John M. Schuberth,
DPM, FACFAS
Chief, Foot and Ankle Surgery
Kaiser Foundation Hospital |
Guest Editorial: John M. Schuberth, DPM, FACFAS, has been one of the most influential educators in the history of podiatry. In addition to over 100 residents that he has directly trained, Dr. Schuberth has written dozens of editorials—in his many years as Editor of The Journal of Foot and Ankle Surgery—serving as the conscience of the profession.
Nobody Told Me...
lthough John Lennon was killed 28 years ago, the event occurred in the midst of my own residency training era. Like many of Lennon’s songs, there are valuable lessons within that I wish I had learned back then. Or put another way, there are issues that I have had to reconcile throughout the years of practice that would have made my transition from novice to “has been” much easier, had “somebody told me”.
First of all, I am willing to venture that most residents today believe that many, if not all of their attendings, “forgot” what it was like to be a resident. Nothing could be further from the truth, as most practitioners have a vivid recall of the excitement, enthusiasm and uncertainty that pervaded our souls. Clearly it was and should be one of the most critical and influential times in our personal and professional life. Although most would suggest that there is little personal enhancement during residency training, there certainly was a molding of values that form the basis of our professional behavior. Trying to extricate one from the other is foolish.
Nobody told me that nothing can "ruin" a perfect technical execution of a surgical procedure like a little follow-up. Although some of you may have access to some of the patients “long-term” follow-up, the majority do not. As such, can anyone recall asking an attending “How is Ms. Smith doing” and getting any other answer other than “wonderful”? I vividly recall the first time I saw one of my patients that experienced my “technical wizardry”, only to observe that the entire construct had fallen apart. I vividly recall seeing a patient 10, 15, 20 years later that I had operated, only to have them tell me “I never came back because I thought it would get better, but it never felt good after surgery”.
Nobody told me that there is absolutely no condition on earth that cannot be made worse by an operation. This concept is potentiated by performing complicated operations on patients with simple problems or complaints. Contrarily, if the presenting condition is difficult, the consequences of surgery are more likely to be accepted by the patient.
Nobody told me that the legal system may not be entirely interested in “right or wrong”. Although a convoluted system, the primary divisor medical legal system is the conflict of the cost of emotional vs. monetary capital. It is axiomatic to surgeons that a bad outcome doesn’t imply malpractice, but this is a society of opportunists, and opportunity abounds.
Nobody told me that experience counts. I recognize now that one cannot gain experience without some missteps along the way. Yet the steepness of those steps is what segregates bravado from responsible patient care. Nothing could be more idiotic than doing complex procedures fresh out of residency that take years to master. The key is to take incremental steps, asking for competent help along the way.
Nobody told me that most medical equipment and health insurance companies do not have patient welfare first and foremost. Enough said….
Nobody told me that the lecture circuit is over-rated. Clearly I remember the excitement of standing up in front of a large crowd shortly after residency with a huge sense of self importance. I thought I had something to say…. In an almost exponential fashion, there were so many weekends I was absent from my life. Time I can never recover….Now it is easy to say no. It is easy to say no because I understand the hypocrisy or perhaps the difference between education and commercialism. It is easy to say no because the “nothing to say” club is expanding and I don’t want to be a member. It is easy to say no because the lecture hall is not the venue for education.
Nobody told me that I should have had more training. I recall declining to accept a prominent 3 year residency program in 1981, because I was naïve enough to think that the 3rd year would be a waste. Yet the dichotomy is that I did have more training, I just didn’t recognize the instructor. The instructor is the practice of medicine and that instructor is a stern task master. I learned that the more I know, the more I recognize how much I don’t know. I learned that I should learn from every surgical encounter, every patient encounter, no matter how trivial or egregious the experience.
Nobody told me that it is a privilege, not a right, to operate on a patient. Many residents subscribe to the opposite mentality. My fellow resident and I considered “quitting” because we did not think we were allowed to do enough surgery early in our tenure. We felt that we were denied our “rights”. But now I recognize that the true struggle is tempering the chasm between patient responsibility as that patient’s surgeon, and the responsibility to train the future of this profession. It is funny that everyone understands this on July 1st, the day after graduation.
Nobody told me that the most important qualities for being a successful surgeon are a blend of integrity and humility. You will be granted the humility like it or not… The sense of integrity is up to you.
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