Striving To Stay At The Top Of Your Surgical Game

William Fishco DPM FACFAS

I have been practicing for 12 years now and some things have not changed. I still worry about my patients. I often wake up in the middle of the night feeling flushed when the stress of a recent surgery or an upcoming surgery is on my mind.

You run the surgery over and over in your head questioning whether the fixation is strong enough. Will the patient be adherent? Did I get enough correction? Will the correction hold over time? Did I do the best procedure for that given circumstance?

I tell my residents they have no idea what they are in for. As a resident, you cut and run. Residents do not need to do any follow-up as they leave follow-up for their attending to manage. The old saying is true: “The surgery is the easy part but the follow-up is a (expletive).”

Your surgery training is like learning to ride a bike. When you are a resident, you have training wheels (your attending). After you graduate, you think you know everything. Riding your bike too fast or overconfidently turning a corner will cause you to fall off. You just have to brush yourself off, get back on the bike and keep practicing. There is only one way you can get better at something. You have to do it over and over again.

Preparation for work each day is important for me. I scan my schedule and review the patient’s notes the night before follow-up to refresh my memory. That will ultimately make the encounter more efficient and productive as I will have a general plan for what would be next in line for treatment.

As for planning surgery, it is paramount to review X-rays, magnetic resonance imaging (MRI), etc. Even though you scheduled the surgery a month ago and you know you will be doing an Austin bunionectomy and second hammertoe repair, you want to be mentally ready for potential pitfalls or structural things to consider like metatarsal length pattern.

Even if it is a procedure that I have done hundreds or even thousands of times before, every patient is different. The technique is not going to be new. However, I am striving for attention to little nuances that can make the surgery go smoother or help in obtaining better correction, fixation and/or postoperative results.

To that end, I am always trying new things. These are not major things but simple tweaks that could make surgery easier, quicker and better in the long-term. After all, that is what makes a good surgeon. Otherwise, if you just go through the motions, then you are, in reality, a highly trained technician.

So what gives me my edge? I refuse to let my daily professional life become rote, routine, mundane or typical. Everyone has different sources of inspiration. The inspiration can be listening to lectures at a seminar, reading the medical literature, debating treatment dogmas and ideas with colleagues, or having an innate drive to learn and accomplish new things.

Some professional athletes do not know when to hang up their cleats. I know I will need to call it quits when I do not worry about my patients, stop getting nervous when I walk into the operating room and lose interest to keep up with the information relevant to daily practice. After all, if you cannot be at the top of your game, why play?


Not just in surgery, but also in podiatric medicine, podiatric wound care, and podiatric pathomechanics. Podiatry is an art and a science. The artistic part of podiatry is what makes podiatry interesting, because tweaks, modifications, and revisions are involved, which in turn leads to the unexpected and 'thinking out of the box'. The science part of podiatry are the technical aspects found in textbooks, or the predictable aspects that are mastered by repetition and practice. So 'the best of the best' licensed, residency-trained and/or fellowship-trained podiatrists in America who are diplomates and/or fellows in podiatric surgery, podiatric medicine, and podiatric orthopedics always have to be 'on the top of their game' in conducting lectures and working in health-care settings like hospital floors, the ERs, the ORs, the clinics, and the nursing homes until it is time to retire professionally.

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