In his Presidential Address at the Convocation Sunday night, Ronald V. Maier, MD, FACS, FRCSEd(Hon), FCSHK(Hon), the newly installed President of the American College of Surgeons (ACS), said surgeons should follow the “Platinum Rule” in caring for their patients. Applying this standard, surgeons care for patients “not only as we would wish to be treated ourselves, but as [patients] wish to be treated based on their own unique ethnicity, gender, backgrounds, experiences, cultures, and the entirety of their intersectionality.”
Dr. Maier, the Jane and Donald D. Trunkey Professor and vice-chair of surgery, University of Washington, and surgeon-in-chief, Harborview Medical Center, Seattle, WA, addressed the more than 900 Initiates from around the world who attended the Convocation. This year’s Initiates class was the largest ever, totaling 1,970.
“Patients will come to you vulnerable, and you will return them to strength. Patients will come to you with diseases, with dysfunction, and you have the skills and the technology and the capability of returning them to a position of health and function. Of the honors one may receive, none is greater than the daily respect and faith our patients place in us as they place their care and lives in our hands,” Dr. Maier said. “Always remember their valor, their dignity, their humor, and their determination.”
Surgeons should always place their patients’ needs first, Dr. Maier said. “No matter how famous you become, remember whom you serve. Be humble. Accept with an open mind what your patients teach you daily. If you do, they will find a way to keep you humble in so many unique and challenging ways.”
Dr. Maier also encouraged the Initiates to commit to lifelong learning. “Maintain your love for attaining new knowledge and be open to a lifetime of learning. As you enter practice, if you believe you have all the answers, you are in the wrong profession. Science and technology are constantly changing,” he said. “Be humble and recognize your gaps and acknowledge your deficiencies.”
An effective way of uncovering those areas in which one is experiencing challenges is by benchmarking outcomes against other surgeons. “Outcomes assessment was a foundational value upon which the College was established, and the ACS has remained a worldwide leader in this respect,” Dr. Maier said. “Whether it is developing the structure to improve the outcomes of your trauma system, measuring the effectiveness of your bariatric center, or evaluating the individual surgeon, the ACS offers programs that allow surgeons to compare outcomes against data generated by other surgeons, rather than arbitrary standards developed by an accountant.”
Dr. Maier also encouraged surgeons to serve as leaders within their institutions and on their multispecialty teams through mentoring and teaching. “We are the teachers, coaches, sponsors, and constant supporters of our mentees and team members. Take time to teach—whether it’s a patient and his or her family, a trainee, a mentee, or your health care colleagues,” he said. “Share your knowledge willingly and daily. As consumer activist Ralph Nader has said, ‘The function of leadership is to produce more leaders, not more followers.’”
“Treat each other the way you would want to be treated, with kindness, professionalism, and respect,” he added. “How often will a bad outcome be avoided if the nurse or any member of the team is respected, encouraged, and empowered to speak up? To be effective, your colleagues, including all members of the health care team, must trust you. And, in return, you must trust that they are hardworking, committed, and dedicated to the care of our patients.”
Surgeons should use their decisiveness, skill, and independence to lead outside the hospital as well. “Assume the societal leadership role willingly. Work with your patients, your community leaders, and our elected officials to do what is right for our patients,” Dr. Maier said. “Be an advocate for our patients to have reasonable access to surgical care and the guaranteed right to medical care. Be a leader, whether in your hospital, your hometown, or your professional organizations.” In these efforts, surgeons should focus not on pointing out problems, but on finding solutions.
“The world needs you to embrace your role as a moral leader in society”—one who fights to achieve equity for the most vulnerable among us. “Being a moral leader means standing up for truth, reason, and science. It means not being afraid to stand up for your principles or hold elected leaders accountable for meeting the needs and the values of our communities,” he said. “We’ve been told that we should shy away from political controversy. But your obligation from today onward is to stand up for the vulnerable and the voiceless.”
To deliver optimal care and to fight for their patients, surgeons must be in optimal physical and mental health themselves. However, because of administrative burdens, staffing shortages, diminishing resources, and regulatory and payor demands, “physician burnout has been reported to be occurring in more than 50 percent of our colleagues and is increasing,” Dr. Maier said.
“Patients routinely change physicians, employers change insurers, and insurers change physician panels during frequent employer-insurer negotiations, absent input from either patients or physicians, who are left powerless and without a voice in the process. Thus, the passion for our profession erodes, and we become more and more isolated,” Dr. Maier said.
“It is time to heal the healers. Avoid burnout and the attendant loss of compassion. As challenges and pressures continue to change and mount, you must develop an active strategy to prevent overload and depression,” he added.
Noting that young surgeons have proven to be at the greatest risk of burnout, he encouraged Initiates to develop resilience. “One of the recognized best tools in the development of resilience is the development of friendships, communities, and support upon which to rely,” Dr. Maier said. “One of the best ways to develop these relationships is through joining and working within professional organizations and their attendant communities.” These groups offer opportunities to form relationships with other surgeons who are facing and successfully overcoming these challenges.
The ACS provides an online self-assessment tool to help surgeons identify whether they are at risk of burnout, as well as a wealth of opportunities for growth, involvement, and reward, he said. He pointed to his 20-plus years of involvement with the ACS Committee on Trauma. “The positive rewards of working within and for a community of like-minded professionals committed to improving the care of the injured patient was an unbelievable opportunity to continually reenergize, enjoy, and experience positive self-worth as I have advanced through my career,” Dr. Maier said.
“Regardless of your specialty or your personal interests, the College provides a multitude of avenues and opportunities for you to become involved, work with your colleagues and elected officials, and to improve the care of our patients,” Dr. Maier said.
“Surgery is not only a great profession, but also the best profession in medicine—a profession, I would argue, that will provide you with the recognition and rewards that you deserve based on the years of hard work, dedication, and commitment to become and remain the best surgeon that you can be,” he said. “May you find the true joy and satisfaction in our profession, the best there is, and fulfillment through your life’s work in caring for our patients.”