What's in Your Tool Chest?

August 20th, 2016

I recently contributed a blog to www.JHSFocus.com--- a website sponsored by the American Society for Surgery of the Hand. It addresses the necessity to continue to develop---not as "surgeons" but as caring and compassionate "physicians.":

I have never considered myself a “Carpenter” and am not particularly handy around the house. My enthusiasm for Orthopaedic Surgery was not a love of hammers and nails, but a desire to be able to be both primary care musculoskeletal provider and surgical subspecialist. I initially wanted to become a cardiac surgeon, and my interest in complicated problems and surgical solutions attracted me to hand surgery and reconstructive microsurgery. Over the years I have added many technical advances to my “tool chest” but did not really contemplate what nontechnical skills might be lacking, or shall we say, underdeveloped. Quite frankly, like many surgeons, I have long regarded my surgical skill, instruments, and decision-making as paramount to superlative outcomes. But a good outcome nowadays has been reframed. It’s rightly defined by our patient’s perception of their outcome. And this involves not only their functional return and pain relief, but their “care-experience” and satisfaction with us, as providers.

In 2012 I started to rigorously investigate patient satisfaction with my care, and it has become very clear over 4 years that my scores are higher when I spend more time with patients. This single metric facilitates being a more attentive, and empathic listener. And deliberate intention to engage and connect with my patients leads to building mutual trust. Further, and most compellingly, I have found that I have rediscovered the purpose-driven enthusiasm for my work, despite its nonclinical burdens, increasing paperwork etc.
Now, I have to admit that my revelation did not instantaneously occur one day. Rather, it was only after a humbling crucible that inspired me to challenge my previous narrative---“that I was a very busy and successful specialist, and that it should be enough for patients to receive technically great care-- that I should be given a pass if I did not necessarily resonate with each and every patient when it came to how they perceived their care experience.”
One need not investigate farther than a random query of some of my most illustrious colleagues in the American Society for Surgery of the Hand, or the American Shoulder and Elbow Surgeons to find that this narrative is all too common, especially among our “finest.” Here is a sampling from Vitals.com:

Don't go to this dr. for warm and fuzzy care. While he's an excellent surgeon, his bedside manner is crass. If you're going to him post-op make sure you warm your hand up/ do exercises before you see him -- he prays on your "weakness" and goes for it. Not always the most pleasant experience; but he really is an excellent doctor otherwise.

And here’s a rebuttal from a physician who was also a patient of the same hand surgeon:
Why do patients find it acceptable to bash doctors when the doctors have no recourse to reply? You chose the doctor not the other way around. We cannot perform miracles and sometimes you have to live with what you have and accept it. I find it shocking that people would rather see a warm fuzzy orthopedist than the best technician/diagnostician. I also have a long wait time as we specialists aim to treat as many people and give them the best care possible in the constraints of time and space availability. Why do patients think that there is a time limit on medical care? Take the day off and appreciate the time your given. I would be concerned about seeing a doc with an empty waiting room and "lots of time" on his hands to see patients quickly.

Reflect on these two reviews. Do we actually provide the best care possible by overbooking and seeing our patients for 5 minutes or less? Are our competence and craft the only tools in our tool chest? Have our training, pursuit for innovation, notoriety and accolades, which many of us have genuinely achieved with the best of intention, unknowingly stigmatized purposeful, compassionate care, such that the economic opportunity cost of being more empathic and slowing down is characterized cynically as “warm and fuzzy?”

At a recent orientation session at the University of Michigan, where my son will be attending this fall, a Professor extolled the value of the campus’s diversity and the importance of appreciating and respecting different points of view. He actually said, “Do you want your son or daughter to leave these 4 years with a limited number of tools in their tool chest? If they only have a hammer, and a situation arises where they need a different tool, they will be disadvantaged. Our job is to equip them well----to fill their chest.”

“I find it shocking that people would rather see a warm fuzzy orthopedist than the best technician/diagnostician”

I find it shocking that we would not aspire to be both warm and fuzzy and supremely competent as technicians. We do a lot of CME to sustain and grow our competence as surgeons and diagnosticians. We must not ignore the importance of developing our nontechnical competence.

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