World Journal of Surgery Official Journal of the International Society of Surgery © Société Internationale de Chirurgie 2005 – 10.1007/s00268-005-1116-4

Twenty-one Commandments for the New Surgeon in Little Town Surgical Center

I have been a rural surgeon for nearly 27 years and have made a few observations watching about two dozen docs come and go in various specialties. Here are some things to consider:

1). You need to get accepted in the community—both by the patients and the docs. Take the referring docs out for lunch or bring a deli lunch to their office, a gift at Christmas, and talk to them socially and professionally; let them know what your special interests in surgery are or what you can do to help them with problem patients; ask their advice and input on patients and get medical consults on unassigned surgical patients, even if you know how to take care of the problem of fluid overload or hypertension etc., always keep them in the loop on their patients with follow-up letters, op notes, and thank you notes; and NEVER disparage their care even when it is off the mark by your standards.

2). Always talk up their great care to the patients they send you and send them back for follow-up when the surgery problems are resolved.

3). Attend the non-surgical CME and meetings in the local hospital and participate.

4). Present some CME for them. Be nice to all the hospital personnel also. They can be your best advertisements if they like what they see of you at the hospital.

5). Be soft and friendly and not biting or sarcastic.

6). Keep your office staff happy with birthday presents, and flowers on secretaries’ day.

7). Give your patients all the time they need to talk to you and listen to what they say. If they don’t need surgery just yet, tell them so, even when your schedule is empty. The word in the community will be that you don’t operate when unnecessary and they will come back to you for everything in the future.

8). Be very supportive with the families when their loved ones are in great need.

9). Write some key word notes in your office chart to remind you to ask about their trip to Hawaii or their kid in college, or whatever they mention to you at your last visit.

10). Don’t get into controversy or in-house battles for the first 10 years in a new place.

11). Don’t do Whipple’s in a little hospital. You can’t afford the fallout of high-risk surgery in rural hospitals.

12). Hold hands and touch your patients. Stand by their side, hold their hand, and talk to them as they go under anesthesia. Be there when they wake up.