Letters to the Editor

Editor’s note: The following comments were received regarding recent articles published in the Bulletin.

Letters should be sent with the writer’s name, address, e-mail address, and daytime telephone number via e-mail to dschneidman@facs.org, or via mail to Diane Schneidman, Editor-in-Chief, Bulletin, American College of Surgeons, 633 N. Saint Clair St., Chicago, IL 60611.

Letters may be edited for length or clarity. Permission to publish letters is assumed unless the author indicates otherwise.


Dr. Thal remembered for his love of medicine

I was saddened to read of the death of Erwin Thal, MD, FACS. I knew Dr. Thal well, as I was a resident in neurosurgery at Parkland Hospital, Dallas, TX, while he was in his general surgery residency. As noted in the obituary (Bull Am Coll Surg. 2015;100[2]:40), he was an accomplished surgeon and a leader in the field of trauma. However, the characteristic of his persona that I grew to respect the most, not mentioned in the text but captured in the accompanying photographs, was his love of medicine and the unquantifiable joy he took in his practice. Just look at the smile captured in the published portrait! That was Dr. Thal.

At times, that joy bubbled over to infect all around him. One day in 1988, I was flying from San Antonio, TX, to Washington, DC, with a scheduled stop in Dallas. On the flight from San Antonio to Dallas I rapidly developed intense and severe abdominal pain. As soon as the plane landed, I called a friend in Dallas and told him to find Dr. Thal, and tell him that I was in a cab on my way to Parkland Hospital with an acute abdomen. The cab driver through the dispatcher repeated the message. I was assured Dr. Thal had gotten the message and was waiting for me in the emergency department (ED).

Upon arrival, I stumbled from the cab, through the swinging doors, into the triage lobby of the ED. There was Dr. Thal—all five feet and five inches of him—wearing his long white coat and his brilliant, comforting smile. Surrounding him were about 25 students, interns, and residents all in long white coats, “ready to care for you,” as he put it. By the time they had me on a gurney, I was feeling better, knowing he was there, as I passed, otherwise uneventfully, my first kidney stone. Medicine and surgery, and especially the College, have lost a true ambassador of the profession.

A moment of silence, please.

Clark Watts, MD, FACS
Georgetown, TX

Addressing the source of surgeon burnout

I truly enjoyed the article on managing burnout in the March issue of the Bulletin (Bull Am Coll Surg. 2015;100[3]:26-29) and agree that this problem is growing in surgery as more surgeons become employees of large organizations. Unfortunately, the article does not provide systemic methods to prevent burnout, but rather treats it like an individual problem. Christina Maslach carefully elucidates in her 1997 book The Truth about Burnout—How Organizations Cause Personal Stress and What to Do about It (Jossey-Bass) that burnout is a consequence of systemic organizational problems, and she offers solutions to it, including the following:

  • Set reasonable work expectations
  • Give workers control
  • Reward and recognize in a way that is meaningful for the individual
  • Build community in the workplace
  • Build fairness in the workplace. A workplace is perceived to be fair when three key elements are present: trust, openness, and respect
  • Develop, communicate, and live organizational values

Exercise, hobbies, and spending time with friends and family may improve a surgeon’s quality of life, but to truly prevent burnout, the individual must work in a functional workplace. As more surgeons become employees of large health care systems, it is the responsibility of these systems to provide a supportive, meaningful, and fair workplace.

Charles M. Ferguson, MD, FACS
LaGrange, GA

PreOp program applauded

The exceptional May 2015 issue of the Bulletin contained many gems, including the articles on “going green” in the operating room, corneal transplants in developing countries, principles for surgeons, and the one that resonated so deeply with me—“PreOp program: Can we achieve a ‘trickle-up’ effect?”

At Cornell University Medical College, New York, NY, in April 1959, I finally had my surgical rotation under the New York Hospital greats like Frank Glenn, MD, FACS, with two months to go in my senior year. Internships had long been solidified, and I was headed for straight medicine at NY Hospital. The thrill, joy, wonder, and the “fixing it today” aspect of the surgical theatre was a complete revelation for me, and I knew that I, who could repair and build anything from electric systems to leaking faucets, belonged in surgery. I kept my promise to fulfill the internship and after that was completed, began my surgical residency, albeit not very proficient at tying sutures for a while, at the University of California, San Francisco.

Had I been privileged to scrub in and participate in surgical procedures earlier than my last two months of medical school, the path would have been a bit shorter, and, as described in the article, I would have “loved the operating room” much sooner. The program outlined by the authors is worthy and is “an opportune time to pique medical students’ interest in surgery and guide them toward surgical careers.”

John N. Baldwin, MD, FACS
Twain Harte/Monterey, CA


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