Surgeons aren’t just the first clinicians in the hospital in the morning and the last ones to leave at the end of the day. Surgeons were the very first clinicians.
“The first doctors in recorded history were people who did things that we, as surgeons, recognize,” said Allan D. Kirk, MD, PhD, FACS, the David C. Sabiston, Jr. Distinguished Professor of Surgery, chair of surgery, and professor in pediatrics and in immunology, Duke University School of Medicine, Durham, NC. “As mankind is concerned, the differentiation between a doctor and a surgeon is a relatively modern invention. Throughout most of time, people cared for other people through physical means. Surgeons were the very first doctors.”
Dr. Kirk will use this construct of our past to explore the future of surgery and surgeons during the 2021 Excelsior Surgical Society/Edward D. Churchill Lecture, First Doctor, Last Doctor, at 9:00 am Central Time on Tuesday, October 26. The lecture is named for the famed surgeon who served as a military consultant to the U.S. Army in Italy during World War II.
“As health care is changing, there is a sense that surgery is becoming less relevant,” Dr. Kirk continued. “That’s not the case. The unique perspective that surgeons have is completely necessary to drive innovation in modern medicine. Surgeons need to stay engaged with innovation, even those areas that seem, on the surface, not to be surgical culture.”
Machine learning and artificial intelligence (AI) have long since trounced human masters of chess and other games of strategy and are as good as, or even better than, the typical clinician at reading Xrays and other clinical images. Not a surgical issue, right?
Not so fast, Dr. Kirk cautioned.
“The most problematic thing in AI is that data is not grounded in reality, it’s just massive datasets thrown into the model. Garbage data in, garbage results out,” he said. “The beauty of surgeons is that we are grounded in reality. We are the people who are there with the patients. We are touching patients and we know what is really going on with them and in them.”
This unique proximity is valuable to those mapping AI-based tools for clinical decision support, Dr. Kirk noted.
“We can guide the development of artificial intelligence by being sure that the data in the model is grounded in reality, in real patients, in real populations,” he said. “That’s just one quick example of how surgical expertise plays into what might look like nonsurgical areas.”
Surgeons also need to actively shape surgical issues. Surgeons must thoughtfully define who needs surgery, who is most likely to benefit, and who can benefit more from another approach, Dr. Kirk continued. Surgeon-researchers have led the way in identifying diagnostic and prognostic factors to determine who can safely avoid which types of breast cancer surgery, who might be better served with nonsurgical options for prostate cancer, and other treatment choices. This approach is critical to ensure that surgical care remains value-based care.
“There is nobody better to know who actually needs a procedure than someone who does that procedure,” Dr. Kirk said. “Surgeons are best equipped and trained to navigate the issues of risk and benefit, and in this regard, we have to address our potential conflict of interests head-on.”
Surgeons are paid per procedure, so performing more procedures is in their financial interest, at least in fee-for-service models. However, those models are changing rapidly.
“Just as we were the first doctors ever, we are going to be the last doctors in health care decisions and health care advances to make sure they stay real,” he said. “We have to make sure we’re letting reality and biology speak to us and not money. Finances can’t dictate our reality, but reality will ensure our sustainability. It’s worked for the first 200,000 years.”
The Excelsior Surgical Society was a group of 80 medical officers who first met in 1945 at the Excelsior Hotel in Rome. This lecture honors both the society and surgeon Col. Edward C. Churchill. It is sponsored by the Military Health System Strategic Partnership of the American College of Surgeons.
This lecture and other Clinical Congress 2021 sessions are available to registered attendees for on-demand viewing for a full year following Congress on the virtual meeting platform.
For a detailed discussion of this session, view an interview with Dr. Kirk. Conducting the Clinical Congress Daily Highlights interview is Julia Coleman, MD, Vice-Chair, Resident and Associate Society of the American College of Surgeons.