Would You Like Your Surgeon to be Fast, or Meticulous?

One of the chief fascinations of surgery is the management of wounded vessels and avoidance of hemorrhage. The only weapon with which the unconscious patient can immediately retaliate upon the incompetent surgeon is hemorrhage. If he bleeds to death, it may be presumed that the surgeon is to blame. Whereas if he dies of infection or shock or from an unphysiological operative performance, the surgeon’s incompetence may not be so evident.

  William S. Halsted

The precision of tissue handling and respect for them is one of the characteristics of Halsted’s operative philosophy. He was known to say, that each time a surgeon even touches the tissues, he inflicts damage to the patient. He used custom-made, fine tip hemostats, painstakingly precise hemostasis, fine ligatures used carefully so including only as little tissue as humanly possible. His entire technique was designed to minimize trauma, which each surgeon inevitably inflicts on his patient. And he was merciless in demanding that from himself and his residents. The result was, however, that his operations took a long time to complete.  And I mean a loooong time. One day, he had visitors – surgeons from New York. After the surgery was over, one of them remarked, that it was the first time he saw by the end of the operation, that the upper part of the incision was already healing without the surgeon finishing the procedure.

But his overall results were spectacular. The main yardstick of all complications at that time was the infection rate, and his was exceptionally low. It was happening in times, when just a few years before, surgical infection was almost expected to happen. Both, meticulous hemostasis combined with pedantic antisepsis made his fame and the patients were flocking to his clinic from all over. Or he went to their homes accompanied by his team of nurses, technicians, hauling even his own equipment. And operations not infrequently were done on the kitchen table. If the patients were affluent, and quite many of them were, he charged fees in the range of several thousands of dollars, which in those times were real money.

Nowadays, we all know surgeons, who pride themselves, or are being described by staff, as fast, “speed demons.” It’s fine, if it doesn’t come with shortcuts and unnecessary roughness. After all, the time the patient spends under the anesthesia on the operating table, is not totally harmless. And sequential scheduling surgery within the allotted time puts time restrains on everyone.

So speed, or precision?

The answer is both. As always, golden medium. Speed is important, but not to the point of compromising the patient’s wellbeing. Sloppy surgery is too big a prize to pay for being talked about as a “fastest surgeon in the West.”

But nothing beats the great feeling of an accomplishment after a well done surgery. You know it. Everything clicks, there are no setbacks, no ‘oopses’, no drama. You finish the case, take your gown down, put it neatly in a trash bin, and follow with the gloves. Then you say ‘thank you’ to your operating team. You feel like a conductor in the Met after finishing the Fifth Symphony. It’s time to bow and leave the stage. And have coffee in the doctor’s lounge.

Then you marvel, how quickly your patient recovers. And he and his family sign your prizes for the rest of their lives.

And in the next case you have a complication, not entirely of your making, and the patient sends you a letter with notification of intention to sue.

This is the life of a modern surgeon.