The High Tech Surgeon
What I learned as a Plastic Surgeon prepared me for the world of Technology.
In many ways the practice of surgery is more akin to learning an ancient artisanal craft than it is developing future technology. The methods and techniques of surgery have long been passed from master attending surgeon to apprentice resident with direct lineages to the greats. For example, as a plastic surgeon at Stanford Hospital and Clinics, I had the privilege of working under surgeons whose hands were guided by the father of craniofacial surgery, Dr. Paul Tessier. Similarly, techniques from Shumway, Halsted, DeBakey, and many others continue to be the foundation of surgical education.
Today, I mostly work with 1s and 0s in the world of machine learning, though the burgeoning innovation in use cases such as medical NLP, robotic surgery, and digital radiology… all feel as vibrant as a busy operating room. That’s because today’s world of data and technology requires as much creativity and humanity as that which I experienced as a surgeon. And what’s more, the lessons I learned in the operating are just as true now as they were then, including…
Two Types of Problems
Time is one of the most important factors in the operating room. As cost and patient risk increase with every passing second, a good surgeon learns to be economical with everything from their hand motions, to the their tool setup, to even their decision making. It’s within this last area, decision making, that I learned one of the most important principles that I continue to apply to my work today.
The procedure was a routine cyst removal from the wrist and a miscalculation from a talented surgeon resulted in damage to the radial artery which feeds the hand. This injury could have devastating consequences including even risk that the patient could lose their hand. The surgeon calmly prepped a vein graft from the back of the hand and together we removed the damaged portion of the artery and created a conduit using the vein.
After the operation, the attending surgeon turned to me and said, “Sina, there are only two types of problems, one’s you can solve and one’s you can’t solve”. He said that if you encounter a problem you can solve, start solving it, and if it’s one you can’t solve, then you can go home and process in any way you need to.
Today I use this lesson when approaching multimillion dollar projects. Obstacles are inevitable but I don’t spend too much expending emotional energy on them. Instead, I remember the calm surgeon with the serious complication and get to work finding solutions.
The Solution to Pollution is Dilution
Before I was Sina Bari MD, Director of Medical AI, I was Sina Bari MD, the intern, low man on the totem pole. As an intern, you worked very hard taking care of patients before and after surgery so that you could get to spend some time learning to operate in the OR. The OR was the most fun place in the hospital, a humming movement of people, working in concert to do miraculous things.
The OR for most interns, though, was limited to the most basic operations and for a plastic surgeon, that was often wound management. Plastic Surgeons are sometimes considered the surgeon’s surgeon because they can often help manage the complications of other surgeons. One example of this is complex wound management.
I remember one experience in the OR as an intern managing one such complex wound. The patient had a surgical site that had become infected and we were there to wash out the wound. After applying copious bottles of saline using a bulb syringe, the attending surgeon said “the solution to pollution is dilution”.
At the time, we thought the best way to treat a wound was to wash and keep washing. Today we know that this is limited at best and that debridement or removal of devitalized tissue is more important that washing. This same issue is often discussed in Artificial Intelligence circles when managing the volumes of unstructured data necessary to train models.
As times the solution to many complex problems in AI seems at first to be more data. In reality this comes with operational and financial challenges. Here I again here, the words of my attending and also remember that aphorisms aren’t always true.
Dr. Sina Bari MD, Plastic Surgeon and Director of Medical AI, works at iMerit helping companies create large scale datasets for medical artificial intelligence.
