Conference Coverage

Presidential Address: 'Changing Me to We in Vascular Care'


When R. Clement Darling III, MD, took to the podium at the Vascular Annual Meeting to present his presidential address, he highlighted the importance of teamwork and collaboration in training, in maintaining personal well-being, and most importantly, in patient care.

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Dr. R. Clement Darling III

His talk, titled, “Looking Forward Through the Past: Changing Me to We in the Evolution of Team-based Vascular Care,” addressed these issues through a very personal lens. To make his point, Dr. Darling outlined four key take-home concepts that he had found useful “over five decades of working in an operating room as a technologist, a student and a surgeon,” and as chief of the division of vascular surgery at Albany Medical Center Hospital (N.Y.). These formed the basis of his entire address:

1. “None of us is as smart as all of us.” We learn from each other which is the foundation of team-based training.

2. The key to resilience, healing and health, whether for our patients or for ourselves, is caring and supporting each other more.

3. Failure is not an end result. It is the path to success through learning.

4. Remember the past but look to the future. The best predictor of future behavior is the past, but the future we are experiencing now, is like no other!”

Dr. Darling spoke from the heart about the importance of his colleagues and his parents, especially the role of his father as a pioneer in vascular surgery, and of the women in his life as role models.

He stressed how “one of the invaluable things I have learned is the value of failure, evaluating the past to avoid the same mistakes and the benefit of the TEAM in providing support and care.”

“Every day we’re asked to do the impossible and every day we get up, go to work. We do the best we can. We can make the best plans, treat the sickest patients and get a tremendous fulfillment for what we do in what we do. We do the right thing for the patient,” Dr. Darling explained, in summarizing the passion that he feels for vascular surgery.

“We are always willing to do and try the impossible. We’re always willing to be the last person to call when things look bleak. It brings me great glee whenever we get called to the operating room and people look around and go, ‘oh thank God, the vascular surgeon’s here.’ Our colleagues in other specialties are often afraid of blood vessels, afraid of death, afraid of complications. We thrust ourselves every day into situations where nobody else will go,” he added.

“As vascular surgeons we face failure and roadblocks daily yet still persist where others are scared to tread. Many of you have faced far worse barriers of discrimination and unreasonable arbitrary barriers, and I am constantly humbled by your ability to overcome them,” Dr. Darling said. He pointed out that: “This innate ability to focus on the problem is what makes vascular surgeons great. No problem is too complex, no detail is too small. We do the right thing despite the odds against us. We do right by the patient.”

After telling some of his own stories of “failure,” to illustrate its importance as a learning tool, Dr. Darling spoke of one person’s reception of his application to join the SVS: “When I applied for membership to the Society for Vascular Surgery, someone had written a note saying that ‘I should never be considered, nor was I deserving to be a member of the SVS, and never should I be admitted into this austere society.’”

Throughout his address, Dr. Darling re-emphasized the importance of teams and the collaborative nature of patient care. “The SVS has developed strong partnerships with the Society for Vascular Nursing, The American Venous Forum, The Society for Vascular Ultrasound, and is seeking to strengthen relationships with the regional vascular societies, VESS, the Society for Clinical Vascular Surgery, The Society for Vascular Medicine, the American Heart Association, and many others.

“The SVS is developing these relationships with the patient at the center, and with purpose, focusing on ‘shared vision,’ of specific advancements, programs, and initiatives that will advance quality of care. By tapping into this vast array of talent Vascular Surgery will become more agile, intelligent and thoughtful in our care of vascular patients,” Dr. Darling predicted.

But vascular surgeons must become comfortable with moving from the concept of “captain of the ship” to the role of team leadership, he emphasized, if they are to truly succeed in their careers and in providing optimal patient care.

“Currently, each patient coming to your service touches over 100 staff during their experience. This includes your office, vascular lab, angio suite, recovery room, hospital floor, ICU, CT scanner to name a few.” This is part of the need for the evolution from ‘captain’ to ‘leader,’ he added.

“If you have not had any formal training in leadership or team development, I strongly suggest you add this to your learning portfolio,” Dr. Darling counseled. “The SVS is addressing this through its Leadership and Diversity Committee, and you will see an expanding array of learning opportunities in the future.”

With regard to his own tenure as SVS President: “I am proud that during my year as president, the SVS has invested in several new Task Forces to address critical future issues including: Alternative Payment Models for vascular surgery; a national inpatient and outpatient vascular certification program; a focus on our own health, wellness, and potential ways to mitigate potential burnout; and Dr. Makaroun will be taking on the issues of vascular surgery valuation and workforce in the new Task Force on the Future of Vascular Surgery.”

He further discussed the role SVS is playing in helping to define the future of vascular surgery.

“As we work to strengthen our brand and identity, the SVS Executive Board has supported, and thanks, Amy Reed and Will Jordan for their leadership in the APDVS [Association of Program Directors of Vascular Surgery], and for taking the first step toward attaining a separate Vascular Residency Review Committee or RRC.” In addition, he described how “SVS is also working closely, and collaboratively, with the American Board of Surgery, and the Vascular Surgery Board, to complete the work that was begun a decade ago, and achieve an autonomous vascular surgery board that is an equal partner and stakeholder in the ABS.”

Dr. Darling then outlined one of his major concerns and interests: the exit path of senior vascular surgeons, and how this is often a tremendous waste of talent and expertise. “In the last decade of work when senior surgeons are trying to transition to non-clinical work, I think we throw away much of their intellectual skill and experience in dealing with vascular surgery problems,” he said. He urged that “as our senior surgeons leave clinical practice, we need to use their intellectual expertise and experience in a more productive way.”

The Society for Vascular Surgery is establishing pathways for leadership and pathways to train people in administration, he added.

Turning back to the extreme importance of teamwork, Dr. Darling addressed the future.

“We, physicians, nurses, PAs, technologists, staff, and administrators, need to work together, think together, to grow together, not only for our patients, but for our partners and our families. We are all part of the vascular team,” Dr. Darling said.

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