By Veronica A. Diaz, MD

Having been asked to write on this topic for ASSH Perspectives, I viewed it as the perfect opportunity to pay tribute to my mentors in Hand Surgery. Below I share the sage advice and practice habits that have shaped me as a hand surgeon, as well as traits that I try to emulate in my endless quest to be better.

Call your patients the morning after ambulatory surgery: Paul C. Dell, MD
This seemingly minor act goes a long way.  It helps elucidate any problems before it is too late, and the payoff in terms of building rapport with patients is immeasurable.  It lets them know you care.  Dr. Dell’s service as a medical student at the University of Florida was the birthplace of my interest in hand surgery.

Never turn down an opportunity for supervised practice: Patrick W. Owens, MD
Residency and Felllowship are the main opportunities one has for what Dr. Owens refers to as “supervised practice”.  My advice to residents and fellows: If a case that you have never seen or performed is going late on a Friday, bite the bullet and volunteer to cover it.  You will be glad you did when it comes up as an attending. Thank you, Dr. Owens, for the countless hours of supervised practice at Miami, even if it was often in the middle of the night.

It’s permissible not to know something. It’s not okay to not know that you don’t know: Steven P. Kalandiak, MD
This is what Dr. Kalandiak had to say after my attempted “reduction” of a proximal humerus fracture dislocation as a junior resident. I had not appreciated the nondisplaced fracture when I attempted to reduce the glenohumeral joint in the ED without image guidance and without first consulting someone more senior.  The result was complete displacement of the articular segment in an elderly and frail patient, buying her an open operation that might have been avoided had the nondisplaced fracture been stabilized percutaneously under fluoroscopy before attempt at reduction.  Having confidence in one’s skill and fund of knowledge is of critical importance in our profession, but being overly confident is highly undesirable.

It is not about what you can do to the patient, but what you can do for them: H. Thomas Temple, MD
I should have recalled this advice before offering sagittal band reconstruction to an elderly woman with gait disturbance.  The postsurgical splint further compromised her ability to maintain balance, resulting in femoral neck fracture and, indirectly, probably earlier mortality.  She would have been better off with benign neglect or low profile splint treatment of her unstable tendon.  This advice is now a basic tenet of my approach to clinical decision-making.

Always let the tourniquet down before closing: Dean G. Sotereanos, MD
Why wouldn’t you? What are you afraid of discovering? Maybe the reason Dean taught me this is because there is very little he fears.  I try never to close a skin incision before letting the tourniquet down to look for bleeders.

Keep your skills up and find time to read: Christopher C. Schmidt, MD
Dr. Schmidt’s evening journal clubs in Pittsburgh would sometimes go until near midnight, which I may not have appreciated at the time the way I do now.  As a self-employed surgeon who manages most of the operational aspects of her solo practice, finding time to read or attend meetings is a challenge.  But every time I do, I glean important information about what’s out there and how things are changing.  Dr. Schmidt’s diligence in this regard is reflected in his OR, where he shows equal aplomb when anastomosing a 1mm caliber vessel as he does when expertly revising a failed total shoulder.

Being well liked and not losing your cool are undervalued: Thomas B. Hughes, MD
Dr. Hughes is as cool, calm, and collected as he is technically skilled.  I have yet to encounter a surgeon more universally liked by patients, colleagues, and staff.  I may always fall short, but I do my best to channel his enviable demeanor under pressure.

Learn how to turn it off.  Be socially responsible: Mark E. Baratz, MD
Somewhat ironically, the greatest lesson I learned from the person who taught me the most about hand surgery is how important it is to cultivate interests outside of one’s métier.  At the start of my fellowship, I was so in awe of Dr. Baratz’ mastery of hand surgery that I assumed his profession was all consuming for him.  Imagine my surprise upon discovering his myriad outside interests, from snowboarding to riding horses to tending to his chickens to playing harmonica in a Blues band. I now recognize this as a critical ingredient for professional success.  I am better for my patients by virtue of affording myself time away for recreation and repose.

Dr. Baratz was also the first to bring to my attention the health care industry’s alarming contributions to carbon emissions.  Before fellowship, I had never considered the impact of unnecessary waste in surgery on the soaring costs of health care delivery, and more importantly, its negative impact on the planet.  Opening my eyes to this may prove to be the most important lesson of all in shaping me as a hand surgeon and a human.