I was in my surgical residency back in the days of “you can go home when the work is done.” A few years before I arrived as an intern, one of my attending surgeons had decided he was going to jump on the trauma train. Trauma was in its infancy back then, and he was convinced (and rightly so) that patients could be greatly helped with this relatively new concept of the “golden hour.” I remember hearing stories of him taking a trip to Baltimore’s Shock Trauma Center, and when he returned he was full of great ideas. He designed an incredible system for our program including three helicopters and a dedicated trauma room where the residents ran the show. By the time I arrived in the program, the program was running like a Swiss watch.
I learned how to treat and manage a trauma victim from the guys over me. There was always a trauma team on call, and that team consisted of two interns, a second year, and a third- or fourth-year resident as well as two trauma nurses and various other ancillary hospital personnel. The third- or fourth-year guy was the captain of the ship in that room. He had one job, and that was to stand on a four-foot high box and watch everything “from above.” He watched as the team carried out it’s assigned duties, and then he directed procedures as needed. When it came to be my turn on the box, I immediately understood the genius of having the senior man in the room looking at the trauma and the trauma team’s moves from a different point of view. It gave him a perspective that he didn’t have from “ground level.”
For most of our medical careers, we doctors have a ground level perspective. We are slugging it out in the daily grind and never get much above that level. But when you reach the age of retirement, your point of view begins to take on a higher view; it looks more like the view of the “man on the box.” You look around you and see things you haven’t ever seen before. You realize that not only has health care changed, but you have changed, too. So when someone asked me the other day, “What’s one thing you have changed your mind about since you started in surgery?” I had to think a bit before I answered.
Having trained in that bygone era, I was of the mindset that surgeons pretty much did it all. They operated, made rounds twice a day, if possible, and made all the treatment decisions. But I watched as my colleagues began to hire helpers. Helpers who became more than just assistants in the OR, they began to take over some of those functions like rounding and medication decisions. I realized that these were well-trained people who were very capable. In many ways, they freed up the doctor to doctor better.
Lately, I have had the privilege of working with several bright and conscientious nurse practitioners who have convinced me with their brains and skills that they are up to the task. They are aware of their limitations and are thankful for a physician supervisor. My oldest daughter is a nurse anesthetist and does an amazing job in the OR, but there are times when she “calls for back-up” from the anesthesiologist and she is grateful for their expertise.
Much has changed since I started as a surgical resident. Most things have changed for the worse because the patient-doctor relationship has suffered from the changes in health care and health insurance. But I am now of the opinion that the patient-doctor bond has strengthened because the doctor no longer needs to do it all. That does not mean he can become a glorified technician in the OR, he must still see his patients and their families and still take care of himself and his own family, but now he’s able to that even better.
Dave Redd is a surgeon and founder, QuikSurg.
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