Don’t be an incredible surgeon

One of my former surgical bosses, now deceased, had a slightly cruel wit. In describing the work of a newly appointed consultant in vascular surgery, he claimed that the new colleague’s latest operation was “a middle cerebral to inferior rectal artery bypass”, which is indeed funny, in a surgical sort of way (you should be able to work it out). The new guy was a productive academic, but a patchy surgeon. His interest in vascular surgery – as opposed to, say colorectal or breast – related to the availability of consultant jobs, rather than any great skill in that domain.

The point is a real one.  A problem in medicine in general, and very much surgery in particular, where you actually do things to patients, is credibility. That vascular surgeon (long since retired to research), lacked it, from the start.

In surgery credibility is everything when it comes to peer approval. This is emphatically not an ‘old boys club’, rather an essential recognition that your work is generally good for patients, that you have the chops to deal with things when they go wrong, or when you encounter the unexpected. Both scenarios will happen. Lack of credibility can be a career-long problem.

The other side of this coin is a sense of entitlement, best defined in this context as “belief that one is deserving of or entitled to certain privileges “. Surgeons crash and burn when they claim that they have all the answers, and demand special privileges accordingly. Even the finest cancer surgeon may find that they best operation they did all month was incision and drainage of an abscess, in terms of patient outcomes at least. One feature of the 21st century NHS is the rise and rise of bogus superspecialisation where newly appointed 35 year olds claim to have special skills in dealing with complex problems, and should be treasured accordingly. The truth is that however well trained you are, nothing can substitute for experience, gained over time. A humility failure, where you claim those special privileges just because you briefly worked in a famous institution (as a common example), will always lead to problems – interpersonal, professional and clinical.

Tracy, next to one of her masterpieces
Tracy, next to one of her masterpieces

All this has parallels elsewhere, which is what stimulated me to write this post. Take, for example the world of fine art.  Mark Rothko’s later (and lucrative) work is really just abstract blocks of colour, which may or may not be to your taste. It’s certainly not technically difficult. But earlier on in his career, he had already shown himself to be a fine figurative painter. Tracy Emin, on the other hand, sells works for significant sums of money (see also the slightly more gifted Damien Hirst, for whom there remains a suspicion that his technical accomplishments may be down to his assistants). She became the Professor of Drawing at the Royal Academy in 2011. I have yet to see anything by her that suggests any significant skill or inspiration that would merit that, but there you are. Successful monetarily, but not credible, I would suggest.

In music, when John Coltrane, in the few years prior to his death, wandered off into realms of jazz that quite a few people still consider to be unlistenable – all free improvisation and some squawking – one of his would be imitators, Sonny Sharrock (on guitar) was getting advice from Coltrane’s long term bass player, Jimmy Garrison. Garrison told him to “get those (chord) changes together man”. The confused Sharrock responded “Come on, you played with Coltrane. You know what was happening in that band”, to which Garrison simply said “Coltrane can play his changes”. It’s the same lesson as in surgery: you can start branching out only when you’ve mastered the essentials, and that can be a long, arduous process.

Why am I writing this? I suppose it’s partly frustration at the whole concept of demanding respect, a very modern vice, as opposed to earning it. NHS management is just as bad. I’ve written previously of the need to hold at arm’s length any manager who claims to be ‘strategic rather than operational’. Operational is what gains you credibility.

We all want to be good surgeons and doctors, we like to be able to do the occasional genuinely amazing operation, we want to be admired by our peers and our students, we all want to make people better, but we don’t want to be incredible.

The IT geek business clearly has the same risks. Quoting Tom Hayes, a Silicon Valley executive and blogger:

“Claiming that you are what you are not will obscure the strengths you do have while destroying your credibility.”

 

 

*Coltrane, effortlessly demonstrating his credibility

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