My hand is outstretched. The room is quiet, but with that underlying hum of concentrated activity that occurs when multiple people are intensely and efficiently completing the many tasks necessary for the patient to have a successful outcome. The pace is quick but confident. Without a word, I feel the necessary instrument placed in my hand. My attention to the procedure, removing the thick layer of clotted blood from the surface of the patient’s brain, never varies. Irrigation, suction, and retraction, when required, all are provided by my assistant with minimal need for communication. Our anesthetist, an expert at providing anesthesia to critically ill patients, is constantly scrutinizing the monitors, watching for any change that should be announced to the room. Our circulating nurse is moving quickly, not only responding to requests, but following the progress and anticipating the next needs before they occur. As a team, we have performed this surgery many times before.
After the last sutures are placed, the head wrapped, the patient evaluated following emergence from anesthesia and the family appraised of the status, my patient is tucked into the ICU. The critical care nurse knows how to contact me and knows I will respond promptly. On my part, I know that she is vigilant, able to identify subtle neurologic changes. I can sleep knowing my patient, a 65-year-old grandmother of four who tripped when her legs caught in the leash of her new puppy, is receiving the best care possible and, as a consequence, will have the best outcome possible.
My skills as a neurosurgeon, accrued over seven challenging years of residency and refined in more than 30 years of practice, are human skills. A level of competent performance of manual tasks is found in every successful neurosurgeon. My hands, eyes, and reflexes are no better than anyone else’s. What may set me apart, however, is the ability to build a team. As a patient, I want not only the best surgeon, but the surgeon with the best team, since the outcome is dependent on everyone that touches a patient.
When my patient does well, awakens to discover the shocking haircut that she received in the OR and gradually returns to fussing over her new puppy and her grandchildren, I will get much of the credit. But the credit, the gratitude of the patient, her children, her grandchildren, and her puppy, should go to the team which consists of multiple staff members whose efforts resulted in that successful result.
Being part of a team is one of the experiences that drew me to a surgical specialty. At times residency felt like you were in the trenches, receiving fire from all directions alongside colleagues that you supported to your utmost, and who, in turn, would support you. I have tried to create and nurture similar relationships after completing residency and moving into practice, hopefully with a lesser degree of incoming fire.
One of the most rewarding aspects of my practice has been the ability to discuss challenging patients with my coworkers. At times we will be huddled up to the computer screen reviewing unusual images. Other times we will be troubleshooting treatment failures or celebrating treatment successes. Occasionally we may strategize on an approach to a patient with a difficult personality or a family that requires maximal support to get through a catastrophic event. Sometimes the collaboration is with other surgeons but equally as often I am drawing on the expertise of NPs, physical therapists, social workers, RNs, and others. The nurse who has worked with me for 30 years can diagnose cervical myelopathy when walking the patient to the exam room and I often rely on her wisdom as well.
Team building, fostering collaboration amongst all these entities, is a skill that not only leads to optimal results but also functions as a practice survival technique and helps to keep burnout in abeyance. When the challenges seem almost insurmountable, a pre-authorization for surgery turned down for a patient in agony, a head injury patient whose intracranial pressure keeps climbing, or a pager that seems to go off like clockwork 20 minutes after I have fallen asleep, it’s my team that buoys me, that reminds me of the joy in every battle, won or lost. If you’re just starting practice or if you’re in practice, but want a surefire strategy to enhance your practice experience, consider expanding your connections and deepening your bonds by building your team. The reward will be a sustainable practice with less stress, richer experiences, and better patient outcomes.
Who are some great clinicians on your team? Shout them out in the comments.
Dr. Ellen Nichols is a neurosurgeon in Joplin, Missouri who practices in a group of four neurosurgeons, two physiatrists, four NPs, and one PA. She has provided general neurosurgery services including spine, cranial and peripheral nerve surgery to the four-state area (Missouri, Kansas, Oklahoma, and Arkansas) for 31 years and is currently Medical Director of the NeuroSpine Group.
All names and identifying information have been modified to protect patient privacy.
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