Experiences of a Fourth-Year Surgery Resident
Written by: Buğra Tugertimur, MD | PGY 4 Surgery Resident - Lenox Hill Hospital, NYC
Dr. Buğra Tugertimur with Dr. Fabio Santanelli
Anxiety and excitement filled me during my first day in the breast unit at Sant’Andrea Hospital in Rome. In medical school, I had been invited by Dr. Fabio Santanelli, the Secretary-General of the European Association of Plastic Surgeons to learn about breast surgery and reconstruction. The patients all had a common goal of putting their devastating breast cancer diagnosis behind them after mastectomy and reconstruction by being with their loved ones and families, as themselves, with their body image intact.
We spent as much time with each patient as needed to answer their questions, allay their worries, and ultimately earn their trust. At the end of each encounter, Dr. Santanelli’s breast reconstruction patients all shared a distinct body language which expressed a genuinely positive outlook and cheerfulness, despite the ordeal they were about to face. I found this captivating cheerfulness to be contagious and a common theme among patients, residents, attendings, and ancillary staff alike. In-between cases, the residents and I would step outside to enjoy the cool summer breeze; as is common in Europe, they would light up their cigarettes and we would all exchange stories and reminisce about life over cappuccinos and espressos.
Upon self-reflection many years later, it struck me that over my 3+ week rotation, during these breaks, not once did we discuss medicine, the hospital, or the nuisances of our day. The cliché of work hard, play hard was as true as it could be. The entire experience was… Utopic.
Having been my first real clinical experience, my rotation in Italy set my expectations for the rest of medical school and eventually residency. I left Italy with a smile on my face knowing that I had chosen the right profession. I left a part of my heart in Rome. While admittedly this was, in part, due to the delectable food and coffee, it was more importantly because it again confirmed to me that I was doing exactly what I always dreamt of for my life. I have wanted to become a surgeon since I can remember. I have always enjoyed working with my hands and building things, whether it’s putting together a custom computer for cryptocurrency mining, or “modding” my old BMW’s inline-six twin turbo engine, body, and ECU for the track; surgery was the natural choice for me.
My motivation for becoming a physician was never about making a difference, but rather, eliminating it. I moved from Istanbul to the United States when I was six years old. Immigrating from a different culture and speaking a different language, I lost my sense of belonging and experienced the challenge of regaining it. Throughout volunteering, medical school rotations, and especially residency, I noticed that many patients are not unlike this, feeling a loss of belonging due to their acquired or inherited physiological ailment or physical deformity. My ability to relate to these patients through a shared understanding of what it is like to be an outsider has been central to my style as a physician and surgery resident in bonding with my patients. As with any relationship in life, whether it is marriage, friendship, or that between doctor and patient, establishing a strong foundation of trust takes dedication, patience, and time.
This is what I experienced in Italy. As it was my first true clinical experience, it was also what I expected throughout my career. But I quickly realized the difference between this experience and my future in healthcare.
In medical school, my first official rotation was in the outpatient office setting in Primary Care. Starting the workday at 9:00 am, I was shocked by our census of almost 40 scheduled patients who were double- and triple-booked. Calculated from a typical 9:00 am to 5:00 pm office day, this meant that each patient was allotted 5-6 minutes for an entire history and physical, formulation of assessment and plan, and most importantly, patient education. We flew through seeing patients, and by the end of the day, the patients were probably in as much of a daze as I was. This was my first experience in the volume-centric approach to medical reimbursement. It was an awakening to my idealism, and portrayed to me, that the role of a physician today was not the same as what I aspired to be as a child.
In 1977, Dr. George L. Engel of the University of Rochester formulated the Biopsychosocial Model. The tenets of his philosophy were that in considering healing a patient’s ailment, the physiology of an illness is inseparable from its psychological, behavioral, and social impacts. The reciprocal influences of these elements are such that they must all be considered in understanding diseases and providing treatment. While we are taught such principles in medical school, the theory from our lessons is disconnected from the reality of our practice.
The reality is that medicine has become a business. The moral responsibility of a business is to its shareholders. As physicians, our moral responsibility is, first and foremost, to our patients. While our goals sometimes align, oftentimes they can be in conflict. One example of this is Electronic Medical Records (EMR) systems. EMRs were designed with good intentions, to theoretically eliminate menial tasks and improve efficiency to increase quality of healthcare by improving the length of facetime spent with each patient. In speaking with my predecessors and mentors, and considering my own experiences, this has not proven to be true compared to the use of paper records. While the reasons for this are controversial, the bottom line is that the dramatically increasing patient-per-provider ratio has been a common theme leading to less time spent with each patient.
While I am criticizing the state of modern medicine, like we do with family and close friends, I am doing so out of love and with only the best of intentions. As medical students, residents, and attendings we have all shared the burden and struggle of being rushed. Despite this, I am extremely fortunate that my colleagues, attendings, and mentors are excellent role models that I would trust, without reservation, in caring for me or my family. However, globally, our healthcare system is due for an evolution from volume-centrism to quality.
As a fourth-year surgery resident, I am proud of where I am, something that I owe my parents, friends, and teachers who have been, and still are, there for me along my journey. I cannot help but notice that these individuals are all getting older and I owe it to them to not only be the best that I can be, but also to contribute to the betterment of our healthcare system so that they are afforded the quality care they deserve, instead of being just a number in a massive quantity.