I have delivered over 10,000 hours of emergency neurosurgery care.

Advice to myself back in 2014 🧵 1/ Call for Help

If you think you need help, you need help.

The small voice in your head means you should pick up the phone.

No one will say, "Why did you call me?!"

They will say, "Why didn't you call me?!"

The over-confident surgeon causes harm by doing too much.

The under-confident surgeon causes harm by doing too little.

5 steps to building surgical confidence 🧵 The old model of confidence said, "fake it 'til you make it".

To act confident and have absolute belief in your skills.

But the person who proclaims their confidence is anything but confident.

Why being a surgeon is a Loser's Game 🧵 In the 1999 book, Extraordinary Tennis for the Ordinary Tennis Player, Simon Ramo explained the difference between amateur and professional tennis players.

It goes like this...

The operating room is a hostile environment for surgeons.

38% of surgeons are in pain.

87% if using an endoscope.

A primer on surgical ergonomics to save you suffering 🧵 Ergonomics is dedicated to understanding the interactions between humans and systems.

It focuses on making sure the environment fits the worker.

Physical, cognitive and organisational ergonomics create safe and efficient work environments.

As a neurosurgeon I've taught about the Dunning-Kruger effect.

But it isn't real.

If you think it is, this will be an eye-opener.

If you haven't heard about it before, you will still learn how false ideas can be useful and true ideas can be harmful. 🧵 Towards the end of surgical training, you are particularly dangerous.

If you've passed your final exams then you are doubly dangerous.

Your governing body has agreed that you have the knowledge to operate independently.

How I got my Consultant Neurosurgeon job.

(all the stuff they don't tell you on prep courses) 🧵 FRCS done. CCT check. Fellowship finishing.

Then comes my first consultant interview and there's no playbook.

"Do an interview course and read the CQC report."

I do this and feel a bit better.

I don't get the job.

Here's what I did second time round to be successful.

After 1400 operations and 8 years I completed my neurosurgery training.

In some ways I was obsessed.

Here are 9 lessons for the driven that I wish I knew when I was obsessively training and neglecting just about everything else: 1/ Focussing on one thing early in your career blinds you to opportunity.

After 3 years of being a doctor, neurosurgery was everything. It seemed like nothing else mattered, which was wrong.

Mentors will give you perspective by bringing you bak to the big picture.

The operating room is a hostile environment for surgeons.

38% of surgeons are in pain.

87% if you use an endoscope.

THREAD - How I Cured My Shoulder and Leg Pain Work related musculoskeletal disorders (MSKD) are associated with:

- continual repetition of movements
- fixed/constrained body positions
- force concentrated on small parts of the body
- pace of work that does not allow recovery between movements

Sound familiar 🤔

Surgical lessons from the Navy SEALs.

How breath control has kept me calm when 💩 hits the fan. The SEALs have a fierce reputation.

80% of people do not survive the 1st week of training.

Their training seperates those who can handle stress, from those who can't.

Breath control is a key part of their training.

But why?

Nearly 2000 years ago Marcus Aurelius knew that no day would go to plan. ...I have long perceived the nature of good and its nobility, the nature of evil and its meanness, and also the nature of the culprit himself...none of those things can injure me, for nobody can implicate me in what is degrading."

I am greatest person to ever wield a blade.

I can't say this.

But Miyamoto Musashi could, the greatest swordsman of all time.

I've spent 100hrs+ reading his writings and philosophy.

Here are his top lessons for the modern day medic (and one I disagree with) Who was Miyamoto Musashi and what did he do?

▪ A philosopher, writer and swordsman who lived in the 16th century
▪ He developed his own style of sword fighting
▪ Was undefeated in 61 fights to the death
▪ Never lived in one place
▪ Created paintings still admired today

I have meditated consistently for 15 years.

The results have helped me in the operating theatre more times than I can count.

Unfortunately most people don't "get" meditation.

Learn how to easily start meditating and my favourite 3 techniques. (No. 3 is my current favourite) 🧵 There is no "right" way to meditate.

There is no specific outcome you are aiming for.

This is where most people stumble.

You can't really "do" meditation wrong.

Instead, meditating is about 2 things - awareness and focus.

I am a brain surgeon, but I couldn't solve this puzzle.

Connect the dots by drawing four connected straight lines. You can't lift your pen from the page or retrace a line.

If you can't solve it, I will teach you something about how you think 🧠

(Answer at the end of this 🧵) If you couldn't solve the problem, don't feel bad.

Only 9% of people are able to connect the dots.

If you are a medic, what you learn below could save someone's life.

There are 4 reasons we couldn't tackle this problem.

A boy dies after an appendicectomy.

A man dies during routine oral surgery.

What is Task Fixation and how we can combat it 🧵. Fixation errors are a human error in thinking.

Teams focus on one aspect of a situation, while ignoring more relevant information.

There are 3 types of fixation error.

How an orthopaedic surgeon turned GP/family physician changed my view of what it means to be a doctor 🧵. 14 years ago I was a medical student doing my general practice/family medicine rotation.

My trainer, let's call him Dr R, used to be an orthopaedic surgeon but changed to be a GP.

11 things I know at 35 I wish I'd know at 25.

For surgeons and doctors 🧵 1/ You Can be Lethal

You are most dangerous when your skill set outstrips your experience.

This is towards the end of your training as a surgeon.

Surgeons in training - be aware of context switching, attention residue and decision fatigue.

Below is a near miss of mine I don't want you to repeat. I was performing an out of hours emergency operation when a referral came.

The referring doctor was adamant that they wanted to speak to me.

I was at the stage of training where I would stop operating to take referrals.

How to speed up your medical training.

13 simple (and not taught) ways to reduce learning time 🧵. 1/ Ask "Stupid" Questions

How will asking stupid questions speed up learning?

Because the main thing holding people back from learning something new is the fear of looking dumb.

Either:

It is a dumb question and you learn.

or

It isn't a dumb question and you learn.

"Resilience" is a desired character in a surgeon.

But surgeons are just as frail and vulnerable to stress as the general population.

My thoughts on being a resilient surgeon 🧵 Resilience is "the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress".

More simply, it is the ability to bounce back.

I have performed over 9600 hours emergency on call.

This is advice to myself back in 2014 🧵 1/ Call for Help

If you think you need help, you need help.

The small voice in your head means you should pick up the phone.

No one will say, "Why did you call me?!"

They will say, "Why didn't you call me?!"

In 1944 the CIA made The Simple Sabotage Field Manual.

A step by step guide to sabotage any organisation.

Read the steps below.

Then do the exact opposite 🧵 1/ Organisation Sabotage

- Insist on doing everything through “channels.” Never permit short-cuts to be taken in order to expedite decisions.