I am in a book club with a bunch of other women doctors. We are all doctors; we all have kids; and we read nonfiction books. We just got off a series of Atul Gawande. He wrote a book called Complications, and a book called Better. At the end of Better he has five suggestions for doctors. I was moved by his book. There are always little life pearls in any good insightful book, and one of his themes he discussed was the variation in doctors. Those doctors who are “the best” doctors with the best outcomes. Who are they? Why are they better? He calls these doctors “positive deviants.” The biggest question?
………………How do you become one?
So. He has five suggestions to doctors. I will repeat them briefly here:
1. Learn something about your patient. He says to ask “the unscripted question,” like where did you grow up? tell me about your family? He talks about making the human connection. I love his focus on this. I love to know my patients. People are why I entered medicine in the first place. I think it is great on a personal level, but it is also important on a patient/doctor level for plastic surgery. Plastic surgery is not cut and dry. It is not black and white. Knowing you, what bothers you, what your life is like, what your expectations are– these are critical to a good outcome in plastic surgery.
2. Don’t complain. Yes, patients you will love a doctor telling other doctors to not complain. “To be sure, a doctor has plenty to carp about: predawn pages, pointless paperwork, computer system crashes, a new problem popping up at 6 clock on a Friday night.” Why does he want us to stop? It doesn’t solve anything, and it will get you down.
3. Count something. We should be scientists. I love this one. You don’t have to be a bench researcher at Stanford to do research. I have tried to focus my “count something” studies on those things I see the most- the mommy makeover changes in our bodies after kids. My focus on breast: how do your breasts change with pregnancy. Volume? Droopiness? What effect does breastfeeding have? Are there ways to change how we do things to improve the outcomes? And on the body: What is your diastasis? Did you get a hernia?
What can we do to prepare our bodies before, during, or after pregnancy to make us one of the ones who “looks great after 3 kids” instead of “permanently 6 months pregnant”? I want to take what I see and analyze it to help advise women in the future.
4. Write something. “What you write need not achieve perfection. It need only add some small observation about your world.” Again, I love this one. Welcome to my blog. I post on realself, Quora, Facebook, and other sites. I believe in education.
5. Change. ” Make yourself an early adopter. Look for the opportunity to change. I am not saying you should embrace every new trend that comes along. But be willing to recognize the inadequacies in what you do and to seek out solutions.” Again, I love this one. almost 10 years ago I changed how I do breast reductions to a shorter scar vertical breast lift. I love the lift. It amazes me significant numbers of my colleagues still only do the 30 year old inferior pedicle anchor technique. More recently I started doing fat grafting to the breast for breast augmentation and offering it as an option instead of using an implant. This is not a new, wild technique. I studied with Dr. Khouri, who has been very scientific and thoughtful in his approach and analysis.
Part of what drew me to medicine in the first place was the constant evolution. Face transplants, stem cells, botox for wrinkles. Pushing to find better solutions is exciting. I believe change is good. It is why I constantly read, go to meetings, and evolve.
I hope to be a “positive deviant” in Dr. Gawande’s analysis. I hope to always strive to be better.
**And to Dr. Gawande, if you are reading this and you are ever in the Palo Alto / Stanford / Bay Area, please let us know! You have a mini fan base among my book club.