No question about it, we are entering another uncertain time in health care.

Those of us of a “certain age” may yearn for a return to the days when we surgeons faced few restrictions on our practice or our decisions. Each of us has developed his/her own perspective on the state of U.S. health care and the best path forward, most frequently shaped by our background, geographical location, and practice environment. The tendency among a great many of us has been to erect walls rather than bridges and to view our own situation as unique and more threatened than that of others. Specialists and generalists, urbanites and rural dwellers, all tend to view their own worlds as uniquely challenging.

If there was ever a need to reach out and communicate with one another and understand that the overwhelming desire of every surgeon is to provide his/her patients with the best possible care, it is now. After all, we’re all surgeons who face the same sets of challenges in the OR. There is far more in our professional lives that unites us than separates us. It is critically important that surgeons maintain open lines of communication and solidarity, no matter what other characteristics of politics or place separate us. How do we accomplish this seemingly Herculean task in the midst of the dissension and disintegration occurring all around us?

One powerful tool that can help break down barriers to honest dialogue and reinforce solidarity among surgeons is the ACS Communities. This hugely successful communication platform, which grew out of the old ACS Rural List, is now an electronic meeting place and venue for dialogue for all members of the College. The Communities is a safe place where participants, despite their many differences in specialty, location, practice type, and political views, share the common goal of improving the care available to our patients. Postings range across a wide spectrum of topics – from clinical to fiscal, social, personal and philosophical, sometimes all in the same thread. All ACS Fellows are free to sign up and post on any subject that is of concern to them, as long as their postings adhere to a baseline respect for other members. The contributions are curated by Tyler G Hughes, MD, FACS, coeditor of ACS Surgery News, but they rarely stray from the boundaries of civil discourse.

The diversity of voices on the Communities is gratifying. Midcareer surgeons, recent grads, and retired specialists all converse with each other in this space. Surgeons from different practice types and locales, including from those who work in rural critical access hospitals and those in academic medical centers, all come to discuss, ask for opinions, exchange information, and debate. These colleagues offer opinions based on long years of practice and from article of the highest quality from the literature. The whole is somehow greater than the sum of its parts. Divergent opinions add depth and breadth to any conversation and lead to a greater understanding of the entirety of a subject. I always learn something from these dialogues.

Most threads involve questions about clinical issues that have arisen in the author’s practice. One recent topic was interval cholecystectomy in which the question was raised about whether the gallbladder needs to be removed after placement of a tube cholecystostomy (usually by Interventional Radiology) for acute cholecystitis, a practice that seems to be proliferating in many areas. Over a two-week period, responses poured in from a wide variety of practice sites and types and ranged from expert opinion to references from the literature. Other threads involve less commonly encountered conditions such as coccydynia or splenic cysts or offer opinions about such “hot-button” items” as attire in the OR or music in the OR. Almost every subject is interesting and provides the reader with food for thought.

Other topics stray from the purely clinical or surgical to the health care system itself. One current ongoing and timely subject of a thread on the ACS General Surgery community is entitled “Care for the Vulnerable vs. Cash for the Powerful.” Opinions have been expressed from many perspectives and have truly been educational and enlightening. While the general public discourse has been fraught and divisive, the Communities discussions have been respectful and collegial. This basic unity underlying our diversity is the foundation of the Communities and it is a source of strength for the surgical profession.

The ACS Communities is the work of many hands and hearts over many years, and I am truly grateful to those who made it happen and to the ACS for sponsoring this great platform for communication.

Dr. Deveney is professor of surgery and vice chair of education in the department of surgery, Oregon Health & Science University, Portland. She is the Coeditor of ACS Surgery News.

Strength in Community