The feature article “Operating with pain: Surgeon workplace injury underrecognized" touched a nerve with our readers! The following comments appeared in the ACS Communities on the topic of pain and occupational injury among surgeons:
I recently was forced to undergo an anterior cervical decompression and fusion (ACDF) involving C4,5,6 and 7 due to worsening radicular pain and weakness due to severe cervical spinal stenosis. This problem was likely initiated by multiple injuries that I sustained as a wrestler in my younger days, but was no doubt exacerbated by 23 years bent over the OR table in extended periods of flexion, ignoring pain, and working every day no matter how I felt with no time for nuisances like physical therapy. Such is the mentality of the surgeon. In any case, my experience demonstrates that surgery, unlike many other medical specialties, takes a physical toll on its practitioners and also requires a certain level of fitness for surgeons to practice well.
The concept of wellness among surgeons is relatively new, in my opinion. Historically, surgical training was notorious for long hours, extended periods of sleep deprivation, irregular eating habits, strained interpersonal relationships, and frankly, sometimes an emotionally abusive environment. Many changes have been made to adapt training to be more livable, but these changes have been predominantly in the areas of work hours, sleep, and time off. Little has been done to teach adaptive strategies for the physical demands of performing surgery day after day.
Do we need a formal “plan” to educate surgeons how to save their backs and necks? Perhaps not, but surgeons do need to be aware that the cumulative “wear and tear” on our bodies can definitely affect how well we do our jobs, the number of years we are able to do our jobs, and the enjoyment with which we do our jobs. So tell the resident to stand up straight, teach them to operate with the table at the correct height, to hold the instruments in an ergonomic fashion, etc. Let’s begin to make proper ergonomics a part of our surgical culture so we may serve our patients for many years to come.
Bryan K. Richmond, MD, MBA, FACS
I remember attending the ACS meeting as a chief resident. There was a laparoscopic instrument rep taking a survey about ergonomics, especially arm, shoulder, neck, and back pain during surgery. I just remember laughing and saying, “Heck no, no issues for me.” Well, now as a 50-year-old, I’ve got issues! I find that I have to be very aware of my posture during procedures and not spend too much time in one position. Hand cramps are not an infrequent problem during longer surgeries as well. Getting used to wearing slightly looser gloves has helped some.
Peter Krone, MD, FACS
As much as we all love surgery, it seems operating is definitely taking its toll on most every surgeon I know. Short of changing how we operate (i.e., lap vs. robotic, etc.), it seems there is little we can do to protect ourselves. I learned of gel mats a few years ago. They are awesome for longer cases. For me personally, it has been bilateral carpal tunnel releases and a C5,6/6,7 ACDF for degenerative changes causing radiculopathy. Fortunately, both operations were 100% successful.
I applaud you for looking at the (virtual lack of) ergonomics in surgery.
Brent C. Jackson, MD, FACS
I finished my vascular surgical fellowship in 1991. Being old school, I continue to do some general surgery along with my comprehensive vascular surgery. In 2008, I had an urgent ACDF. Shortly thereafter, I attended the Southern Association of Vascular Surgery meeting and took an informal survey. I found that at least 60% of vascular surgeons in practice for 10 years had required an ACDF obviously secondary to loupes. Now in the endovascular cases wearing lead, lumbar back issues are also becoming very common in our field. This is a hugely important topic, and ergonomic study and training should become an integral part of training and retraining.
Thomas Appleby, MD, FACS
I am naturally right handed and have had the opposite experience of having left-handed surgeons teach me how to operate with my left hand throughout training. It is something I continue to do today. It comes in quite handy when helping one of my colleagues since they feel I am standing on the ‘wrong’ side of the table for most open procedures – but that was best for the left-handed approaches I learned.