Neurosurgery, demands a set of core values.

Naturally, everyone is going to have an opinion on this and the answer you get depends on multiple factors. As a trainee I used to ask nurses in our operating theatres which consultant was the best at X operation and Y operation. The answers were so wide ranging and had no rooting in the a) actual technical aspects of the case, b) awareness of post-operative complications (as theatre nurses do not work on the wards), c) teaching and training of neurosurgeons in the making. d) appropriate patient selection and e) interaction amongst other members of the wider medical and surgical profession and discussion at multiple disciplinary meetings (MDTs).

If you asked nurses on the wards the answer you got was different again. Why? They see the pre-operative state of the patient, the impact of intra-complications and post-operative complications that arise but above all they see the neurosurgeon interacting amongst nursing colleagues and more importantly how they talk to patients and their families. If you asked the medical secretaries you got a different answer again. If you asked colleagues in other medical and surgical specialties that answer changed again. It all depends on the access the person has to that aspect of a neurosurgeons practice.

What overwhelming came across as a significant factor in shaping peoples perception if a certain neurosurgeon is the best was how they came across as an individual, e.g. being nice goes extremely far in shaping perception. This value is greatly underestimated by some but is highly valued and regarded in almost every single step in medical and surgical recruitment. Yes, it is entirely possible for a neurosurgeon to exist who is excellent at operating (and interacting favourably amongst nurses in theatre) but is terrible at interacting amongst nurses on the ward (or disastrous at patient and family discussion). However, this is not common. 

The multiple component parts of the job, e.g. pro-actively running an efficient outpatient clinic to reduce waiting times, interacting well with patients and their families in clinic and during pre-surgical assessments, explaining the intention of a proposed management plan in a clear and compassionate manner to the patient and their families, requesting investigations in a timely manner, updating patients on plans in a timely manner, answering the myriad of patient questions and concerns that come through to the secretaries in a timely and compassionate understanding manner, ensuring pre-operative investigations have been done, are accurate and any concerns raised with relevant specialties.

Furthermore, one must always ensure consent is robust and open to scrutiny, booking patients for operations and ensuring kit is available, taking time to talk to your registrar (junior doctor) who is in theatre with you about the plan and their role in it, ensuring good attention to detail of post-operative plans and updating patient and families, being aware of individual patients anxieties to know either everything (or only things they need to know), ensuring patients get discussed at relevant MDTs and doing this for each and every single patient on your books is an impossible task but requires showing up each (and every) day to do the job as well as you can.

I have not even mentioned the actual operating. Or the knowledge of neurosurgical anatomy, critical care, pathology and research relevant to your area of expertise that gets bigger each and every single year. However, this is the job and therefore the core values I employ are to a) be nice to everyone at all times, b) admit your errors and mistakes, c) listen to feedback no matter who it comes from and no matter how painful it can be to hear, d) be efficient regarding paperwork, e) keep up to date as much as is possible and f) always show up. 

A book which shaped my attitudes to patient care was Being Mortal by Atul Gawande. I love all of his books (and read Complications in the Amazon jungle). This book gave me more of a desire to work harder at trying to understand what is going through a patients mind during complex discussions about their care. This is not always easy to do as a doctor (and I am only human). But I must always continue to try.