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A view from the coffee room…what I regret most in my career

Authors: Virve Koljonen M.D. PhD.
Department of Plastic surgery
Helsinki University and Helsinki University Hospital
Helsinki, Finland
Professor Virve Koljonen

I have come to the point in my surgeon career, that is seems appropriate to look back and ponder some of the choices I have made. Therefore, it is time to warm up and dust off my trusty retrospectoscope. According to the title, I will inspect only things that I regret.

And starting in  three… two…one… ignite!  Strange working hours, no I don’t regret that… high stress levels, challenge of being up-to-date …definitely not those… what about this; uncertainty in early career, nooh.. Now I found it! Here it comes.

What I regret most in my career, is that when I started back in 1990s, there was no talk about ergonomics. And now I pay the price of it.  My both shoulders are worn out, some days it is nearly impossible for me to lift my arms over 90 degrees, I had bilateral golf or tennis elbows – not sure which, because I chose to treat myself. My feet are mess, my wrists hurt and I have back pains. Some of you may think, well it´s because of her genetics. No, I am not alone with these issues.

Work-related musculoskeletal disorders are frequent among surgeons, rating up to 94% in open surgery, a whopping 100% in conventional laparoscopy and up to 80% in robotic-assisted surgery1.  Systematic analysis revealed that 69% of surgeons doing minimally invasive surgery reported pain compared with 60% of surgeons doing open surgery2. In addition, numbness, stiffness, and fatigue are important and debilitating symptoms, but less reported related to our profession2.

Among orthopedic surgeons, 86% reported at least one musculoskeletal stress areas with an average of two per surgeon3. Back pain, lower in 56% and neck 42%, were most common issues3. In a another study including several surgery specialties 95% had experienced musculoskeletal problems in the last year, and most had pain in four parts of the body4. In line with orthopaedic colleagues, most common were lower back pain in 74% and neck pains in 55%4. Standing during operations results in lower back pain5 and neck symptoms are further exacerbated with the use of loupes6. It is noteworthy, that operating intensified pain in 61% but only 29% had sought treatment for their symptoms2. Musculoskeletal problems may lead to leave of absence, modification of job description or even to early retirement7. Surgeons’ symptoms may also change the  recommended operation for the patient2.

Apart from the wear and tear issues, surgeons also face characteristic work-related musculoskeletal  injuries, such are cervical spinal stenosis, lumbar disc herniation, cervical disc herniation8 and  carpal tunnel syndrome9.

When I was starting my surgery career, I remember that sitting and operating was a definite no-no. I was taught that only pregnant surgeons can sit and operate. Another exception to this always-stand- rule was morbidly obese colleagues, that according to hearsay, had to sit an operate otherwise their belly would hinder them to reach the operation area. I have to say that I have never seen a situation like this. Thus, I learned to stand, and have to say I became a very skilled stander. Static standing for hours is not healthy, nearly 55% of surgeons reported high levels of musculoskeletal pain while standing during surgery, when only 14% report pain when sitting5.  But so deep is the conviction of standing buried in my soul, that despite my pain problems I feel that I perform better while standing…sad isn´t it ?

We all know from our clinical work, that musculoskeletal issues have detrimental effect on the quality of life. Why should we surgeons be different? It is alarming, that less than a third of us, have sought treatment for their symptoms2.  Are we taking the ancient proverb Medice, cura te ipsum  – Physician, heal thyself – too literally? Why does the premise that us surgeons should treat patients and ourselves alike, evidence based, not occur10. Surgeons are more likely to recommend surgery for the patient than for themselves11. It seems that when we make treatment decision for the patient vs. for ourselves, we think differently10.  

I have witnessed too many colleagues, including yours truly, operating through pain, be in a worse condition than our patients. The proverb Physician heal thyself, means actually that we should take care of ourselves, that we can take care of others. A more familiar analogy is when the flight attendant instructs “put your oxygen mask on first before helping others”. Since, if you run out of oxygen yourself, you can’t help anyone else.  

Conflict of Interest Statement: The author declares no financial conflicts of interest with regard to the data presented in this manuscript. The funding of this article was none.


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