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Stress management: Preparation is key
One of the best ways to manage the stress of a busy OR schedule is to prepare. Alan Hobson, cancer survivor and Mt. Everest sumitteer has stated: “Success is 97% preparation and 3% execution.”
While by no means do I profess to have mastered my craft, I do find that preparation is indeed the key to success in surgery. I endeavor to practice my “5 Ps” of preparation before every day I am lucky to be in the OR. The principles for comprehensive surgical preparation are: prepare, plan, picture, practice and — lastly for me — pray.
Prepare
I look at my schedule the morning before surgery and make sure I have all the equipment and proper understanding as to why I am doing the operation. This includes reviewing my last office note and often more records in order to discern my goals of the surgery. I also have compiled a computer file for every surgical technique I perform. I continually amend this document, especially when I make an error or have an epiphany as to how the procedure can be performed better. Thus, it behooves me to peruse my file and refresh my memory on my personal tricks of the trade.
Since short-term memory is usually no longer than 3 weeks, if I haven’t performed a certain procedure in awhile, I am wise to consult my notes and avoid previous errors. If I need to consult the literature, I will do so in order to avert any surprises.
Plan
I plan the day, assigning each case to certain rooms and the order of cases. I reserve the longer cases for last and try my best for the day to flow smoothly. I plan my approaches and which implants I will use. Then, for more difficult cases, I take a few moments to draw out the steps on paper. This exercise is invaluable and allows me perform rather than meander through cases. Planning also means doing the pre-op flight check … going to the back table before the case commences and making sure all instruments are present.
Picture
When we visualize an action, we are enhancing success. We are manifesting what Steven Covey alludes to as “the first creation.” The subconscious mind cannot differentiate what we imagine from what we experience. When we picture the cases performed effortlessly, we are merely wiring our brains to execute more effectively. I picture the cases flowing smoothly on my way to work in the morning. It is no surprise that days that I am especially mindful of visualizing success, it manifests more readily.
Practice
Surgical skills can only be developed through practice. Principles govern, and the only way to get better at any skill is to practice. The Orthopedic Learning Center has been invaluable to me in terms of honing skills and learning proper techniques which merit practice. I used to carry a knot pusher in my bag and I undoubtedly irritated my wife by tying knots on chairs, refrigerator doors and key chains. I still use plastic shoulder models on occasion in order to rehearse the steps of a new procedure.
Finally, I learned a great deal by visiting master surgeons and gleaned countless pearls from their collective experience. As I practiced what I saw, my cases surely became more “lyrical” and less laborious. As one of my colleagues, Pat St. Pierre, stated, “If you are not getting better, you are getting worse.” There are no shortcuts to mastery of any profession. Practice the skills required for your calling and you will help more patients than you ever imagined.
Pray
I believe in a Higher Power, and I include my beliefs into everything I do. Before every case, I do my best to surrender to a force greater than I. In doing so, I am much more inclined to do what is best for each patient. When we resign ourselves to our Higher Power, something far greater than us takes over; our hands will execute more smoothly and precisely like never before.
Postscript
Mistakes are inevitable and reflect our humanity. However, they can make us grow. I write down in my computer file every lesson I learn so I won’t repeat it in the future. In addition, a post-flight briefing with the OR staff after every case affords us the opportunity to thank them for all the positives and also render feedback for any glitches that may have occurred.
If we all adopt the 5 Ps, we will surely improve our ability to render our patients the care they deserve. Your surgical time will be sharply decreased. This requires great discipline, but the dividends are enormous. If we can successfully negotiate the 5 Ps you will gradually manifest the 6th P — more time for play.