Prerequisites of the Surgeon

Dimitrije E. Panfilov

Which qualities does the ideal surgeon require? The ideal surgeon should:

  • Posses a strong capacity for understanding and patience, both while operating and when listening to patients
  • Have undergone the right training, but also have kept abreast of the current literature after completing the specialist training
  • Attend congresses and courses at which the latest methods of treatment are demonstrated, and have work-shadowing experience with prominent surgeons who produce particularly good results using certain operative procedures
  • Have technical aptitude and dexterity, a high degree of precision, but also a leaning towards artistic design
  • Work systematically and with endurance

Furthermore, humour is of great advantage. Finally, sincerity and a love of his/her work are indispensable for the ideal surgeon.

Albert Einstein once said that "fantasy is more important than knowledge". Apart from his/her experience, a plastic surgeon too must have fantasy in order to be able to already envisage the final result at the start of the treatment, that is, how the patient will look in 3 weeks', 3 months', or 3 years' time. This is particularly important with operations which can only be performed over several sessions. As early as 1972 the cofounder of the Association of German Plastic Surgeons, Ursula Schmidt-Tintemann, drew up the following rules which are still valid today:

  • The plastic surgeon must be able to judge whether a certain procedure is really going to help the patient above and beyond any organic reconstruction or improvement.
  • He/she must be in a position to weigh up whether the operative risk is in reasonable proportion to the effective result.
  • He/she must be capable of explaining these aspects to the patient so that the, in the first instance, 'healthy'patient is informed and can make an independent decision.

It is not always easy for patients to find a reliable surgeon who appears to be suitable for their particular problem. It would seem logical to consult their family doctor about it. Some patients are ashamed, however, to shed their sorrow in several places and instead opt for the direct way. Some also fear that their secret might be somewhat at risk, if not from the family doctor himself/herself then perhaps from the staff. And besides, the family doctor's basic attitude might be hostile towards the entire aesthetic plastic surgery. Our experience has shown that family doctors and other doctors in private practice only refer patients to us if they themselves are convinced about our work. That is by all means a good thing.

The best and surest way to find a good doctor is by word of mouth. Unfortunately with aesthetic plastic surgery, patients are often disinclined to admit that they have had surgery. Not frequently, beauticians and hairdressers send us their clients for counselling. Some patients just "stumble" across the sign on the door, even though they are otherwise accustomed to going about such things more systematically. The addresses of specialist societies willing to send their list of members are available from the medical association. Many patients search for the addresses of clinics and surgeons in newspaper adverts. This is also certainly a way of finding good reliable surgeons, but one can also run into some "black sheep" who have followed quite obscure training pathways and only posses a very limited degree of experience and knowledge. One cannot warn too often about such "denigrators" because they discredit the entire medical profession by the damage they do.

No surgeon in the world, not even celebrities of our profession, can talk them free of any complication. With well-trained and experienced plastic surgeons, these complications are rare. When something happens, these are mostly minor complications and we are educated to master them. The ideal plastic surgeon also has honesty and the ability to recognize his/ her own mistakes, and is able to correct them and move on.

Ursula Schmidt Tintemann

The well-mastered operative technique is "conditio sine qua non". There is the proper training to be completed. Learning surgical technique is some sort of "monkey discipline": as good as our surgery teacher is and as good as we can imitate him/her, so much we will be better ourselves. In my first year of general surgery training a female patient of 40 years, mother of ten children, died 10 days after strumectomy of recurrent struma because the surgeon from whom I learned cut the a. carotis communis in the belief it was a superficial neck vein. He palpated it - but too briefly. He was always hurrying when performing surgery: he did his appendectomies within 4 min.

After this tragic experience I stopped considering operative speed as one of qualities which I should aimed for. I have seen many luminaries operating; I have also watched many of the co-authors of this book at work. No one was hurrying. All of them operated slowly and carefully, but the operating times were always very short. Why? The real masters in our profession have no unnecessary movements. Every act, every movement is well planned and carefully carried out. That is the whole secret.

Notnagel said that "only a good human being could be a good physician." In a similar way we can add "only a good physician could be a good plastic surgeon", besides being a good human being. We can summarize the characteristics of an ideal plastic surgeon:

  • Passion
  • Fantasy
  • Precision
  • Patience

- Artistic talent

Fig. 15.2. Ronadro's "Surgeon's Prayer": Many plastic surgeons pray to God for help in doing surgery well and in making their patients happy

Surgeons Prerequisites. My former teacher, a great didact, wrote at the end of his judging certification: "I wish him ... and luck, so badly needed of any surgeon."

The New England Journal of Medicine made a questionnaire among thousands of physicians to see if they are praying for the welfare of their patients. Those who had prayed had significantly more success in healing!

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