Rules of Surgery


Rules of Surgery


  1. Operations are for other people. This is self-evident to most surgeons. Contrary to popular perception, most surgeons are not ‘knife happy’. We are intimately familiar with the Law of Unintended Consequences and do not recommend surgery lightly. It follows then, that we would be extremely reluctant to have surgery ourselves. We know all the bad and unexpected stuff that can happen. Plus, we’re all control freaks and anesthesia and surgery represent an intolerable loss of control.
  2. The patient is the one with the problem. Leave your bad day, the fight with your spouse, the unpaid bills and all that personal crap at the door to the operating room. It has no place in surgery. Your sole focus should be on the patient and their operation.
  3. Don’t mess around. Get in, do the job, get out, in the most expeditious manner possible. That doesn’t mean hurry. Speed in surgery doesn’t come from moving fast, it comes from moving efficiently. The surgeon who doesn’t waste motion, doesn’t do things that are of no use, is the fast, safe surgeon that you want doing the operation.
  4. Training never stops. As my friend, the late Troy Brinkerhoff, used to say, “Every day is a school day.” You never stop learning new techniques, new ways to look at a problem, new approaches that improve your efficiency. Plus, it’s so damn interesting, how could you not continue to train?
  5. Wishful thinking is for losers. Just because you want something to be so, doesn’t make it true. Never let your expectations or desires color your judgment.
  6. Be familiar with all specialties. You may be a general surgeon, but you should know enough medicine to be a passable Internist. You should know what the gynecologist does and how in general to do a hysterectomy or oophorectomy as well as how to do a proper pelvic exam. You need to know the basics of Orthopedics, Urology and Thoracic surgery because there will come a time at 0-Dark:30 when you are all alone in the operating room and will need those skills.
  7. Learn to see what cannot be seen and to touch what cannot be felt. This sounds a bit mystical, but is about developing intuitive knowledge and instinct. In other words, learn when to trust your gut. More often than not, it will show you the way.
  8. If the operation is difficult, you’re doing something wrong. It may be that you’ve made the wrong incision or chosen the wrong procedure. Maybe you picked the wrong patient (didn’t account for all the potential risks before operating). Figure out what’s wrong and the operation will become easy.
  9. All bleeding stops eventually. It’s your job to make that happen while the patient is still alive.
  10. God watches out for fools, drunks, and young surgeons. Sometimes it is better to be lucky than good.

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