The power of role models in surgery: Positive and negative
Innovation is not just technology, but changes in practice and paradigm shifts in teaching and training. Many times innovations in technology and processes require a disruptive force or what we like to call a true transformational change. These kinds of changes are good because they require us to re-evaluate the clinical needs of our patients and colleagues. However, there is a dark side of disruption when it is used to describe personal behavior.
In this column, Gerald B. Healy, MD, FACS, FRCS(h), FRCSI(h), former president of the American College of Surgeons, addresses this form of disruptive behavior and explains why positive role models in medicine are important as we move towards new models of health care delivery that require teamwork and transformation of our medical training and resident programs.
Anthony M. DiGioia, III, MD
Emerging Technology & Innovation Editor
Present surgical training models date back almost 100 years and focus heavily on apprenticeship and technical ability. Most trainees get little instruction on the human elements of being a caring physician during their years of preparation.
It is very apparent that trying to reshape and remold an aging system to meet the demands of todays patients and their physicians is not going to be effective. For example, in the past educators paid little attention to working conditions for trainees such as the living and learning environment, social support and compensation models. Trainees were just fortunate to be chosen and admitted to the right of passage.
To be effective, surgical educators in the 21st century must reexamine their roles and consider what messages they are sending to future generations. Jonas Salk, MD, once said, Our greatest responsibility is to be good ancestors.1 This charge is more important than ever in our rapidly changing health care world. The challenges to surgical educators mount by the hour with ever emerging new technology, demands on time and constant influences of outside forces such as government, insurance carriers and regulatory bodies.
Challenges to care
The report, To Err is Human, documented significant breaches in patient care. Many of these breaches involved issues of poor communication, lack of professionalism and inability to work as a team. These three elements form a substantive part of the general competencies that serve as a basic template for practice throughout medicine, from medical school to the end of practice. Many of the deficiencies noted in the report were the result of actions of people who form the heart of the surgical education community and can be framed as glaring examples of poor role modeling. The examples set by these surgeons, positive and negative, have a lasting effect on the development of the next generation. These breaches also present significant challenges to safe and cost-effective care.
Communication, conduct and professionalism
Unfortunately, the ability to transmit effective skills in communication has not been seriously addressed by surgical educators and, in fact, many who consider themselves role models for young surgeons seriously lack this skill and are often the worst offenders in modeling proper approaches to the issue.
Disruptive behavior and unprofessional conduct continues to be an increasing problem in the medical profession. This activity, including physical and verbal abuse of colleagues, is on the rise. Humiliating, degrading or shaming behavior is a threat to patient safety because of immediate and long-term negative effects on the recipient. In the immediate aftermath of an episode of humiliation, the recipient experiences a mixture of intense feelings of anger, shame, isolation, self doubt, frustration and depression. These feelings significantly affect the ability to think clearly. As a result, the individual, at that time, is much more likely to make an error in decision-making, judgment, calculation, or performance. Emotional distress impairs cognition. Intimidation may also lead to a failure to communicate significant patient care issues in the future and force a person to commit unsafe acts. In many settings, surgeons are the worst offenders in this regard.
A deep sense of professionalism forms the core of most physicians self images. While definitions of professionalism vary, placing the patients interest first is central to all. The Physician Charter on Medical Professionalism proposed by the American Board of Internal Medicine and others list primacy of patient welfare as a fundamental principle. A high percentage of physicians agree with the commitments expressed in the charter. Many surgical educators have failed to effectively address this in training programs and, thus, have failed as role models in this critical area.
Finally, we must address the concept of team care. Working in a system of a care has not been the traditional structure of surgical training, and, thus not an integral part of the practice pattern of current role models. The one doctor/one patient model is outdated in that this is no longer how we care for patients. Surgeons must begin to view themselves as leaders of a high performance team lest they be left as mere technicians waiting to be replaced by a surgical robot and a software package.
The need to address these critical issues is clear and awaits surgical leaders who are committed to leaving real legacies as role models and mentors.
- ABIM Foundation, ACP-ASIM Foundation, European Federation of Internal Medicine. Medical professionalism in the new millennium: A physician charter. Ann Intern Med. 2002; 136(3):243-246.
- Campbell EG, Regan S, Gruen RL, et al. Professionalism in medicine: Results of a national survey of physicians. Ann Intern Med.2007; 147(11):795-802.
- Fahey L, Randall RM (Eds.) Learning from the Future: Competitive Foresight Scenarios. (1998). Wiley, New York.
- Anthony M. DiGioia III, MD, is the editor of Emerging Technology & Innovation. He can be reached at Renaissance Orthopaedics, PC, and Pittsburgh, Pennsylvania Innovation Center, Magee-Womens Hospital of UPMC, Pittsburgh.
- Gerald B. Healy, MD, FACS, FRCS(h), FRCSI(h), isa Professor of Otology and Laryngology at Harvard Medical School, Boston MA. He can be reached at email@example.com.
- Disclosures: DiGioia is a shareholder in Blue Belt Technologies.