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AANS Neurosurgeon | Volume 28, Number 2, 2019

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The Mindful Neurosurgeon and the Art of Doing What’s Right

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Being a mindful neurosurgeon is a lofty and on the surface, a seemingly complex goal indeed. Over a decade ago, I was in the audience for a lecture on spine surgery at a national meeting. The lecture hall was packed and each person in the audience had access to an audience response system. The speaker presented a case and asked the simple question, “Would you recommend surgery for the patient just presented?” Roughly 80% answered in the affirmative. Subsequently, he asked the question, “Would you undergo this operation yourself?” Roughly 80% answered in the negative. This dichotomy is damning for our profession. Simply put, this is a violation of the Golden Rule – do unto others as you would have done unto yourself. Mindfulness was not featured in the lecture hall that day. I am not sure of the right thing to do in that case, but I am certain that the majority of the surgeons in the room, at least during the time frame encompassing the lecture, were not mindful. They were not focused on the Golden Rule.

A Calling

Many factors have driven neurosurgeons to who they become as physicians. These include personal gratification, professional advancement and monetary gain. But, the aforementioned factors are more or less mechanical and are representative of what most people associate with the advantages associated with their job. Paul Kalanithi, in his riveting book, “When Breath Becomes Air”1, addresses this very point in discussing the notion that physicians should be or become selfless; i.e., place our patients’ interests above our own. He then makes a clear separation between a job and a calling. 

“Indeed, this is how 99 percent of people select their jobs: pay, work environment, hours. But that’s the point. Putting lifestyle first is how you find a job – not a calling.”

The mindful neurosurgeon has mastered the art of doing what’s right. The mindful neurosurgeon does not look at a job from the perspective of the job being a commodity generator, but from the perspective of the job as a calling.

Becoming a Mindful Leader

We neurosurgeons are all leaders and should act accordingly. Good leaders are selfless. They are egalitarian. They have visions and possess self-direction as well as the ability to motivate. They are socially and self-aware. In other words, they are mindful of themselves and those with whom they interact. They have a worldview that causes them to do what is right.

Good, mindful leaders guide patients to better places. They are concerned much more about doing what’s right than they are about revenue generation or academic advancement. They focus on the good they do (value-based care), not on how much they do (volume-based care).

Truly mindful leaders also perpetually reflect. They honestly assess themselves and their own actions. They are very critical of their own results. They strive for honesty. The words of Sir William Osler resonate here (from The Student Life, 1905):

“Begin early to make a threefold category – clear cases, doubtful cases, mistakes. And learn to play the game fair. No self-deception. No shrinking from the truth. Mercy and consideration for the other man. But none for yourself, upon whom you have to keep an incessant watch…. It is only by getting your cases grouped in this way that you can make any real progress in your education; only in this way can you gain wisdom from experience.”2

Finally, and most importantly, mindful leaders are empathic. Empathy has two components; caring and showing that care. Most people care. Neurosurgeons care about people, results and interpersonal interactions. All of us, however, occasionally fail to express the fact that we care. Being aware of one’s self and how to project in conversation and action is a truly difficult task. Self-awareness is integrally woven in with social awareness (the ability to understand and respond to the needs of others). These terms can be thought of in the context of how we project ourselves, versus how we perceive and respond to the needs of others.3 Bottom line, we need to remain mindful and considerate.

The Truly Mindful Neurosurgeon

Hence, the mindful neurosurgeon is an empathic leader who values doing what is right over all else and approaches his/her career as a calling. Sounds simple, but it is oh-so difficult to achieve. Remembering the worlds of Osler may serve us all well as we strive to achieve the pinnacle of mindfulness. Doing all these things may appear difficult or even impossible, at first, but that can become a labor of love with nurturing and work. Then, it feeds on itself! When we do what is right, we get good results. Good results translate into job satisfaction and fulfillment. Satisfaction and fulfillment, in turn, translate into happiness. A happy surgeon is an effective and productive surgeon.

References

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1. Kalanithi, P. (2019). When Breath Becomes Air. Random House USA.

2. Osler, W. (1905). The student life: a farewell address to Canadian and American medical students. publisher not identified.

3. Benzel, E. C. (August, 2019). World Neurosurgery Editor in Chief Newsletter.

Leave a Reply

Jeffrey Crecelius | February 6, 2020 at 11:34 am

Thank you for these thoughtful comments and your leadership.

Edward Fletcher Eyster MD | February 7, 2020 at 2:43 pm

I was also in the room that day and was appalled at the response of the audience.
DrBenzel is correct and a lot of spine surgeons should read his article.
Simply said “patient first”