A patient today asked me "How did you became the best eyelid surgeon in Denver". I laughed because I don't think I am the best. I am think I am a very good eyelid surgeon but I think it is very hard to determine who is the best. In fact I believe that if you think you are the best at something you are not only not the best, you are probably not very good at all. When I think of the best eyelid surgeon in Denver, I think of my partner Jerry Popham. Training with him in 2007-2009 I learned a lot of principles of surgery and principles of doctoring that have helped me to become the surgeon I am today. I really analyzed it tonight as a my daughter started to fall asleep at 9pm and I had a few minutes to write this article. What principles guided me to become the surgeon I am today? The one repeating concept or person that came to mind...Jerry Popham, my partner.
I have learned a lot from Jerry. He trained me in oculoplastics along with Robert Kersten MD from 2007-2009. I went on to practice at Georgetown in Washington D.C for 5 years before he asked me to join him in practice back in Denver. During the two years I trained with him as a fellow, I learned a lot about the technical aspects of oculoplastic surgery. I also learned a lot from Bob Kersten who now practices at UCSF. Most importantly, I learned from Jerry many of the things that are nonsurgical that makes him the best eyelid surgeon in Denver and probably one of the top in the country. These are things that I learned from him during my fellowship but I have carried throughout my career. When I came back to Denver to join him almost 10 years later, I still see Jerry exhibiting those principles.
During my two years as his fellow, I tried to analyze what particular traits as a doctor made Jerry so great. Patients love him. He is a great surgeon. He has a great practice. How did this happen? I wanted to be like him. Who wouldn't? Every young surgeon who sees a mentor surgeon wants to emulate them. I tried to analyze what were the formative values that Dr Popham held that drove his career to such success? I found five principles that he exemplified consistently. As his fellow, I learned these from him and when I dig deep I feel these are at the central core of me as surgeon and doctor. You mimic your mentors. These are principles that guided his practice back then. These principles I believe still guide him today. As his partner and former student they guide myself today.
5. Take pride in your work
As a surgeon, one can have the approach to surgery of "how do I perform this surgery to the maximum of perfection?" or "How do I get through this and get home?" I was once operating with a surgical assistant who was not very good. She didn't know the names of the instruments to hand me or the proper way to set up the surgical instruments. The case was long and was made more difficult by her lack of skills. At the end of the case I said "Wow that was not fun" in a frustrated tone. She replied "Well it's ok, we got through it". I remember thinking to myself "Is this really what we are trying to do when we perform surgery here....just get through it?" She never worked with me again.
I think when I saw Jerry analyze his work on each patient as a fellow, I would see that he would try to make every blepharoplasty, eyelid procedure or tear duct surgery better than the last one. He is constantly trying to improve and perfect himself. From how he analyzed the patients in the clinic, performed surgery on them and took care of them after surgery, he was always looking to make himself better. Questions he reflected on include:
"How do I improve the patients cosmetic appearance even more?" "
"How do I reduce the swelling after surgery in the next case"
"In what way could I have performed surgical steps better"
"Was there anything new I could incorporate into the next time I perform this procedure"
As an oculoplastic surgeon, I often wonder about this myself. How do I perform each case better? What could I do next time that would improve things? You can hit a homerun and be satisified but maybe next time you can hit the homerun further. Any surgeon will tell you that the worst surgeons actually are the ones that perceive that they are the best or "perfect". The factor that makes them bad is that their self perception is so poor they don't improve on their weaknesses. If you think you are perfect, you will never improve your weaknesses. In fact, the best surgeons are ones who accept their weaknesses and try to focus on improving them throughout their career. Jerry Popham is always is trying to improve his technique, reduce his complications, reduce recovery for patients and anything else that makes him a better surgeon and doctor. I saw that in 2007 and tried to emulate it has his student.
4. Be kind to all patients regardless of means
During my training we were at a staff meeting once and someone mentioned there was a complaint from a patient that one of their surgeries had to be rescheduled because of an emergency case. One of the staff exclaimed "That patient has Medicaid anyway". Jerry was very upset by this statement and staff member.
In our practice, we may see patients who have hundreds of millions of dollars to patients who have no financial means. As a physician, surgeon and decent human beings. we are not going to treat patients any different based on their means. I believe Jerry Popham's Christian faith gives him these values. (but it could also be great parenting). I do know that this is a value that he holds dear to his heart. He yearly performs surgery in Vietnam on needy children and adults to help those that need care. Kindness to patients equally regardless of care is a foundation of Jerry Popham's practice and his being. Treating humans equally with kindness and gentleness are inherent to his personality and gives him the desire to give the best outcomes for all patients. This principle guides our practice to treat old, sick, rich, poor with the same respect, dignity and care.
3. Take your time
When I was a fellow, I worked with some surgeons who valued speed as the primary determinant of surgical talent. They felt if they could race through a case, they must be a good surgeon. It is true that slow surgeons are generally poor ones. That being said, I learned through Jerry to slow down. In the operating room, it is important to take one's time with the case. Don't leave a stone unturned. In the clinic, take your time with the patients. Get to know them. Examine them thoroughly. Don't miss anything. Speed is not the only endpoint. Patient happiness is. Success with patients is predicated on taking time and not rushing. Sometimes being a little delayed is not the end of the world as long as you know you did your best on each case. Each patient will appreciate the time you take with them.
2. Be humble
There are times as a surgeon where you will feel really good about yourself. There may be a surgery like a drooping eyelid surgery which has a 90% success rate but you have a string of 20 in a row that are great. The way to prevent a mishap is to limit your overconfidence. Be confident in your skills but be humble. Always remember that you may have seen a lot of things in your career but you haven't seen everything. A humble surgeon is prepared. A humble surgeon is ready to handle a surgical complication as quickly as a surgical success. Overconfidence causes surgeons to not recognize subtle signs where a case may be different. Dr Popham's humility reflects his experience seeing thousands of patients and treating them. I believe that he has remained a great surgeon through his humility. I have tried to learn that through my career with him.
1. Care about your patients
If there was one guiding principle that I learned from my partner and former mentor, Jerry Popham is that if you genuinely care about your patients, everything else follows: good surgical outcomes, being liked by patients, a busy practice, being a successful surgeon. If you don't genuinely care about patients, you can try to game the system by pretending, having a great marketing team or having a fancy office but it will never build a great practice. I have seen surgeons in Colorado who are technically proficient but view each patient as a lamb to bring to slaughter. They try to analyze how to maximize revenue or how to do as many procedures on a patient as possible. At the end of the day, that karma comes full circle and their practices are not busy, their patients seek care elsewhere and their reputation suffers.
As my mentor, Jerry has always put this principle first and foremost and I think it is the foundation for his practice and his surgical career being so great. Caring about your patients will always lead you to do the best things for them. It will push you to have better outcomes. It will lead you to be kinder to all your patients even the most vulnerable ones. You will slow down and give the patients the best care possible. Your ego will be placed aside as you look for the best possible results for your patients. At the end of the day, what goes around comes around and your practice will be like Jerry Popham's...wildly successful. I have used these principles in my career for the last 8 years and found that they have served me well as a doctor and surgeon at Georgetown and now here in Denver for the last two years.