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RACS ASC feature
The creative surgeon The British Journal of Surgery Oration 2021, delivered by Professor Mohamed Khadra AO Those who are not surgeons tend to think of surgery as a highly technical and physical specialty. The thought that surgeons could be creative causes cognitive dissonance. They box surgeons into occupational categories that include mechanics and carpenters, or in my case as a urologist, plumbers. When people talk of creativity, they often use one small subset of creativity as their measure: that is, artistic creativity. We know, for example, that Picasso or Bach or Monet were creative. We don’t think of a surgeon doing a laparoscopic cholecystectomy as creative. When you ask people to define creativity, they often use the words like ‘artistic’ or ‘create’. Generally accepted definitions of creativity encompass more than art. The Oxford English Dictionary defines creativity as the use of imagination or original ideas to create something; Edward De Bono says creativity is the use of ideas and skills to create something that was not present before. Perhaps the best definition of creativity was put forward by Robert E Franken, a Canadian psychologist and researcher living and working near Vancouver. He defines creativity as ‘the tendency to generate or recognise ideas, alternatives, or possibilities that may be useful in solving problems, communicating with others, or entertaining ourselves and others.’ Using this definition, we as surgeons display creativity daily to make difficult diagnoses, approach challenging operations or deal with patients and their families. Creative surgeons devise new ways of doing operations, new clinical pathways and models of care, and push the boundaries of disease even further towards conquest. The story of surgery, even to our modern day, is rife with examples of invention and innovation. Most of the time, as is evidenced by the data collected on our endeavours, we are successful in our clinical outcomes. Australia and New Zealand boast some
of the best outcomes in surgery and are two of the safest places in the world to have an operation. The Royal Australasian College of Surgeons has, since its inception, had a central theme in training us for excellence. Yet there are times when even our best skills, clearest thinking or our most innovative technologies do not yield a desired result. Patients die or are forced to live a lifetime with complications that we have caused. We, as human surgeons, are forced to rationalise these injuries. They are cumulative in their effect on our collective souls. Time does not ease the pain of the harm we cause. The years only condemn. Some of us turn to alcohol and other addictive drugs. The data tells us that 14 per cent of doctors in Australia have an alcohol problem and two per cent have narcotic dependence. Depression and anxiety are higher per capita in our profession than the general population. We suffer for our craft and our craft suffers as a result. This collective post-traumatic stress disorder has to be resolved. I would contend that the solution is within us all. Using our innate creativity as surgeons and directing it towards artistic creativity is an unparalleled mental release. The
artistic feeds the surgical creativity and the surgery feeds our art. They are a continuum of one and the other. The desire to create beauty out of the ugliness of disease, to contribute something with our creative energy outside the sterility of the operating theatre, provides, for many of us, the counterbalance to insanity and allows us to gain an equanimity that physician Sir William Osler so often expressed as the foundational characteristic of an effective doctor. Anton Chekhov, the Russian doctor and playwright wrote, ‘Medicine is my lawful wife, and literature is my mistress. When I get fed up with one, I spend the night with the other.’ For me, writing and art have always been my haven and I have been lucky enough to have four novels published by Random House. My first book, Making the Cut, has become a best seller and has sold more than 30,000 copies. In some ways the book is also a historical text. It documents what it was like to be a resident and registrar in the late 1980s and early 1990s, long before safe working hours and ‘woke’ communication with our bosses.
