Sisters by choice: A community Woman surgeon leading charity since 1989

A native Georgian, Dr. Rogsbert F. Phillips-Reed is a general surgeon specialized in breast surgery. I had the pleasure to meet her last week and was inspired to write about her great work.When I first mentioned Association of Woman Surgeons (AWS), she smiled mischievously and recalled as being one of the first few AWS resident members.

She graduated from Columbia University School of Physicians and Surgeons in 1977 and in 1982 became the second woman and first African-American woman to successfully complete Emory University's surgical Program. When she started her general surgery practice, majority of her referral was Breast related. She welcomed all patients alike and gave best care possible. Over a period of time she was successful in building a  very broad based general surgery practice. Her caseload ranged from Hernias to Whipple. All that only inspired her to learn more, do better and keep up with new innovations in surgery. While midway in her practice, she trained herself to do complex laparoscopic as well as oncoplastic procedures. Forapproximately 30 years she has practiced medicine in metropolitan Atlanta area, serving a diverse patient population. Today she heads Metro Surgical Associates, a community-based surgical practice with offices in downtown Atlanta and Lithonia.

Georgia ranks 10th in population among the fifty states, but 40th  in physician supply per 100,000 population. In fact, latest figures tell us that 15% of Georgia's population is medically underserved for primary care. Access to more specialized services is even worse. Since majority of  Dr Rogsbert-Phillips's practice was breast related she soon realized the need for programs that would not only increase public awareness of breast cancer but also bridge the gap in care. So, in 1989 she founded Sisters By Choice (SBC). Initially formed as a support group for women diagnosed with breast cancer and their families, SBC has evolved into a multi-faceted organization serving women in Georgia.SBC provides over 800 free mammograms and breast exams to uninsured, unemployed and homeless women each year as well as free educational seminars, workshops, and health fairs to promote breast cancer awareness.

Realizing that there are health care disparities surrounding access to quality breast care in rural Georgia; Dr. Phillips-Reed has started an initiative to address this disparity by developing a Mobile Breast Clinic. This unique mobile breast clinic will facilitate remote screening and diagnostic services. It will provide screenings, diagnostic services, treatment referrals, education and access to clinical trials to medically underserved men and women in rural and urban Georgia. This complete diagnostic care will make this clinic historic. It will be the first of its kind in Georgia, and among the first in the nation.

I was pleasantly surprised to see how much her patients admire her for her care and compassion. One can also see that most of her family and friends either work or volunteer at her practice. Of all the people, her husband Mr Reed and son Kasim Reed Mayor of Atlanta, are one of the biggest supporters of her mission. With pure good intentions, she has not only earned loyalty of her patients but devotion of her family for a cause that is dear to her. She has proved that all it takes is one dedicated woman community surgeon to change the way care is provided to vast section of the community underserved or uninsured.

------------

Bharti Jasra is a Breast Surgical Oncology Fellow at UTSW 2014-2015. She completed General Surgery residency at Saint Louis University Hospital in June 2014.

A bit of kindness

by Amalia Cochran, MD

The following is an excerpt from an email I recently received from a mentee:

“I love, love, love surgery, but even as someone who has thrived in this environment, I now acknowledge that there are some aspects of the culture of surgery/academics/surgical and medical education that I am deeply unsettled by and wish very much to change. I see fellow students, residents, fellows, young faculty transform from being full of zeal and goodwill into angry, bitter, jaded people, and it’s absolutely disheartening to see. What’s more infuriating (to me because of the wrongness of it all and because I’m such a fixer) is that those who have been negatively affected and are the very ones capable of enacting positive change because they’ve “been there” sadly become the very ones who perpetuate the indignities of the broken culture, and they don’t even recognize that they’re doing so.”

Her important question that she asked me, and one that I found incredibly wise, was, “Did you ever struggle with this during your training or see this among your colleagues? Or even now?”

I asked her if I could answer this on the blog, and she graciously said yes. It was important for me to do so because I feel obliged to make some confessions related to her concerns.

The biggest one? I had many days during my residency when I was so tired, so broken, so frustrated that I wasn’t a nice person. While I was able to focus on doing the right thing for my patients, I could be and often was impatient with students who needed nurturing and staff who were still learning too. I was so Hell-bent on my own survival, on not making mistakes, on not showing any shred of evidence that I might not be able to succeed as a surgeon that I had no qualms about running over people. I nearly quit surgical residency during my PGY2 year because I didn’t like what I was my self becoming (then was nurtured by some VERY kind mentors who managed to help me hang in there).

I attribute a significant portion of my behaviors when they weren’t outstanding to sleep deprivation and not having a functional set of skills for coping with my chronic exhaustion. I also attribute some of my less-than-ideal behaviors to the surgical culture in which we were supposed to prove that we’re tough and don’t have flaws. Reality check: I may be resilient- I far prefer that word to “tough”- but I do have flaws. Sometime around my 40th birthday, I became okay with that.

• I want to believe I was asked about this topic because I’m seen as someone who is generally patient and supportive. A few key lessons have helped me get back to this place, one in which I think I existed prior to my 7 years of complete exhaustion and chronic stress.
• We’re all struggling. Every one of us is, in one way or another. That’s not a source of shame, it’s a source of humanity.
• If those moments in which your lesser self shows up are rare, people believe you when you apologize for your behavior.
• We are all learning, ever hour of every day. That’s what we’re here to do in a teaching environment.
• As someone in a position of leadership, my team and those around my team rely on me to set a tone. I don’t want that tone to be one of nastiness, blaming, and negativity because I want/ need a high-achieving team. Therefore, it’s up to me to be supportive, to be patient, to take a deep breath before reacting, even when my gut wants to say, “WHAT were you thinking?!?”
• When people are intimidated, their ability to think critically is impaired. Working in an ICU, I need everyone around me to be a critical thinker. Kindness does much more towards that end than bullying.
• If all else fails, go for a walk with the dog. Dogs are masters of this moment being the very best moment ever and that influence is contagious- particularly on a snowy day if one has a Siberian Husky in their life (as I do).

If nothing else I wrote tonight resonates with you, it’s my hope that a picture of an incredibly happy husky will help you pause and be a bit kinder.

This post originally appeared March 24, 2014 on Dr. Cochran's website Life in the Wild West

~~~

Dr. Amalia Cochran is Associate Professor of Surgery at the University of Utah.  She is heavily involved in undergraduate medical education, serving as the Surgery Clerkship Director and the Director for the Applied Anatomy track for 4th year medical students at the University of Utah.  Her research interests lie in surgical education and in clinical outcomes in burns.  She is completing her term as Vice President for the Association of Women Surgeons. 

A Recipe for Success: One Surgeon's Story

 by Minerva Romero Arenas, MD, MPH

 

There are two questions that students frequently ask me about becoming a doctor. One is, “What did you do to become a doctor?” and “How did you stay motivated?” I often tell students attending the Tour 4 Diversity in Medicine (T4D) that becoming a doctor is like running a marathon. The pathway to medicine is long and challenging; I jumped through a lot of “hoops” (prerequisite courses, examinations, extracurricular activities, letters of recommendation, interviewing, etc.) just to get to medical school. At this point, I swear if their eyes get any wider they will come out of their socket. Then I tell them about the time I have spent in residency, research, and fellowships – and overwhelming is probably a gross understatement.

There are many factors that contribute to a person’s success – especially the success of a doctor. In my own personal path, I credit my success to at least four essential factors.

My family has been one of the main sources of strength and motivation. Like many immigrant families, we moved to the United States to pursue the American Dream. I was 8 years old when we moved, but since that young age I knew that my family (yes, I mean my parents, tías and tíos and abuelita) wanted better opportunities for our family. While my family never pushed me to be anything in particular, they always supported and encouraged me to pursue higher education – an opportunity they did not have. When a situation challenges me, I think back to how fortunate I am to have a loving and supportive family and any doubt is erased from my mind.

I also credit my mentors – yes, more than one – with a large part of helping me succeed. Some of them were professors who helped me stay on track and grow academically. Others were instrumental in helping me develop leadership and life skills. Yet others were research mentors or clinical mentors who helped figure out my interest in these fields. Even now as I am in my surgical training, I continue to keep in touch with some of these mentors and have even gained new mentors who are helping me grow and develop as a surgeon-in-training and future leader in healthcare.

I also found motivation in programs that helped me remember why I wanted to be a doctor. In college it was when I worked in certain clinics or doctors. In medical school, student-run clinics, organizations that connected me with other students and doctors who shared similar backgrounds or interests such as ending health disparities. In fact, even now that I have become a doctor and am completing my surgical training I still find it refreshing to remember why I chose this career in the first place. This is part of the reason I joined Tour 4 Diversity in Medicine. Talking to students about my love of surgery, or helping patients, or my research – it always help make me feel more
motivated.

Lastly, I tell students the most important factor in achieving success is the one that nobody else can help you with: hard work. There have been many people who have provided guidance, support, and opportunities that helped me achieve my dream of becoming a doctor. However, I know that my own effort helped me earn the respect and time of my mentors and make the most of the opportunities that were provided. Most importantly it has given me a source of pride and confidence that will continue to make me a successful person and surgeon.

This article was originally posted on February 5, 2014 on the Tour 4 Diversity website under the title "#T4DWest Day 2: A Recipe for Success – One Surgeon’s Story"

~~~

 

Dr. Minerva Romero Arenas is a general surgery resident at Sinai Hospital of Baltimore and is completing a research fellowship at The University of Texas MD Anderson Cancer Center in Houston, TX. She obtained her MD and MPH from The University of Arizona, and studied Cellular Biology & French at Arizona State University. She is also involved in mentoring and public policy. On her personal time she enjoys spending time with friends and family, especially when it involves good food.

Changing the paradigm

by Robert Swendiman

Whether I am at Grand Rounds, a department meeting, or the American College of Surgeons Clinical Congress, it is often like looking into a mirror. I cannot help noticing the abundance of white men – especially at “the top.” While I meet numerous female and minority surgical residents and junior faculty, most of the chairs, program directors, and full professors are men.

Outside of the medical profession, surgery has an “old boys club” reputation. But I come from a school of leadership where difference and diversity are more than just opportunities for social progress – they are requirements. So I was disappointed when I perceived the stereotype affirmed. The more I look around, the more men I see.

Constant inquiry (or “quality assessment and quality improvement” in medical terminology) is an important component of leadership. Without it, we fail to analyze, understand, and improve the systems in which we are a part. Thus, I began my investigation, and what I found was shocking. Despite the increasing number of women entering general surgery residency programs – from 10% in 1980 to 36% in 2011 – as of last year, women only represent 9% of all full professors, 17% of associate professors, and 25% of assistant professors in surgery. 1, 2 While these numbers are obviously disproportionate, what is perhaps more concerning is that they also remain stagnate. In the last 15 years, these percentages have not changed. 3

Despite the fact that men and women enter academic medicine at equal rates, the rate promotion is uneven. 4-6 Though men and women start at similar ages, the mean age of attaining “Professor” status in approximately five years younger for men. 4 “Even after adjusting for number of publications, amount of grant support, tenure versus other career track, number of hours worked, and specialty, women [remain] substantially less likely than men to be promoted.” 4

Thus, female surgeons remain impressively underrepresented in the ranks of surgical faculty at 21% of the workforce (the average across all medical departments is 37%). 2 Of all academic departments in the basic and clinical sciences, surgery ranks second to last in percentage of total female faculty members (orthopedics, 15%). 2 However, in other specialties, women hold more than half of all faculty positions (obstetrics and gynecology, pediatrics, and public health and preventive medicine). 2

The famous surgeon, Dr. William Halsted, once quipped that the issue with surgeons taking call every other night was that residents would miss half of the cases. In the same manner, when we exclude 51% of the population from top leadership positions, we are missing out on half of the talent. If fewer than 10% of professors of surgery are women – and that figure has not changed in more than a decade – I wonder, “Is our academic community really moving surgery forward?”

Fellow colleague, Sophia McKinley, wrote about her own early lessons in leadership. She states, “Individuals at every position in a hierarchy can exhibit leadership.” I agree, and I see this lack of diversity as an urgent opportunity for real-time leadership at every level. As a white male, I think it is my job to participate in changing this paradigm – chipping away at the explicit and implicit barriers that male surgeons still espouse in surgery, advocating for and leveraging diversity, and staying curious about surgery’s present and future challenges. As an inspiring academic surgeon, this also meant research, which is why I joined a multi-institutional team from UNC, Harvard, and Stanford to better understand how we can change the status quo. I know it’s not enough, and change will not happen overnight, but doing nothing is not a viable option.

I was often asked on the interview trail, “Can an intern or a medical student really be a leader?”

This is the answer I give them.

~~~

References

1. Cochran A, Freischlag JA, Numann P. Women, surgery, and leadership: where we have been, where we are, where we are going. JAMA Surg 2013;148(4):312-3.

2. Association of American Medical Colleges. “Women in Academic Medicine and Science: Statistics and Benchmarking Report 2011-2012.” Table 3: Distribution of full-time faculty by department, rank, and gender, 2012. < https://members.aamc.org/eweb/upload/Women%20in%20U%20S%20%20Academic%20Medicine%20Statistics%20and%20Benchmarking%20Report%202011-20123.pdf>. Accessed November 6, 2013.

3. Sexton KW, Hocking KM, Wise E, et al. Women in academic surgery: the pipeline is busted. J Surg Educ 2012;69(1):84-90.

4. Zhuge Y, Kaufman J, Simeone DM et al. Is there still a glass ceiling for women in academic surgery? Ann Surg 2011;253:637–643.

5. Schroen AT, Brownstein MR, Sheldon GF. Women in academic general surgery. Acad Med 2004;79:310

6. Buckley LM, Sanders K, Shih M, et al. Obstacles to promotion? Values of women faculty about career success and recognition. Acad Med 2000;75:283-8.

~~~

Robert Swendiman is a dual-degree M.D./M.P.P student at UNC School of Medicine and the Harvard Kennedy School of Government. He spent his time at Harvard as a Dubin Fellow for Emerging Leaders at the Center for Public Leadership, researching how leadership principles can be applied to medical education. Robert is participating in the 2014 Match cycle, and is interested in pediatric surgery.

Respect

by Erin W. Gilbert, MD 

“Your job gives you authority. Your behavior gives you respect.”
—Irwin Federman, general partner at U.S. Venture Partners

Throughout my surgical training I blindly accepted that having grey hair (and experience) equaled garnering respect as a surgeon. Now that I am junior faculty at an academic institution (and beginning to grey myself), I’m wondering if there is more to the story. There is a noticeable difference in how residents treat me as compared to how they treat the Department Chair- which is of course OK by me, but I have begun wondering how can I ensure that I will achieve and more importantly maintain the same level of respect?

As a medical student at LSU in New Orleans, we followed a very hierarchical system where the intern was the boss of the students, the junior was the boss of the intern and so on. It seemed to me in this system that the doctor’s role dictated the level of respect they earned from the team, but just because you follow someone’s orders does not mean you respect them. Other misconceptions I have had include believing respect comes from being a good dresser, having large muscles or simply being intimidating in some way. Now that I have matured a bit I am learning that people may admire good looks, muscles, or a power suit, but this does not translate into respect.

Federman’s quote alludes to the real heart of the story. Think about people in your life you respect; who you would follow into battle without question, who you try to emulate… they are kind, generous, caring, and fair. They treat all of those around them with respect - from the hospital CEO to housekeeping staff - without question and without needing a reason to show respect. They value others’ efforts and acknowledge them; they listen, and they are always sincere. I may just be figuring this out for myself now, but thanks to my upbringing, I know that treating all people with respect is the expectation not the exception- I just didn’t realize how much it could influence how others treat me.

Readers, think back to the role models in your life. What behaviors of theirs did you respect? Share with us in the comments below. 
 

~~~

Erin Gilbert is an Assistant Professor at Oregon Health & Sciences University in Portland where she is a member of the Knight Cancer Institute. She received her medical degree from LSU in New Orleans and completed her general surgery residency at the University of Washington in Seattle. She was fellowship trained in Minimally Invasive Surgery at OHSU and specializes in the surgical management of pancreatic disease.

Sexism & Surgery

by Amalia Cochran, MD, MA, FACS, FCCM

How many of you saw this great piece from Emily Graslie a couple of weeks ago? 

 

I loved this video for a couple of reasons. One is obvious if you are familiar with her work- Emily’s video series from The Brain Scoop is a terrific, user-friendly approach to science. The other was that I honestly empathized with the comments that Emily included in her video, as I suspect many of us do, and I loved her approach to dealing with sexism and science. She’s no-nonsense about it and addresses the issue head on.

I thought back to my first encounter with sexism in medicine, going back to high school. Our family’s physician, upon being told that I was leaving for college at the end of my junior year under an early admission program with intent of going to medical school, simply commented, “Well, I guess it’s okay for women to be physicians these days.” No, he wasn’t joking. No, he never treated me again (nor my mother). I’ll admit- this was almost 30 years ago, and with the entry of more women into medical school many things have changed. Or have they?

Plenty of research shows that female medical students often experience gender discrimination, and that this occurs most commonly on their surgical clerkships. Women medical students are more likely to experience gender discrimination during their surgical clerkship than are their male counterparts and are more likely to perceive sex discrimination, typically from male attendings and male residents. My own recent work has shown that female surgeons and residents are more concerned about the presence of sex discrimination in the workplace than are their male colleagues, and that they perceive this discrimination as a barrier to advancement in academic surgery. Clearly this problem isn’t just one of the 1980s; it persists in modern-day medicine.

Stories of incidents can be gathered easily enough from many sources; in one night on Twitter I was able to acquire stories ranging from colleagues or patients refusing to address a woman physician as “Doctor” to women being told they are “too nice” to be a surgeon, or being told that they are allowed to do more in the OR because of their looks. While the overt sexism remains, many institutions are starting to consider the role of “implicit bias,” those subtle behaviors and actions that manage to undermine the leadership and credibility of any minority group. Yes, women surgeons are still a minority group.

So back to where we started, with Emily Graslie’s video. We have a problem still, and what we need is a solution. We can start by speaking up when we hear sexist comments- particularly those of us who are a little more senior and have less to lose than our younger colleagues. We can also work within our institutions to increase awareness of implicit bias in hopes that this will have a durable impact. And, as Emily Graslie stated, “We need to make sure we’re making it possible for people of all genders to feel acknowledged for their contributions and not feel held back by something as arbitrary as their genetics or appearance.”

How have you experienced sexism? And, perhaps more importantly, how have you dealt with it when you have either experienced it or witnessed it?

This post was originally published on Dr. Cochran's blog, Life in the Wild West.

 

~~~

Dr. Amalia Cochran is Associate Professor of Surgery at the University of Utah. She is heavily involved in undergraduate medical education, serving as the Surgery Clerkship Director and the Director for the Applied Anatomy track for 4th year medical students at the University of Utah. Her research interests lie in surgical education and in clinical outcomes in burns. She is Vice President of the Association of Women Surgeons. Follow her on Twitter. Visit her blog. 

There’s Something In the Water

by AWS writer, Denise Harrigan

Often-invisible but highly influential, second-generation gender bias often impedes women’s ascent to top levels of leadership. The Harvard Business Review intends to expose it.

Fifty years after women were first admitted into Harvard’s MBA program, the September 2013 issue of The Harvard Business Review (HBR) examines the status of women in the business world. The cover alone – with a silhouetted female profile and the words “Emotional – Bossy - Too Nice ” -- reveals that women are floundering, not flourishing.

The bottom line is that only four percent of Fortune 500 companies have female CEOs, and 50 of those companies have no female board members. According to Adi Ignatius, editor-in-chief of HBR, women remain “distressingly underrepresented at the top levels of institutions.”

The HBR focus is not on the numbers -- those numbers, in recent years, have been documented to death. The goal, according to Ignatius, is “finding practical new solutions to a seemingly intractable situation. Closing the leadership gap is a formidable challenge. But there’s no excuse for accepting the status quo.”

The issue, part of the Harvard Business School’s global effort to accelerate the advancement of women leaders, features major articles on persistent gender bias and inclusiveness as a mission and moral imperative.

Unfortunate Legacy

The article “Women Rising: The Unseen Barriers,” by Herminia Ibarra, Robin Ely and Deborah Kolb, examines undercurrents that impede women’s progress and identifies second-generation gender bias as a major but rarely acknowledged impediment.

Where first-generation gender bias involved the deliberate exclusion of women, the second generation “erects powerful but often subtle and invisible barriers for women that… inadvertently benefit men while putting women at a disadvantage.”

Insidious

As a result of second-generation gender bias, unspoken cultural perceptions about women often carry more weight than job performance. Perhaps the most insidious belief is that men are natural leaders, and women are followers.

“In most cultures, masculinity and leadership are closely linked,” the authors report. “The ideal leader, like the ideal man, is decisive, assertive and independent. In contrast, women are expected to be nice, caretaking and unselfish.”

Linking leadership with common male behaviors suggests that women are not cut out to be leaders. It can also create a double standard. Assertive men, for example, are admired – and promoted. Assertive women are advised to “soften their sharp elbows.”

As a result, many women waste professional energy trying to project the perfect image -- not too pushy, not too nice. According to the authors, some employ voice coaches, image consultants, and branding experts “to manage the competence-likability trade-off— the seeming choice between being respected and being liked.”

“But the time and energy spent on managing these perceptions can ultimately be self-defeating. Overinvestment in one’s image diminishes the emotional and motivational resources available for larger purposes. People who focus on how others perceive them are less clear about their goals, less open to learning from failure, and less capable of self-regulation.”

Leaders Are Made, Not Born

Leadership is not an innate gift – it’s a skill that requires practice. More often than not, men are given opportunities to practice this skill. The workplace, still predominantly led by men, instinctively grooms men for leadership positions, creating stepping stones where men can practice leadership skills.

According to the authors, “Women have fewer opportunities to develop leadership skills and seem less inclined to create these opportunities for themselves.” By nature or nurture, women often gravitate to behind-the-scenes positions, and their efforts fade into the blur of teamwork.

Internalizing Leadership

“People become leaders by internalizing a leadership identity and developing a sense of purpose,” the authors observe. “Internalizing a sense of oneself as a leader is an iterative process. A person asserts leadership by taking purposeful action—such as convening a meeting to revive a dormant project. Others affirm or resist the action, thus encouraging or discouraging subsequent assertions. These interactions inform the person’s sense of self as a leader.”

In the wake of positive affirmation, “a person’s leadership capabilities grow. Opportunities to demonstrate them expand. High-profile, challenging assignments …. become more likely. Such affirmation gives the person the fortitude to step out-side a comfort zone and experiment with unfamiliar behaviors and new ways of exercising leadership.”

Well-Meaning but Off Center

The authors of “Women Rising” acknowledge that many companies attempt to level the playing field for women. “Many CEOs make gender diversity a priority, set aspirational goals for the proportion of women in leadership roles”…. and invest in building “a more robust pipeline of upwardly mobile women.

“But then, not much happens,” according to the authors. “The solutions to the pipeline problem are very different from what companies currently employ. Mentoring and leadership education programs are necessary but not sufficient.”

Deeply Conflicted Culture

“These approaches don’t address the often fragile process of coming to see oneself, and to be seen by others, as a leader. Integrating leadership into one’s core identity is particularly challenging for women, who must establish credibility in a culture that is deeply conflicted about whether, when, and how they should exercise authority.”

Call It by Name

Since second-generation gender bias “can be subtle, subconscious, assumed but not articulated by both men and women,” the authors recommend that employers begin to address it by simply naming it.

“Second-generation bias does not require an intent to exclude; nor does it necessarily produce direct, immediate harm to any individual. Rather, it creates a context—akin to ‘something in the water’—in which women fail to thrive or reach their full potential.

“Without an understanding of second-generation bias, people are left with stereotypes to explain why women as a group have failed to achieve parity with men: If they can’t reach the top, it’s their own fault for failing to be sufficiently aggressive or committed to the job.”

Alternative Reality

By identifying and addressing second-generation bias, however, companies can finally move toward gender equity – and an executive suite that “doesn’t look or behave like the current generation of senior executives.”

“When women recognize the subtle and pervasive effects of second-generation bias, they feel empowered, not victimized, because they can take action to counter those effects,” the authors promise. “They can put themselves forward for leadership roles when they are qualified but have been overlooked. They can seek out sponsors and others to support and develop them in those roles. They can negotiate for work arrangements that fit both their lives and their organizations’ performance requirements.

“Such understanding,” the authors conclude, “makes it easier for women to ‘lean in.’”

Surgeon Preference and Music in the Operating Room: a Randomized, Controlled Trial

by Marie Crandall, MD, MPH, FACS

Background: Music in the operating room has been studied fairly extensively, mostly in the context of ambient music used to decrease anesthetic requirements during surgery. However, very little has been written about musical preferences of the operating surgeon, which is arguably very important, as “ambient” music often translates into that irritating New Age music which meanders aimlessly, relying heavily on woodwinds and bird tweets, and defies all rhythm or syncopation. Still, apparently it’s very helpful to patients who are not actively driven to poke their eyes out with stray syringes of propofol having to listen to that nonsense.

Methods: The authors (A.K.A. me) decided to conduct a randomized, controlled trial of surgeon-directed music in the operating room (OR). Except that randomization is sort of painful, in that there has to be blinding, measurement of covariates, and I really only had a week. So, instead, I performed a population-based survey, by sending out an email and posting a Facebook notice querying surgeons about their OR musical preferences. I guess one could quibble about the “population-based” aspects, as I mostly just emailed the cool women surgeons whose email addresses were in my Outlook contacts, and well, I suppose my Facebook friends are not exactly a random sample of American surgeons. Oh, yeah, and I only asked women. Just because. But I digress. Four questions were asked, “1. Do you listen to music in the OR?, 2. Is it your music?, 3. Do you let residents pick the music?, and 4. What do you listen to?” (yes, I know I ended the question with a preposition, but remember this is a population-based survey, and EVERYONE does it, ok I’ll change it. See Table 1 below).

Results: Seventeen attending women surgeons responded to the survey (100% response). Nearly all respondents listen to music in the OR. Most bring their own music, but some attendings allow the residents, nurses, and anesthesiologists to choose music. A theme emerged that many surgeons will turn off the music when a patient is unstable. Those who always listen to their own music were fairly vehement about it. Otherwise, musical preferences are all over the map and completely contradictory to each other, defying any kind of theme analysis. And some people listen to really terrible music, as you can see for yourself in Table 1 below.

Table 1: Survey of badass* attending surgeon musical preferences

Question	N (%)	Comments
1.     Music in OR? Yes No	16 (94%) 1  (6%)	“If it’s an unstable patient, I turn the music off,”  “Occasionally it’s distracting when I have to make sure anesthesia is not slipping some pressors in the IV,”  “Will turn tunes on when out of the danger zone,”  “No music allowed. Focused concentration mandatory”
2.     Your music? Yes No	10 (59%) 7  (41%)	“Really?  That’s the absolute best thing about being an attending, choosing the OR music.  That and wearing pajamas every day to work.”
3.     Let residents pick music? Yes No	12  (71%) 5  (29%)	“NEVER,” “Yes, unless it sucks”
4.     Musical choices? Neurosurgery resident playlist; Pandora, dance music  (all decades); “Mostly alt country/Americana with a little Southern rock thrown in; Drive-By Truckers for nec fasc”, “Washed Out, Wye Oak, Beach House, Sharon Van Etten, Wild Nothing, Iron & Wine, Silent Years, Alela Diane, Army Navy”; ‘80s, upbeat dance music, “My Sharona”; “Top 40 radio, classic rock, top 40, jazz, classical”; “Electronica is my office default, but it’s not appropriate in the OR”; contemporary pop; “OR specific playlists with Pink, Indigo Girls, Patrice Pike, Bonnie Raitt, Tim McGraw, Lady Antebellum, Shawn Colvin, The Rescues, just to name a few”;  Indian and American club music; “I use Pandora; liver transplants get 80s pop or Vanilla Ice mix, liver resections get Abba or Pink”, “my iPod (all decades)”; “A mix on Pandora, what it is depends a bit on the case and time of day,  one of our night scrub techs is a huge Disney fan so we tend to play Disney Pandora and have a name that tune session” ; “My music is the best.  I have everything from Metallica to Otis Taylor to Agent Orange to Santana.  If you hate the current song, wait til the next one.” Pertinent negatives:  no country (x2), no musicals, no rap, no metal, no Britney Spears, no Taylor Swift, no Justin Bieber, no smooth jazz

*badass (adj). Used to describe all study participants; indicates clarity of mind, a humorous disposition, and excellence in the field of surgery

Conclusions: My first conclusion is that most of us are united in turning off the music to enhance concentration, consistent with previously published research. Second, in this non-randomized, uncontrolled, not remotely population-based survey of experts in the field of surgery, there is a wide variety of music played in the OR. And, finally, the near-unanimous agreement that the best music to be heard in any OR anywhere is that of Marie Crandall, MD, MPH, FACS.

What music do you like to play in the OR? Let us know in the comments below.

~~~

Marie Crandall, MD, MPH, FACS is an Associate Professor of Surgery and Preventive Medicine in the Division of Trauma and Critical Care at Northwestern University Feinberg School of Medicine. She is originally from Detroit, MI, a product of Head Start and local public schools. Dr. Crandall obtained a Bachelor’s Degree in Neurobiology from U.C. Berkeley in 1991, and completed her M.D. in 1996 at the Charles R. Drew/U.C.L.A program in Los Angeles. She finished her General Surgery residency at Rush University & Cook County Hospital in 2001, and in 2003, completed a Trauma & Surgical Critical Care Fellowship at Harborview Medical Center in Seattle, WA. During her fellowship, she obtained a Masters in Public Health from the University of Washington. Dr. Crandall performs emergency general and trauma surgery, staffs the SICU, and is an active health services researcher. Dr. Crandall loves travel, triathlons, hiking, and is a passionate animal rights activist; you can follow her on Twitter @vegansurgeon.