Are you as good as you possibly can be?

This is Roger Federer. Currently he is 3rd in the ATP World rankings. His record of 16 Grand Slam (GS) titles, including 10 consecutively, along with 23 finals appearances has him regarded by many as The Greatest Tennis Player ever. The other man is Paul Annacone. His highest ATP ranking was 12. In 7 years on the ATP Tour he never progressed further than a Grand Slam quarter final. Paul Annacone is Roger Federer’s coach. Previously he had coached a little known Californian by the name of Panayiotis Sampras. Most people called him “Pete”.

It is clear in tennis that leading players continue to excel not because of personal insight and innate talent but because of the input of coaches such as Annacone who can observe and guide their charges to even greater performance that they themselves may no longer or ever have been able to achieve. The suggestion that a player as good as Federer can improve or has a coach would surprise few. Many however would be uncomfortable with the knowledge that technical specialists such as Consultant Surgeons aren’t as good as they possibly can be and don’t have coaches to help them achieve optimal performance.  What is not suggested by either of these facts is that the performance currently achieved is unacceptable, merely that it is not not exemplary; Federer wants more Grand Slams and surgeons want to excel.

I raised this In my previous post . It may be uncomfortable to hear of shortcomings in performance, difficult to action and even harder to change consistently but if that improvement is possible for Federer or for a surgeon surely that achievement is of greater import than the disquiet, arrogance or ignorance resisting it. Personally, I’m interested to look at my practice both within the theatre and outwith to consider opportunities to improve. I’m sure the same could be applied to any clinician and even manager. Who wouldn’t want to be as good as they possibly can be?

Why I don’t like Atul Gawande.

There was a kid at school that reminds me of Atul Gawande; he was good at cricket, good at rugby, really, REALLY clever and worst of all, everyone really liked him. Atul Gawande is, according to his own website, “surgeon, writer, and public health researcher, practising general and endocrine surgery at ” blah blah blah. You can read it for yourself here because he is ALSO lots and lots of other things not the least a prolific and excellent writer. I’m sure he is also really nice and everyone loves him and he’s a delight to be with and an amazing lover and… and you know why i REALLY don’t like him? Because I think he’s right about most things he writes about and that just makes me uncomfortable. Harsh eh?

I’m not going to go through everything he has written, as there’s a lot and that would probably just wind me up even more. Suffice to say he was right about improving patient safety, right about adverse events and right about a lot of surgical education. I do have issues about some of the surgical training remarks but that is the American rather than UK standpoint which makes a big difference.

So the point of this little post is to highlight the wunderkid’s (he’s two years younger than me) latest piece “Coaching a Surgeon“. In this flowingly written and erudite piece he correctly points out that whilst the majority of highly skilled, technical professionals in sport and music have coaches, in surgery where, despite the teasing of our anaesthetic colleagues, we are actually pretty skilled technicians yet none of the senior staff have coaches to help us continue to progress and further excel. We may improve to a point but such self directed improvement is limited.  The reasoning behind this lack of coaching is probably less intricate than we’d like to think but has to do with ego, performance anxiety and the lack of invitation of critique.  Why do I not like Atul Gawande? Because he highlights my flaws.

Regular/ocassional readers of this blog may wonder at the value of a discussion on development of superior surgical skills within what used to be a blog on clinical leadership. Surgeons strive for perfection in what they do. The means to achieve this are complex and personal but require time, space, resource, reflection and encouragement. The potential results are clear. What is important however is to see beyond having our flaws exposed and see that as a positive thing, a source and opportunity for improvement rather than criticism; the difference between critique and criticism. Where does this fit within the current constructs of clinical leadership and medical management? It resonates with issues of engagement and reward but does not sit clearly in terms of resource planning and efficiency. Improved patient safety is not simply about checklists and mantras but about coaching the star performers and helping them to be the best.

Dang, if Dr. Gawande isn’t right again! I’d love to meet him. grrrr, I’ll probably really like him…