA TUA OBRA.
Qual o momento certo? AGORA.
“So live your life that the fear of death can never enter your heart. Trouble no one about their religion; respect others in their view, and demand that they respect yours. Love your life, perfect your life, beautify all things in your life. Seek to make your life long and its purpose in the service of your people. Prepare a noble death song for the day when you go over the great divide. Always give a word or a sign of salute when meeting or passing a friend, even a stranger, when in a lonely place. Show respect to all people and grovel to none. When you arise in the morning give thanks for the food and for the joy of living. If you see no reason for giving thanks, the fault lies only in yourself. Abuse no one and no thing, for abuse turns the wise ones to fools and robs the spirit of its vision. When it comes your time to die, be not like those whose hearts are filled with the fear of death, so that when their time comes they weep and pray for a little more time to live their lives over again in a different way. Sing your death song and die like a hero going home.”
~ Chief Tecumseh (Poem from Act of Valor the Movie)
The Qualities of a GOOD SURGEON
Following is a list of Dr. Ephraim McDowell’s personal qualities described as “C” words along with evidence corroborating each of the characteristics.
Courageous: When he agreed to attempt an operation that his teachers had stated was doomed to result in death, he, as well as his patient, showed great courage.
Compassionate: He was concerned for his patient and responded to Mrs. Crawford’s pleas for help.
Communicative: He explained to his patient the details of her condition and her chances of survival so that she could make an informed choice.
Committed: He promised his patient that if she traveled to Danville, he would do the operation. He made a commitment to her care.
Confident: He assured the patient that he would do his best, and she expressed confidence in him by traveling 60 miles by horseback to his home.
Competent: Although lacking a formal medical degree, he had served an apprenticeship in medicine for 2 years in Staunton, Virginia, and he had spent 2 years in the study of medicine at the University of Edinburgh, an excellent medical school. In addition, he had taken private lessons from John Bell, one of the best surgeons in Europe. By 1809 he was an experienced surgeon.
Carefull: Despite the fact that 2 physicians had pronounced Mrs. Crawford as pregnant, he did a careful physical examination and diagnosed that she was not pregnant but had an ovarian tumor. He also carefully planned each operative procedure with a review of the pertinent anatomic details. As a devout Presbyterian, he wrote special prayers for especially difficult cases and performed many of these operations on Sundays.
Courteous: He was humble and courteous in his dealings with others. Even when he was publicly and privately criticized after the publication of his case reports, he did not react with vitriol. The qualities of character demonstrated by Dr. Ephraim McDowell 200 years ago are still essential for surgeons today.