Jeffrey Carlson, MD, president of the Orthopaedic and Spine Center in Newport News, Va., talks about what makes the leaders in spine surgery stand out and how surgeons can make an impact on the future.
Q: What qualities are important for a spine surgeon to build and maintain a positive reputation?
Dr. Jeffrey Carlson: A good surgeon builds his/her practice off of a positive reputation. Spinal surgery adds an extra bit of difficulty in promoting and maintaining this reputation. The detriments of a surgical practice that can tarnish a physician's reputation can be divided into several categories:
• Does the physician show empathy and concern for the patient's condition?
• Can the physician show caring attitudes toward staff and employees?
• And can the physician provide for good outcomes for their patients?
Building a positive reputation starts with an inner desire to see patient's lives improved. If there is little empathy for the patient's condition, the physician will appear callused, uncaring and not be viewed in a positive light. Staff in the hospital, administrators and employees get to see a physician's attitude first hand. There can be a façade placed in front of the patient, but those that work with you every day will know your true attitude. This particular attitude is what your patient's will see when they interact with your staff. An unfeeling physician will influence the responses of those around him/her, and these responses will become associated with the physician office and affect his/her reputation.
Outstanding outcomes for the patient, of course, make for the basis of the physician's reputation. This is 2-fold however. The physician needs to know the limitations of the procedures they perform as well as the optimal patient to benefit from these procedures. Reaching beyond the scope of your training or applying the wrong procedure for a particular problem will lead to poor outcomes and a poor reputation.
Q: What makes the top spine surgeon leaders in the field right now stand out?
JC: Leaders in spine surgery today are those that are driving patient outcomes. They have the desire to improve patients' disease processes and restore the patient's function. This desire is born from their empathy for patients as well as their ability to respond to patient desires. As we progress in surgery, patients will tell us what they want. Being able to push the envelope of surgical effectiveness to bend the outcome curve in a positive direction is all based on the patient's drive to improve. There were times when spine surgery meant the end of athletics or never working again. Today we are performing surgery on athletes to return them to top positions on the field.
Q: How can spine surgeons make an impact on the field beyond providing outstanding care for their patients?
JC: Beliefs about spine surgery have changed significantly in the past three decades. In the early years, spine surgery was associated with poor outcomes. Large numbers of spine surgeries were exploratory in an attempt to fix a symptom for which there was no absolute cause. This lead to a large number of patients with severe limitations and the population believing that spine surgery was a last resort. Spine surgery was considered the final straw toward disability. The impact of advanced imaging, diagnostic improvements lead by clinical studies and improvements in spinal instrumentation have turned those views about spine surgery.
There is still significant work to be done. More studies to better define the diagnoses that best fit our procedures, improved diagnostic capabilities and providing patients with a clear understanding of the expected outcomes of our interventions. We need to not only teach our residents and fellows how to treat specific conditions but also teach patients what the options and expectations are for their disease process.
Q: What strategies can spine surgeons use to leave a positive mark on the industry throughout their careers?
JC: I think the old adage "Physician know thyself" applies here. Physicians should know what they are capable of doing for patients. We want our population to continue to trust spine surgery as a viable alternative in the pursuit of their healthcare needs. In order for this trust to develop, physicians will need to fully understand what their particular treatments can do for patients. Don't operate on patients that won't get better with the operation. Make it clear to patients what the expectations are for the procedures. As we are critical of our decision-making, we will continue to listen to patients' responses and continue to explore options that will make patients better. Developing surgery that has less exposure may mean less time for recovery and improved patient satisfaction.
Q: Where do you think it will be most important for spine surgeons to focus their energy — outside of patient care — heading into the future?
JC: Delivery of healthcare is changing. We will need to be advocates for our patients as well as our profession. Spine surgery is a bit late to the outcomes game and spine surgeons will need to be diligent in providing information to patients as well as insurers going forward. Our energies need to be focused on improving patient outcomes, which will drive the healthcare environment toward treatments that make an impact on patients' lives and livelihoods. We know we have a great opportunity in spine surgery to restore function to some of the most debilitated patients. But, we need to be able to impress the importance of what we bring to the health of our country's population in a very succinct and understandable fashion. Unfortunately in the past we didn't have good numbers to back up our treatments which will lead to misunderstanding our place in healthcare.
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