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Modern Concepts in Pancreatic Surgery
Modern Concepts in Pancreatic Surgery
Foreword Modern Concepts in Pancreatic Surgery
Ronald F. Martin, MD, FACS Consulting Editor
I have always found the contradictions in our behaviors more interesting than the consistencies. For example, surgeons as a group tend to be fiercely autonomous in their attitudes and desires, yet they tend to train and work in groups. In my opinion, they work more effectively in group collaborations than when working alone. There has been a long tradition of individual achievement in surgery. Most of the people who were my mentors grew up in the days of the “One riot, one ranger” mentality and regaled us of stories of wooden ships and iron men. Every surgeon worth his salt was on call every day and every night and every surgeon was captain of the ship. Well, the images of those days have pretty well faded in the rear view mirror. Not only are we not necessarily captains of the ships but also it is not even clear to me that we are on ships. In an average work day after reviewing images read at night by “partners” living in Hawaii, one may render a consultation via telehealth to a gastroenterologist colleague working in another town altogether. In my world, at least, gone are the days of consulting about a problem to a patient’s primary care physician who would then either manage the patient or turn her briefly over to us for operative intervention and perioperative care. Today, I try to find who is job sharing with the primary care provider to let them know that a whole series of consultants are now engaged in the care of the patient. More often than not, the reply I get is, “Okay, um, thanks. Let me know how Mr Jones does.” The phone is usually back on the hook before I can say, “Actually, her name is Mrs Smith..” To say that care has become frequently decentralized and even fragmented would be a bit of an understatement. There are probably many reasons for this change: some of it is a simple response to the increasing complexity of paperwork (which is now electronic); some of it is due to hyperspecialization, and some of it may be due to collective “burnout.” Yet, I think there may be a more structural issue that accounts for these changes—the shifting balance between individual and collective responsibility. When I started in surgical practice I was in a solo private practice model. We all were. Yet, ironically, I sometimes think Surg Clin N Am 93 (2013) xiii–xiv http://dx.doi.org/10.1016/j.suc.2013.04.001 0039-6109/13/$ – see front matter Ó 2013 Published by Elsevier Inc.
surgical.theclinics.com
xiv
Foreword
we worked more closely and communicated more readily then than we do now. Everybody knew that if you were caring for a patient you had to tie up all the loose ends yourself; perhaps because you couldn’t blame anyone else if something came unraveled. Today, I work in a system that is extremely connected via digital means and people rarely directly communicate with one another. Instead of phone calls, I get e-mails that hyperlink me to notes and texts. Most often I have to divine what the question or reason for getting the text or e-mail is from reading the record. Occasionally, I get it right. When something falls through the cracks now, there is a diffuse and usually impenetrable layer that obscures who—if anybody—was actually responsible for what went wrong. I would agree that the majority of advances that we have made in the digital era are truly advances, but we have lost some really fundamental processes that were cheap, effective, and frequently educational. We surgeons and physicians are not alone in these issues. Much of the contentious national political discord boils down to disagreements over individual versus collective responsibility and reward. In the extreme, the individualists think they built everything themselves in some sort of vacuum and the collectivists seem to think that they deserve a cut of what everybody else has just for showing up on the planet. Neither side seems to be willing to move toward the center. Some people feel strongly that they are more productive working at home in isolation, while other people feel that people are more productive being co-located. Both sides again are probably right for varying circumstances. Productivity alone may be more readily decentralized, whereas innovation probably requires greater in-person random interaction—the water-cooler effect. Again, the right solution depends on the problem being solved. Being Consulting Editor of the Surgical Clinics of North America has been a fascinating experience for many reasons. The one thing that continues to amaze me every 2 months is just how effectively people with wildly different practices and very different pressures come together to produce such high-quality work. Almost all of the contributors to these issues are extremely busy and dedicated clinicians, yet they unfailingly make time and find ways to contribute to these collective projects with little to gain for their efforts other than the satisfaction of helping the team turn out good work. If I could always find that enthusiasm and effort in my clinical practice, it would be life altering. Dr Behrman and I have been fortunate to be able to turn to our closest brethren to produce this issue on pancreatic surgery. We are deeply indebted to all who contributed. I am particularly indebted to Dr Steve Behrman not just for carrying more than his share of the load, as he always does, but also for many, many years of enduring friendship. He is one of those people who I can always call day or night and know he is there to help. I hope the reader of this issue not only finds knowledge and guidance in the management of pancreatic disorders but also takes stock in what can be done when we focus a bit more on what we can do collectively and a bit less on what doesn’t seem like it is our specific responsibility. A little selflessness can be very self-rewarding. Ronald F. Martin, MD, FACS Department of Surgery Marshfield Clinic 1000 North Oak Avenue Marshfield, WI 54449, USA E-mail address: [email protected]
Foreword Modern Concepts in Pancreatic Surgery
Ronald F. Martin, MD, FACS Consulting Editor
I have always found the contradictions in our behaviors more interesting than the consistencies. For example, surgeons as a group tend to be fiercely autonomous in their attitudes and desires, yet they tend to train and work in groups. In my opinion, they work more effectively in group collaborations than when working alone. There has been a long tradition of individual achievement in surgery. Most of the people who were my mentors grew up in the days of the “One riot, one ranger” mentality and regaled us of stories of wooden ships and iron men. Every surgeon worth his salt was on call every day and every night and every surgeon was captain of the ship. Well, the images of those days have pretty well faded in the rear view mirror. Not only are we not necessarily captains of the ships but also it is not even clear to me that we are on ships. In an average work day after reviewing images read at night by “partners” living in Hawaii, one may render a consultation via telehealth to a gastroenterologist colleague working in another town altogether. In my world, at least, gone are the days of consulting about a problem to a patient’s primary care physician who would then either manage the patient or turn her briefly over to us for operative intervention and perioperative care. Today, I try to find who is job sharing with the primary care provider to let them know that a whole series of consultants are now engaged in the care of the patient. More often than not, the reply I get is, “Okay, um, thanks. Let me know how Mr Jones does.” The phone is usually back on the hook before I can say, “Actually, her name is Mrs Smith..” To say that care has become frequently decentralized and even fragmented would be a bit of an understatement. There are probably many reasons for this change: some of it is a simple response to the increasing complexity of paperwork (which is now electronic); some of it is due to hyperspecialization, and some of it may be due to collective “burnout.” Yet, I think there may be a more structural issue that accounts for these changes—the shifting balance between individual and collective responsibility. When I started in surgical practice I was in a solo private practice model. We all were. Yet, ironically, I sometimes think Surg Clin N Am 93 (2013) xiii–xiv http://dx.doi.org/10.1016/j.suc.2013.04.001 0039-6109/13/$ – see front matter Ó 2013 Published by Elsevier Inc.
surgical.theclinics.com
xiv
Foreword
we worked more closely and communicated more readily then than we do now. Everybody knew that if you were caring for a patient you had to tie up all the loose ends yourself; perhaps because you couldn’t blame anyone else if something came unraveled. Today, I work in a system that is extremely connected via digital means and people rarely directly communicate with one another. Instead of phone calls, I get e-mails that hyperlink me to notes and texts. Most often I have to divine what the question or reason for getting the text or e-mail is from reading the record. Occasionally, I get it right. When something falls through the cracks now, there is a diffuse and usually impenetrable layer that obscures who—if anybody—was actually responsible for what went wrong. I would agree that the majority of advances that we have made in the digital era are truly advances, but we have lost some really fundamental processes that were cheap, effective, and frequently educational. We surgeons and physicians are not alone in these issues. Much of the contentious national political discord boils down to disagreements over individual versus collective responsibility and reward. In the extreme, the individualists think they built everything themselves in some sort of vacuum and the collectivists seem to think that they deserve a cut of what everybody else has just for showing up on the planet. Neither side seems to be willing to move toward the center. Some people feel strongly that they are more productive working at home in isolation, while other people feel that people are more productive being co-located. Both sides again are probably right for varying circumstances. Productivity alone may be more readily decentralized, whereas innovation probably requires greater in-person random interaction—the water-cooler effect. Again, the right solution depends on the problem being solved. Being Consulting Editor of the Surgical Clinics of North America has been a fascinating experience for many reasons. The one thing that continues to amaze me every 2 months is just how effectively people with wildly different practices and very different pressures come together to produce such high-quality work. Almost all of the contributors to these issues are extremely busy and dedicated clinicians, yet they unfailingly make time and find ways to contribute to these collective projects with little to gain for their efforts other than the satisfaction of helping the team turn out good work. If I could always find that enthusiasm and effort in my clinical practice, it would be life altering. Dr Behrman and I have been fortunate to be able to turn to our closest brethren to produce this issue on pancreatic surgery. We are deeply indebted to all who contributed. I am particularly indebted to Dr Steve Behrman not just for carrying more than his share of the load, as he always does, but also for many, many years of enduring friendship. He is one of those people who I can always call day or night and know he is there to help. I hope the reader of this issue not only finds knowledge and guidance in the management of pancreatic disorders but also takes stock in what can be done when we focus a bit more on what we can do collectively and a bit less on what doesn’t seem like it is our specific responsibility. A little selflessness can be very self-rewarding. Ronald F. Martin, MD, FACS Department of Surgery Marshfield Clinic 1000 North Oak Avenue Marshfield, WI 54449, USA E-mail address: [email protected]