The New Surgeon: Patient-Centered, Disease-Focused, Technology-Driven, and Team-Oriented

  • Rifat Latifi
  • Stanley J. Dudrick
  • Ronald C. Merrell


Advances in technology have greatly influenced the practice of surgery in multiple ways. Not only is the surgeon of today patient-centered, academically oriented, disease-based, and highly specialized, but the entire spectrum of surgical care now is more technology-driven than ever before. While these facets of surgery are not totally new, the environment on which the surgeon is operating is rapidly changing for the better. Today’s surgeon incorporates genomics, nanotechnology tools, robots, and cameras to provide care and has much greater knowledge of the biology of disease than in the past. This has resulted in a substantial metamorphosis of the surgeon. While the surgical foundation is fundamentally the same, the modus operandi of the practice of surgery has changed substantially. Today’s surgeon is working in a collaborative environment that is heavily influenced by the financial bottom line, multiple layers of bureaucracy and administration, insurance companies, and continuing changing public policies and perceptions pertaining to health. Regardless of the many outside influences, surgeons continue to strive to maintain the basic principles of caring, teaching, mentoring, and advancing the art and science of the surgical discipline above everything else. The transformation in health care and surgical practice has not changed the basic tenets: surgeons care for the sick and injured, surgeons are healers, surgeons strive for perfection, but surgeons respect the rich surgical past and contributions of our teachers. However, in order to be prepared proficiently for the future, surgeons must constantly strive to understand and master the magnitude and complexities of the new body of knowledge, technology, and teamwork essential to optimal health care today. And finally, the training of the new surgeons needs to be addressed. The new surgeons that we are educating must above all be adaptable because we can expect technology to come in successive waves to challenge our prejudice and demand the best in critical understanding of the changing options for patient care. In this chapter, we discuss some of the elements that we believe are paramount in changing “the old surgeon” to “the new surgeon”: one who can navigate nanotechnology and surgical science, yet maintain the skills of comforting a dying patient, as well as working effectively under exceptionally stressful situations such as war, other disasters, and a myriad variety of other emergencies.


New surgeon Transformation Nanotechnology New surgery world order Outcome-based surgery Surgical volume 


  1. 1.
    Rickert J. Patient centered care: what it means and how to get there. Health Affairs Blog. Accessed 19 Nov 2014.
  2. 2.
    Sosin M, Patel KM, Nahabedian MY, Bhanot P. Patient-centered outcomes following laparoscopic ventral hernia repair: a systematic review of the current literature. Am J Surg. 2014;208:677–84.CrossRefPubMedGoogle Scholar
  3. 3.
    Liang MK, Clapp M, Li LT, Berger RL, Hicks SC, Awad S. Patient satisfaction, chronic pain, and functional status following laparoscopic ventral hernia repair. World J Surg. 2013;37(3):530–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Durham RM, Zuckerman D, Wolverson M, Heiberg E, Luchtefeld WB, Herr DJ, Shapiro MJ, Mazuski JE, Salimi Z, Sundaram M. Computed tomography as a screening exam in patients with suspected blunt aortic injury. Ann Surg. 1994;220(5):699–704.PubMedCentralCrossRefPubMedGoogle Scholar
  5. 5.
    Brooks AP, Olson LK, Shackford SR. Computed tomography in the diagnosis of traumatic rupture of the thoracic aorta. Clin Radiol. 1989;40:133–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Moore FD. Metabolic care of the surgical patient. Philadelphia and London: W. B. Saunders Co; 1959.Google Scholar
  7. 7.
    Dudrick SJ, Wilmore DW, Vars HM, Rhoads JE. Long-term total parenteral nutrition with growth, development, and positive nitrogen balance. Surgery. 1968;64:134.PubMedGoogle Scholar
  8. 8.
    Lerner BH. The breast cancer wars. Fear, hope, and pursuit of a cure in 20th century America. New York: Oxford University Press; 2001.Google Scholar
  9. 9.
    Hermann RE. Three unforgettable surgeons. Surgery. 2004;135:1114–7.CrossRefGoogle Scholar
  10. 10.
    Saxon W. Dr. George Crile Jr, 84, Foe of unneeded surgery dies. New York Times. Accessed 19 Nov 2014.
  11. 11.
    Reynolds Jr W. The first laparoscopic cholecystectomy. JSLS. 2001;5(1):89–94.PubMedCentralPubMedGoogle Scholar
  12. 12.
    Iribarne A, Milner R, Merlo AE, Singh A, Saunders CR, Russo MJ. Outcomes following emergent open repair for thoracic aortic dissection are improved at higher volume centers. J Card Surg. 2015;30(1):74–9.CrossRefPubMedGoogle Scholar
  13. 13.
    Cameron JL, Riall TS, Coleman J, Belcher KA. One thousand consecutive pancreaticoduodenectomies. Ann Surg. 2006;244(1):10–5.PubMedCentralCrossRefPubMedGoogle Scholar
  14. 14.
    Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, Hodgin MB, Sauter PK, Hruban RH, Riall TS, Schulick RD, Choti MA, Lillemoe KD, Yeo CJ. 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg. 2006;10(9):1199–210. discussion 1210-1.CrossRefPubMedGoogle Scholar
  15. 15.
    Freischlag JA, Kibbe MR. The evolution of surgery: the story of “Two Poems”. JAMA. 2014;312(17):1737–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Pruitt Jr BA. Combat casualty care and surgical progress. Ann Surg. 2006;243(6):715–29.PubMedCentralCrossRefPubMedGoogle Scholar
  17. 17.
    Blackbourne LH, Baer DG, Eastridge BJ, Kheirabadi B, Bagley S, Kragh Jr JF, Cap AP, Dubick MA, Morrison JJ, Midwinter MJ, Butler FK, Kotwal RS, Holcomb JB. Military medical revolution: prehospital combat casualty care. J Trauma Acute Care Surg. 2012;73(6 Suppl 5):S372–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Ingalls N, Zonies D, Bailey JA, Martin KD, Iddins BO, Carlton PK, Hanseman D, Branson R, Dorlac W, Johannigman J. A review of the first 10 years of critical care aeromedical transport during operation Iraqi freedom and operation enduring freedom: the importance of evacuation timing. JAMA Surg. 2014;149(8):807–13.CrossRefPubMedGoogle Scholar
  19. 19.
    Palm K, Apodaca A, Spencer D, Costanzo G, Bailey J, Blackbourne LH, Spott MA, Eastridge BJ. Evaluation of military trauma system practices related to damage-control resuscitation. J Trauma Acute Care Surg. 2012;73(6 Suppl 5):S459–64.CrossRefPubMedGoogle Scholar
  20. 20.
    Shanafelt TD, Balch CM, Dyrbye L, Bechamps G, Russell T, Satele D, Rummans T, Swartz K, Novotny PJ, Sloan J, Oreskovich MR. Special report. Suicidal ideation among American surgeons. Arch Surg. 2011;146(1):54–62.CrossRefPubMedGoogle Scholar
  21. 21.
    Bittner 4th JG, Khan Z, Babu M, Hamed O. Stress, burnout, and maladaptive coping: strategies for surgeon well-being. Bull Am Coll Surg. 2011;96(8):17–22.PubMedGoogle Scholar
  22. 22.
    Balch CM, Freischlag JA, Shanafelt TD. Stress and burnout among surgeons: understanding and managing the syndrome and avoiding the adverse consequences. Arch Surg. 2009;144(4):371–6.CrossRefPubMedGoogle Scholar
  23. 23.
    Balch CM, Shanafelt T. Combating stress and burnout in surgical practice: a review. Adv Surg. 2010;44:29–47. Review.CrossRefPubMedGoogle Scholar
  24. 24.
    Shanafelt TD, Oreskovich MR, Dyrbye LN, Satele DV, Hanks JB, Sloan JA, Balch CM. Avoiding burnout: the personal health habits and wellness practices of US surgeons. Ann Surg. 2012;255(4):625–33.CrossRefPubMedGoogle Scholar
  25. 25.
    Sakran JV, Kaafarani H, Mouawad NJ, Santry HP. When things go wrong. ACS Bull. 2011;96(8):13–6.Google Scholar
  26. 26.
    Luu S, Leung SO, Moulton CA. When bad things happen to good surgeons: reactions to adverse events. Surg Clin North Am. 2012;92(1):153–61.CrossRefPubMedGoogle Scholar
  27. 27.
    Wu A. Medical error: the second victim. the doctor who makes the mistake needs help too. BMJ. 2000;320:726–7.PubMedCentralCrossRefPubMedGoogle Scholar
  28. 28.
    Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. Lancet. 2009;374(9702):1714–21.CrossRefPubMedGoogle Scholar
  29. 29.
    Look FD. Leadership and medicine. Gulf Breeze, FL: Fire Starter Publishing; 2009.Google Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Rifat Latifi
    • 1
  • Stanley J. Dudrick
    • 2
    • 3
  • Ronald C. Merrell
    • 4
  1. 1.Department of SurgeryUniversity of Arizona Medical CenterTucsonUSA
  2. 2.Department of Clinical SciencesThe Commonwealth Medical CollegeScantonUSA
  3. 3.Department of SurgeryYale University Medical SchoolNew HavenUSA
  4. 4.Department of SurgeryVirginia Commonwealth UniversityRichmondUSA

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