The fit pediatric surgeon. A personal experience.

Regular exercise in all its forms has plenty of proven benefits. The web is awash with influencers brandishing their chiseled bodies and advocating for the best diet and exercise routine combination. The benefit of exercise for a surgical career is also an increasingly trendy topic. There are few excellent articles on the internet that discuss the benefit of exercise to a surgical career, such as this, and this. In medical literature, exercise is known to be a commonly used strategy to combat burnout amongst physicians, which negatively affects career satisfaction, retention rates and performance. There are few opinion-based articles that discuss exercise benefit to career longevity. There is not much research-based evidence about this though. In this short article, I will try to present my own personal experience with exercise and the impact it had on me as a surgeon.

First, I’d like to put things in perspective, I’m a 50-year-old pediatric surgeon and urologist, practicing mostly privately in an affluent country. Growing up, I was not particularly sporty and was never picked up for any teams in my school or district, except maybe chess. I was more of a nerd. I liked video gaming (still do) and did exercises only for recreation and socializing, such as kicking a ball in the streets of the neighborhood. In my 20s and 30s, I was in the middle of building my career, which eventually required me to work and live in 5 different countries and therefore, hardly exercised. I did not really start regularly exercising until my 40s, typical of a mid-life crisis, then in my mid 40s I started to take things a bit more seriously with dedicated daily time and an exercise routine.

This has really changed me for the better. I look and feel better. I don’t suffer from any chronic illness and have tons more energy. All this on a personal level and -of course- to be expected. I will detail below how I feel it made me better as a surgeon.

1.       I enjoy a better life-work balance, something I chronically ignored before under the demand of a busy career and being used to focus on the academic and clinical sides in my life. I now care more for having “me time”. We -surgeons- instinctively prioritize our careers. This is often something already built in us and then encouraged and normalized through surgical training and practice. Even on a subconscious level, it is difficult to justify to yourself having “fun-time”, unless you are truly convinced it will further your career. I’m sure many surgeons will identify with this statement. Taking time off -without feeling guilt- is just easier when you dedicate this time to exercise because you will feel the tangible benefit on your work.

2.       I started to wake up very early so I could finish my exercise routine and found innovative ways by which I utilized exercise time for other purposes (such as listening to medical podcasts or reciting Quran). All this had the positive side effect of better sleep quality and circadian rhythm. I could not overstate how important this is, especially at my age. I feel fresher in the morning and come to my “surgical battles” already fired up and with a victorious mindset. It certainly makes the day easier.

3.       I feel more confident in my appearance. I’m not the shy type of a person but it certainly helps to be a “picture of health” if you are a healthcare professional, especially in private practice where you have to convince families to choose you as the surgeon operating on their children. Few parents mentioned this to me outright. There is an “influencer” side to private surgical practice and appearances do matter. Being fit is part of the package of being successful, and success brings success.

4.       The difficult and hard to define point of technical surgical ability and performance. Does being fitter make you a better surgeon? Should patients trust a surgeon with 6 packs more? From firsthand experience, the answer is definitely yes. I’m now so convinced that I think physical fitness should become part of any surgical curriculum. I only wish I knew this earlier.

Let’s take hands tremor as an example of the improvement exercise can bring to the technical ability of the surgeon. Very few surgeons are blessed with robots like steady hands. We all tremor and to a variable degree. Stress, caffeine and fatigue make this worse. While by no means I’m suggesting that this has an immediate impact on surgical performance and results, it certainly makes the surgeon look less elegant and confident. While it may not detract from your surgical ability, having tremors will affect your showmanship. There is a reason why operatives theatres are called theatres! I always had a bit of a “steady hand”, but it has certainly improved as I became fitter. I’m now so confident in my surgical “show”, I started routinely video recording surgeries and sharing the raw recording with patients. This has become part of my brand as a private practitioner and is greatly appreciated by families.

I did some medical literature research about hand tremors. Surprisingly very little has been done to address this common problem. Two main interventions have been described: beta-blockers (propranolol) and the introduction of the robot. Exercise is not mentioned at all. This is a gap in surgical knowledge and a good research opportunity. Two main surgical specialties seem to be interested in reducing surgeon’s hand tremors: ophthalmology and neurosurgery. Ophthalmology due to the microscopic nature of some procedures, especially on the retina, and neurosurgery due to the use of long instruments in brain endoscopy.

This led me to realise that pediatric surgery/urology is a very technically demanding specialty! We combine both the need to handle fine instruments laparoscopically and magnified open surgery at the same time and therefore have the most challenging parts of both ophthalmology and neurosurgery! I routinely do laparoscopic hernia repair with 3 mm instruments and hypospadias correction on the same list. These are two very different procedures. Laparoscopy relies heavily on shoulder muscles and large arm muscles, not in themselves designed for fine movements, and requires small arm and hand muscles to be relatively in constant spasm while holding the instruments. Many times, surgeons will have significant tremors when switching from laparoscopic to open surgery, due to the exhaustion of small arm and hand muscles. Imagine yourself batting with a tennis racket for a couple of hours then sitting down to repair a watch. The transition is truly taxing. As I became fitter, I found it easier and easier.

5.       Being fit means you have more stamina and endurance. When you have more stamina, you are less likely to make fatigue related mistakes. We take mental shortcuts when we are tired, and let’s face it, many times we are utterly exhausted, and this will only get worse as we age. Also being tired will make you more irritable and jittery, will impact on your communication and relationships with colleagues. Being fitter will not only help your technical skills, but it will also help your NOTSS (non-technical skills for surgeons).

6.       Being fit will reduce your chances of work-related musculoskeletal injury, which is an increasingly significant concern for surgeons, especially with an aging workforce. This, in addition to all the other points mentioned earlier, improves career longevity. Why let your body fail you at an age you are at your peak mentally? Since I picked up exercise, I feel I could go on operating a lot longer than I did before.

Finally, it must be stressed that a well planned, surgically oriented exercise routine will not target only strength and bulk but will focus on flexibility, control and stamina of the whole body as well.