Seven spine surgeons talk about the best professional advice they have received during the course of their careers.
Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses. Next week's question: Is your practice ready for ICD-10, or will you be ready by the switch date of Oct. 1, 2014?
Please send responses to Anuja Vaidya at avaidya@beckershealthcare.com by Wednesday, April 30, at 5 p.m. CST.
Question: What is the best professional advice you have ever received and how do you apply it to your practice?
Neel Anand, MD, Clinical Professor of Surgery, Director, Spine Trauma, Cedars-Sinai Spine Center, Los Angeles: Be honest with your patients, and treat them like you would treat your best friend. Listen to them and above all else, do what is right for the patient.
Sheeraz Qureshi, MD, Chief, Spinal Trauma, Icahn School of Medicine at Mount Sinai, New York City: The best professional advice I ever received was to have strict indications for when to operate and when not to operate, and to make sure patients fully understand the goals of their treatment plan. I apply these principles to my practice everyday and I think it allows me to have successful outcomes and makes the patient an active part of their care pathway.
Sanjay Khurana, MD, Orthopedic Spine Surgeon, DISC Sports & Spine Center, Marina del Rey, Calif.: The best advice I received was to use the best available clinical data and combine it with your personal training and judgment to make the most appropriate clinical choice for your patient. As technology in spine surgery has expanded in complex ways, this has been the simple equation I have used in treating my patients, and it has proven to be valuable and effective.
Ali Araghi, DO, Orthopedic Spine Surgeon, The CORE Institute, Phoenix: One that I use the most is the advice that I was given by my fellowship director, Dr. Richard Guyer — 'The Acid Test.' Having worked in my college days in the diamond district in Manhattan, I was very familiar with it as it pertained to the use of hydrochloric acid for checking the authenticity of gold.
The acid test was to be used in reference to decision-making regarding patient care. Whenever I am trying to decide whether surgery is the best option for a patient or which type of surgery would best benefit the patient, I imagine the patient is an age and gender that matches a close relative and that helps me reach the best conclusion.
Michael Roh, MD, Co-Founder, Rockford (Ill.) Spine Center: A celebrated academic spine surgeon told me that in the first two years of practice, it is important make a concerted effort to perform surgeries that have at least a 90 percent chance of success and good outcomes.
His rationale was that while your professional reputation is being formed, it is particularly vulnerable to bad outcomes as unhappy patients and referring physicians may develop a negative first impression. Though there may be pressure early on to develop a practice quickly and to prove oneself, a slow and steady approach may ultimately prove worthwhile.
Ara Deukmedjian, MD, CEO, Medical Director, Deuk Spine Institute, Melbourne, Fla.: 'Don't try to be everything to everyone' — one of the hardest lessons for me to learn was that doctors cannot fix everything for 
everyone. There will be a time in every doctor's career when we will have that very difficult situation of not being able to save a life.
As a neurosurgeon training in a trauma center it came early in my career. An 18-year-old college student contracted a fatal strain of meningitis. When she first arrived to the emergency room she was telling her doctors about how swollen and painful her legs had become over the last six hours. She had developed blood clots in both of her legs and required emergency amputations. By the time she reached the operating room her arms lost their blood flow as well, and we planned to remove all four of her limbs. Before the knife contacted her skin, she went into full cardiac arrest and she was coded. I have never felt so useless to anyone as I did that day to her. We did everything a state-of-the-art trauma center could do to help her but in the end we failed. Not every medical intervention has a good outcome.
Another facet of this lesson is that each doctor has special gifts. We need to develop a sense of self awareness of when we can help a patient improve or conversely when our skill set isn't the right match for another patient. Be selective about the conditions you treat and send your patients to the best doctor for the problem. There is no shame in referring a patient that has a medical problem you are not entirely comfortable treating. Always do what you know is best for the patient.
Brian R. Gantwerker, MD, Neurosurgeon, The Craniospinal Center of Los Angeles: A very good plastic surgeon once told me at a wedding, 'Put yourself where you want to be first. The patients will come to you if you are good.'
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