cardsurgguy

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Is being a great surgeon nature or nurture?

I've been thinking about this recently after I finished reading "Walk on Water" as well as my observations in the hospital with the surgeons I've worked with.

Different points in the book/real world that I've noticed that back up either view, so I wanted to ask to get more responses from people who have more knowledge on the subject than I do.

(If anybody hasn't heard of the book, it's about Roger Mee, who I believe just retired after being one of the best, some would say the best, pediatric cardiac surgeon in the world)


Nature:

1. In the book, several of his fellows that worked under him described Roger as having innate skill. One fellow was quoted by the author as saying "Roger's repairs look like God did them."

2. In interviews with Roger, he mentions knowing innately how much tension to put on sutures-not too much, not too little. Overall, it's like he has a "feeling" for the heart and when the repair is right.

Another skill that was noted was that he could see trouble coming when it was still 3-4 steps ahead before anybody else sensed it, which allowed him to intervene before it hit.
It was almost as if he had a sixth sense, above what machines, or vitals, or whatever else would tell him.

3. In one example in the book, he did a biventricular repair on a kid that was told by various CT surgeons at other places, as well as cardiologists, that the kid would have to have a single ventricle repair. If I remember correctly, somebody in the book said that Roger is probably one of a handful of people who not only make a single ventricle repair work post-op, but even have seen the possibility for a single ventricle repair in the first place.

4. In the hospital I worked at, I've heard plenty of times of certain surgeons being regarded by other physicians, nurses, etc... as "gifted" or "skilled".

Obviously, all of these are more towards the nature side of spectrum.
I would assume not everyone can do a repair "like God did it" or has a "sixth sense".


Nurture:

1. The book vividly points out that Roger is an obsessive compulsive perfectionist who "if he doesn't feel that anything is perfect, even 1 suture, he'll do it over again until it's perfect." "If it's not perfect, everybody stays until the operation is perfect" is another quote. The author described him as being intolerant of anything less than perfection.

2. In the hospital I worked at, I've made the observation that a same exact surgeons from above who are described as "gifted" are also extremely OCD and perfectionist in their ways. They want to know everything, be on top of everything, and be in control of everything. And if it's not perfect, it's horrible...

3. He also was known for being very forceful about having a good team around him and realized that he is only one part of the team and that in order for him to be successful he needed to have a top notch team around him.
In other words, if he felt you not to be good enough, you didn't work with his patients, end of story.

These support the nurture idea. Anybody can be OCD and a detail oriented perfectionist and demand perfection around them.





So there's arguments on both sides, so what do all of you think? Nature or nurture?

(Nothing is 100%, so it's obviously not only one or the other, but a combination of both. Which side of the spectrum do you think the answer lies?)
 

zambo

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(Nothing is 100%, so it's obviously not only one or the other, but a combination of both. Which side of the spectrum do you think the answer lies?)

Some are naturals at what they do. What comes naturally to them others cannot equal no matter how much they try. Call it talent or a gift, or whatever. Since you mentioned heart surgery, I recently read a book about the history behind the first heart transplant and there was a little about Denten Cooley (sp?). It said how he was the fastest surgeon because he wasted no movements when he operated. I think it even said he could do operations like twice as fast as other surgeons with equal or better outcomes and how surgeons from all over the world would visit to watch him operate and were in awe of his speed and flawless technique. You see it in professions besides medicine all the time, sports and the arts being among the most recognizable. Some people just have "it".

So as far as the nature vs. nurture argument goes, nurture can take you far...but only so far. But to have the "it" factor and nurture (not waste) that talent separates the likes of the Mozarts, Einsteins, and Gretzkys from the rest.
 

Ecthgar

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He may have had a slight pre-disposition to surgery (i.e. nature), but lets face it, Roger Mee was a green-horn med student once upon a time just like the rest of us. I don't care how "good" you may be......practice makes perfect. No one is born with surgical skills......they're learned. Roger Mee may just have just had great hand-eye coordination. Hell, he could have batted .350 lifetime........who knows.
 
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footcramp

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man surgery is still entrenched in myth and legend. give me a break. i've worked with quite a few world renowned surgeons in my day. all of that talk is nothing but pure hype. surgery is not like painting a masterpiece. it's about approximating tissues together. i don't believe anything about "no wasted movements" or "gifted" "special hands" or any of that stuff. :rolleyes: it's pretty lame. everyone cares about who you worked with, what they're like in the OR. whatever man. let's face it, suturing is cave man technology, and cave men probably told their share of fantastic stories about gods, monsters, and heroes in their day. sadly, not much has changed since prehistoric times when it comes to this personality worship.
 

zambo

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footcramp said:
give me a break. i've worked with quite a few world renowned surgeons in my day. all of that talk is nothing but pure hype. surgery is not like painting a masterpiece. it's about approximating tissues together. i don't believe anything about "no wasted movements" or "gifted" "special hands" or any of that stuff. :rolleyes: it's pretty lame. everyone cares about who you worked with, what they're like in the OR. whatever man.
But you can't deny certain surgeons are well above others in terms of operating skills. It says a lot when other surgeons praise the skills of the likes of Mee and and travel across the globe to watch the likes of Cooley operate. As I said it's kind of like sports...some athletes are just better than their peers for a mixture of reasons (nature/nurture). Not everyone can be a Michael Jordan no matter how hard they try.
 

geekgirl

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there are brains.
there are hands.
and there is judgement - when to do something. when not.

these things differ amongst people.
superstars have all of these to some degree. but the crossover of the 3 characteristics may differ from person to person.
i know technical surgeons with poor judgement, which make them merely good surgeons. and reasonable technicians with brilliant judgement and brains. which makes them rock stars.

if you have all in equal parts - then you are indeed the triple threat. but most people have some more than others.
 
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