During my five years of residency, I performed over 1000 laparoscopic procedures and became an expert because of the volume of procedures I had performed. I was the resident who learned the new laparoscopic hernia procedures and taught them to the entire general surgery faculty, so that became the area I was most known for.
During eight years of private practice in Atlanta, I traveled around the world teaching and performing laparoscopic surgery and eventually I was recruited into the academic world- joining the Emory Endosurgery Unity at Emory University in Atlanta. After three years there, I was recruited to be the Chief of General Surgery at the University of Missouri. It was the responsibility of this role that led me to study the health care system and develop a long-term plan for success for our division. Unfortunately, what I found was a system not designed for long-term sustainability and quality service for the patient. I discovered a fragmented system with each part trying to control and extract resources (primarily financial) and little or no concern for the people being "cared for" or for the people doing the work of providing care. In a 2009 survey of over 4,000 general surgeons, they found that 43% are actively in burn-out and 33% are clinically depressed. It was obvious that we needed a new model. As we implemented a new model for care that was based on a team approach and included the patient and family as part of the team, we could see that quality and satisfaction (and even financial measures) could all be improved.
As we continued to implement this new model, the leadership at the University changed and the new interim group of leaders did not support our new model for care. To make a long story short, I quit my job (even though I was a tenured professor) and we planned to move the hernia program (my area of clinical focus) to an institution where this new model was supported by all general surgeons and the institution leadership.
Over the past three years I have been working with a diverse group to plan and organize the start-up of a new academic medical center with programs or divisions designed around the patient problems, diseases and needs rather than by physician specialty. We have a funded general surgery residency program approved within this new model that started in July, 2012.
I have learned so much from many people outside of our traditional health care system, especially patients and their family members. And like I have heard from Peter Pronovost in his recent talk at the Planetree Conference, I believe that the key to patient safety (and I would add quality and sustainability of our health care system) is for our care givers to remain humble and develop loving relationships with each other and the patients and family members who we work with and care for.