Global surgeons: Prof. O. James Garden

Edinburgh, 8th of June 2019, Prof. O. James Garden retires as chairman of the BJS Society.

Prof. Derek Alderson (left), president of the Royal College of Surgeons, and Prof. James Garden (right)

Looking back, I recall that on the 9th of May 2012, being Prof. O James Garden the honorary secretary of the BJS Society, I was appointed to the editorial board of the BJS. And over the following seven years I have had a meteoric career to become secretary of the BJS Society in June 2018.

Consequently, you might think that what I am about to say is biased, but I must warn you that you would be severely mistaken, because he has been the epitome of a global surgeon long before I even dreamed of becoming part of the BJS community.

Prof. O. J. Garden is an outstanding surgeon, researcher, educator and manager, but as you can read in The University of Edinburgh webpage, retired from clinical practice in the summer of 2018. Even so, he has remained committed to surgical research dissemination and global surgical training for longer.

Over the last two years, given my role as secretary, I have had the privilege of witnessing his chairmanship of the BJS Society. An extraordinary thinker and strategist, with a strong commitment towards the advancement of our two journals, BJS and BJS Open, and the promotion of global surgical training, James Garden will be deeply missed by all of us in the BJS Executive and Council, but be sure he will always be available if we need him.

Thanks a lot Prof. O.J. Garden. Live long and prosper.

Global surgeons

A brief reunion at #DDW19 in San Diego led me to give some thought to posting regularly about some surgeons who are currently in practice, no matter where in the world, and who I admire for their global impact on one or more of the following areas:

  1. Professional leadership
  2. Surgical research
  3. Education and training
  4. Technology and innovation
  5. Knowledge dissemination

So here I am, almost ready to start. Stay tuned for upcoming posts.

With Jeff Matthews, Julio García-Aguilar and Rich Hodin

What I’ve learnt on my second day at #SSAT19

Today has been an intense and long day at #SSAT19: plenary sessions, Foundation awards, presidential address, editorial board meeting, etc.

However, these are the things that come to my mind when I try to recall what I’ve learnt:

The SSAT must be transformed to meet new challenges and generate new opportunities for academic surgeons.

Obesity and bacteria are clearly linked. In mice.

IBD is linked to microbiota.

Bacteria have refined their genetic code for longer than humans. They may outsmart us.

Chemotherapy toxicity may be influenced by intestinal bacteria.

Microbiome may play a role in pancreatic cancer.

John Alverdy is THE expert surgeon in microbiome.

We must solve complex problems because the easy ones are already fixed (Marc Nivet)

Residents and younger surgeons include their Twitter handles in their presentations.

In order to achieve transformation one must challenge his/her biases, get comfortable with being uncomfortable, interrupt the usual, and be curious.

What I’ve learnt today at #SSAT19

On the first day of the #SSAT19 meeting, two of the most important take-home messages came from a a retired surgeon, Prof. Christopher Ellison:

  1. You’re only old once,
  2. You never retire too early.

Robin McLeod has reminded us that the role of women in surgery is… the same as it is for a man.

Alberto Ferreres has pointed out that surgery is a moral practice, guided by three values: self-sacrifice, altruism and unselfishness.

Sachiyo Nomura has showed us how it is possible to manage a perfect balance between workload and well being in Japan.

Finally, Bruno Silverstein has reflected on the moral injuries that surgery inflicts on surgeons and, subsequently, lead to burntout.

La construcción del relato

A nuestra especie, en general, los números no la entretienen. No nos llaman la atención. Con algunas excepciones, nos gusta más una novela, una película o Twitter que una tabla de excel. Los números no nos emocionan tanto como para arrastrarnos a aventuras irracionales.

Y eso lo vivimos día a día.

Vamos creando el futuro así, yendo de la pesadilla al sueño. Porque los sueños no son sólo sueños. También son un plan para conseguir resultados en el futuro.

Los líderes, todos, en cualquier campo de actividad, articulan los relatos de esos sueños a lo largo de tres líneas maestras:

  1. El miedo
  2. La envidia
  3. La mentira

Primero se construye un escenario de crisis, de malestar, de incertidumbre que pone en peligro nuestra salud, o el bienestar, o la misma existencia. A continuación, se cotillea sobre lo que están haciendo otros, a una cierta distancia, sin entrar en los detalles, sin darnos el contexto.

Los expertos ahora lo llaman «benchmarking».

Finalmente, se formula una gran mentira, una fantasia, se crea una bonita irrealidad que promete más y mejor de cualquier cosa que deseemos.

Y partiendo de esa ruta, desde el miedo a la fantasia, el líder inicia el viaje del héroe.

Eso se lleva repitiendo miles de años. Así que debe funcionar.

Klint se despide de 2018

Gustavo mira de soslayo el calendario, estratégicamente colgado de una pared en su pequeño cuarto de la casita del Trastevere.
Ya casi no queda 2018.
Ahora puede caminar tranquilo por Roma.
Con decenas de muertos en sus manos,
con esa lánguida mirada vienesa,
con Prodi alejado de la política.
Sin Michaella, sin Zron, sin Pietro.

«Caminando en silencio por la calle, sentía
que a mi espalda la gente en susurros decía,
cómo me has engañado y cómo he acabado
de triste y de solo.

Cómo odio que me hablen en tono beato,
me resulta humillante escuchar,
lo odio tanto.

Qué talento sublime para hacer el daño
anida en la gente

Oh Dios mío, qué ganas de volverme y de
gritarle fuerte: Tú, tú, ¿qué puedes saber
de todas mis caídas, de mi loco ayer?

Estúpidos, estúpidos

No, no sabes nada, estúpido.

¿Dónde está, quién es?

No, sólo Dios lo sabe y yo también»

Twitter and T84 cell culture: a short story

BIH, circa December 1994.

– JBM: Would you be interested in coming back?
– JM: For sure, after I am done with my residency..

And in early 1996 my family and I left Madrid for Boston, landing at Logan during one of the worst blizzards ever. I would join Jeff Matthews’ lab at the Beth Israel Hospital, later Beth Israel Deaconnes Medical Center.

At that time, I ignored that T84 cells were going to be an important companion over the next years. And maybe for the rest of my life.

I did not have the slightest idea of what cell culture, T84 cells, electrophysiology, Ussing chambers, dual-voltage clamp or patch-clamping meant. My natural instinct was to go down to the BIH library (a small but splendid one) and hide myself behind a mountain of books and articles that I thought would be helpful to accelerate my learning.

This was a totally unintelligible field, due to the absence of any previous experience from my side. Long conversations with Jeff, Bruce, Cecilia, Tim or Jeremy helped me more than any article. Tacit knowledge may be more relevant that explicit knowledge for a beginner. But I must admit that for weeks, at lab meetings, silence and the «tell-me-more look» were the only signs that the rest of the team received from me.

I learnt to take care of T84 cells. I grew my own T84s, not HT29s that I very much disliked because they were more undifferentiated and more appropriate for Hodin’s lab (excellent work, Inram). These cells were my friends for hours in the hood, in the lab, night and day, day and night.

There were flasks, and buffered solutions, and calf sera, and antibiotics, and pipettes, and time, light, temperature. One must treat them well, feed them and let them thrive in monolayers. If you take good care of the monolayers, keep them safe, they will answer your questions.

And they did. In less than six months the first manuscript aimed at the American Journal of Physiology (Cell Physiology) was ready to be submitted. And we were successful!

T84 cells have a well-stablished shape to execute their functions and tightly join each other to form a monolayer, a barrier that resembles what we see in our intestinal mucosa. When externally stimulated, signals are released. Internal communication pathways are activated through different second messengers and cells communicate among themselves in order to coordinate their responses, the vectorial transport of chloride from the basolateral to the apical side, while maintaining the monolayer intact.

But let me go back to the beginning.

I was unaware of how T84 cells had immensely contributed to overcompensate my strong shyness, while responding to my insane curiosity, until I read Graham Mackenzie’s reflection on social media and cell culture.

I like stories, I am addicted to questions. So in the JBM’s lab I had all I could ask for. Sat in my chair, with a dual-voltage clamps and my T84s grown in wells, I couldn’t stop throwing questions to them. Often times, they responded with unexpected answers. In some instances, they gave me the answer that I was expecting or did not respond because the question was wrongly formulated. Then, I could get excited sharing my little findings with people that were far more intelligent than me. That brings enough confidence to go beyond our personal limitations.

Of course there was some noise. But when noise disturbed me, it was just the result of my inability to listen to the exciting stories that my T84 cells were telling me. Noise is meaning at a different scale.

I joined Twitter following Jeff Matthews’ steps. Maybe what I experienced and learnt during my stay at Matthews’ lab helps me enjoy social media more than what most people do. Maybe B¡because, like cell culture, social media is growing a network with more connected people, more diverse, increasing the density of connections and letting information freely flow from one person to another.

If I cultivate the network, if I sincerely connect with other people, they will enjoy answering questions with me. We may not be right all the time, but we enjoy the pleasure of figuring things out together.

That’s why I love what I do and I do what I love.

«Social media provides ways to understand who makes and shares health stories, the potential audience, and the stories themselves» – Graham Mackienze

No, no hacemos eSalud. Y tampoco pasa nada.

Un poco de provocación de vez en cuando no viene mal. Por eso escribí esto:

«No quiero sonar cínico, pero un poquito de contención no nos vendría mal. La mayoría de los que hablamos de eSalud no hacemos nada de eSalud, salvo tuitear.»

Una de Preguntas Frecuentes rápidas:

Tengo un blog sanitario. ¿Es eso eSalud? – No
Tengo una cuenta en Twitter y soy sanitario. ¿Es eso eSalud? – No
Doy charlas de eSalud ¿Es eso eSalud? – No
Doy clases en un master de eSalud ¿Es eso eSalud? – No

Bueno, no es eSalud tal como la entiendo. Para mi, la eSalud o salud digital es un concepto que no tiene nada que ver con digitalizar la práctica sanitaria.

Empezaré por lo que no es eSalud porque, como soy muy simple, me resulta más fácil

1. No es eSalud hacer divulgación sanitaria por canales digitales
2. No es eSalud contestar a mi padre una consulta por teléfono
3. No es eSalud salir en la televisión a hablar de salud o de eSalud
4. No es eSalud hacer informes de alta en pdf
5. No es eSalud hacer una consulta por Skype
6. No es eSalud rellenar formularios en una historia clínica electrónica

Paso a explicarme.

Lo genuinamente digital requiere asumir que toda la realidad es información y que funciona según un conjunto de instrucciones definidas, ordenadas y finitas. Los seres vivos, individual y colectivamente, y todo lo que nos rodea no dejamos de ser un conjunto de algoritmos.

Por tanto, un marco conceptual de salud digital implica aceptar que la salud, la felicidad, la enfermedad y la infelicidad responden a un funcionamiento más o menos correcto de esos algoritmos.

Consecuentemente, la eSalud requiere recopilar la información que define al ser humano sano y enfermo, individualmente y en grupo, desarrollar las herramientas para procesar y analizar esos datos, y, finalmente, producir las herramientas que permitan manipular el o los algoritmos para maximizar lo que en cada momento se defina como «salud».

Vamos, que la mayoría de nosotros lo que somos es productores de datos para que unos pocos hagan eSalud.

¿Qué es ser un buen médico?

Día tras día, año tras año, seguimos preguntándonos ¿qué es un buen médico? ¿cómo se le reconoce?

Mis reflexiones en un podcast que ya ha sido escuchado más de 7.000 veces