Your Best Life: Managing Stress—Preparation is Key

The more I engage with our wonderful vocation, the more I recognize the importance of preparation [5]. When I prepare for surgery and for office visits, not only do I decrease my stress, I also raise the quality of the care I deliver [2]. It is evident that good patient outcomes are a huge “uplift” to any surgeon and will help maintain energy and sidestep burnout [8]. Taking the time to prepare benefits surgeons and patients alike.

Why We Don’t Prepare

Most of us fall victim to the whirlwind of events that barrage us daily—the cascade of phone calls, emails, insurance hassles, and the omnipresent mounting email chain. We tend to the “urgent” but not important matters, hoping that by completing the to-do list, we can find some semblance of peace. Sadly, we may often find ourselves arriving to the operating room ill-prepared with the mindset, “I’ll figure it out during the case.” This approach is an invitation for excessive surgical times, complications, and needless stress. When we can subordinate the “urgent but not important” items to more high-yielding activities like preparation, we are on the path to living a more effective life [3].

Preparing for Cases

The more experience I gain, the more time I devote to preparing for surgery. I once heard that the venerated surgeon Maurice Müller was known to say, “The operating room is a bad place to think.” In other words, the prepared surgeon must be ready to execute the essential steps without much thought. True preparation is realized when the case is already rehearsed in the surgeon’s mind.

My preparation for surgery includes a review of contemporary techniques and the available evidence, a review of my personal “tip sheet” (a compilation of pearls I have learned over the years), and drawing out the steps of the case. As a matter of disclosure, I do not do this for every procedure (perhaps I should), but I certainly try to do so for the more difficult procedures.

Online media are helpful, too. They allow us to review newer techniques quickly and efficiently. I tend to favor videos vetted through orthopaedic periodicals and societies. Surgeons are a competitive lot and I, for one, am always eager to incorporate the latest technical tips.

The Case File

I keep a Microsoft Word file for every case I perform and continually edit this document. I write down lessons learned and failure paths to avoid. Since working memory has a duration of a mere 15 to 20 seconds [4], it is important to refamiliarize your mind to the nuances of a particular case as soon as you can. Even though I have performed innumerable rotator cuff repairs, I learn something from each case, and I attempt to record each new epiphany in my Word file. Doing so has helped me avoid complications. Mistakes will always happen, but this approach to preparation has diminished the frequency of repeat errors.

Draw It

As I mentioned, a useful tool for me is drawing out the steps of a procedure, including a sketch of the pertinent anatomy. A sound knowledge of anatomy is essential for proper execution of a case and if I cannot draw it, then I do not know it! Even if one is not gifted in sketching, the simple act of putting the sequential steps to a case on paper will expedite mental consolidation. Studies show that the simple act of manual writing enhances retention [6].

Visualize It

For years, athletes have used mental imagery to enhance performance [7], and this technique is finally being used by surgeons. Mental rehearsal contributes to enhanced surgical performance, regardless of training level [1]. Visualizing and mentally rehearsing a procedure before we execute it helps us perform the procedure more readily and seamlessly.

Expect the Best, But Be Prepared for the Worst

We are not fully prepared if we are not ready to address complications that may arise. I try to visualize a certain subset of potential surgical challenges and firmly hold the image of my successful triumph over each potential misadventure. After acknowledging and visualizing successful negotiations of adverse events, I return to my principal image of a case that flows flawlessly.

Football legend Jerry Rice emphasized the role of preparation when he stated, “Today I will do what others won’t do so tomorrow I can do what others can’t.” Take the time to prepare. Your stress level will dissipate, your patients will benefit, and your results will improve.

And yes, like Jerry Rice, you will do what you couldn’t do otherwise.

Tomorrow, Try This:

• The evening before surgery, visualize each case as you would like it to go.

• Draw out the steps of the procedure and, with a pen, illustrate the pertinent anatomy.

• Create a Word file for your surgical repertoire and refer to it often. You will be refining your skills continually.

• Scan the next day’s patient list for clinic and brush up on the more unusual conditions that may come your way.