Author: carrie

by Dr Carrie Kollias MD FRCSC

“Did you always plan on becoming a children’s author?”

This was a question recently posed to me by a group of teachers and librarians. We were discussing my recently published children’s book, Maria’s Marvelous Bones.

The short answer was “No”, but the real answer is much more complex.

Ten years ago, as an orthopaedic resident, I got the idea to write a kids’ book to help explain fractures. But other priorities came first: I finished residency, the Royal College exam, fellowships, and started community practice. I had two kids. I became involved in health advocacy where I experienced some victories but many frustrations, often due to the health-care bureaucracy that demoralizes many of us over time.

About 18 months ago, I decided to finally write that kids’ book. By then, my own kids were asking questions about my job. With celebrated UK illustrator Gill Guile, we featured a group of health-care professionals diverse in both gender and ethnicity.

Since the book’s publication, readers have told me how it’s changing kids’ perceptions: a 10-year-old girl who snuck anatomy books to bed at night to read with a flashlight; a boy who approached his treatment with confidence after breaking his leg; a girl who declared she wanted to be an “astronaut surgeon,” and a boy who now eats broccoli because it is good for his bones. Small but meaningful victories. Fortunately, Maria’s Marvelous Bones made the top of the fiction best seller list in Calgary. So yes, bones really ARE cool! 

This project has fulfilled me both personally and professionally. This, we know, is important: the physician health literature indicates that spending at least 20% of our time doing high meaning professional activity is associated with lower rates of burnout¹. This means that if your highest meaning activity is teaching, or administration, or research, or even performing a specific surgery, you should aim to allocate a minimum of 20% of your work schedule to that area.

What goals do you have in the next 18 months? This may mean pioneering a surgery nationally or in your centre, stepping up for a leadership role, focusing on your own health, mentoring a colleague, building a marriage or learning to surf. Many of us however, exist on a professional hamster wheel day to day, spinning along with little intentionality. We mindlessly grind through patient waitlists. Sometimes it feels like we have no choice in a system where resources and patient access can be scarce. Large personal financial commitments can force us to run along at too rapid a pace. For others, we are living a version of ‘malignant’ intentionality: single-mindedly climbing ladders of power and influence with not enough regard for the wellbeing of our family, our colleagues, or our own health.

I often think of my colleague, Spencer McLean, M.D., FRCSC, who passed away with aggressive kidney cancer in 2013 at the end of his orthopaedic surgery residency in Calgary. Spencer lived intentionally: with kindness, appreciation, generosity, love for family, nature and orthopaedics. On the day of Spencer’s funeral, I recall sitting across the table from my colleague; we were absolutely shell-shocked. We were early in our careers, with the sacrifices of residency still fresh in our minds. We talked about how to honour our colleague’s memory. We hung a picture of Spencer, given to us by his wife Christina, in our office. In this way, Spencer continues to inspire us to pursue a life that is deliberate. We remember that each day is a gift.

As surgeons, we go through seasons professionally and personally. Along the way, it is important to critically evaluate: does the way we are living and practicing align with our personal values? For those of us who have never explored this, online tools are available². For those of us who already know what our values are, we may need a reminder. Living with intentionality can require uncomfortable choices like sacrificing income, prestige, or even ego. It might mean writing a kids’ book, collaborating more with colleagues, or reconciling with others. As any health-care professional knows, we have no guarantee of good health, nor of the years we will get. We need to think about how to make every one of them count.

Special thanks to Christina Frangou

This article originally appeared in Canadian Orthopaedic Association Bulletin Winter 2018

References

1. Shanafelt T.D., West C.P., Sloan J.A., et al. Career fit and burnout among academic faculty. Arch Intern Med. 2009;169(10): 990-995.
2. Personal Values Assessment https://www.valuescentre.com/our-products/products-individuals/personal-values-assessment-pva

I have been asked many times why in the world I decided to write a children’s book. Don’t surgeons have other things they should be doing?

I got the idea for Maria’s Marvelous Bones nearly ten years ago when I was an orthopaedic resident. Since that time I have seen thousands of kids. Many of them have been anxious coming to the hospital as it is an unfamiliar environment. The place smells different and there are so many different people with various roles in the healthcare team. It can be hard for little brains (and big brains 😉) to keep everyone straight. Thousands of kids get fractures every year and I thought knowing what happens next would comfort them. As I now have my own kids, I also wanted to write a book that explained the science behind bone healing. Most children’s books about the body are quite dry and uninteresting to young readers, but my aim was write a book that draws kids in through a narrative and educates them with accurate and age-appropriate information.

Gender and ethnic diversity within the healthcare professions is also a passion of mine. Orthopaedic surgery is the least diverse of all medical specialties. In the USA, only 6.1% of orthopaedic surgeons are women, and even less are visible minorities. Times are changing though! At the recent annual meeting of the Canadian Orthopaedic Association, 27 percent of attendees were female. We have more work to do internationally. In Maria’s Marvelous Bones, the triage nurse is male and the orthopaedic surgeon is a visible minority female. I hope that kids from all cultural and social demographics will read this book and set their sights on whatever career they wish. Maybe I will even get to work with one of them someday as a future orthopaedic surgery colleague! #ilookLikeaSurgeon

The recent article “The Pregnant Orthopaedic Surgeon: Risks and Precautions” rightly addresses that pregnancy is not an insurmountable obstacle for women choosing a career in orthopaedics. I am a practicing orthopaedic surgeon and mother of two children, and pregnancy did not factor into my career choice in my mid-20s. After reading this article, I am curious to know how many surgeons have used pregnancy to justify the lack of gender diversity within orthopaedics. Such a superficial explanation, however, keeps us from looking in the mirror and critically evaluating ourselves and our specialty.

Some orthopaedic surgeons may recoil from the latest initiatives to attract a diversity of recruits to the profession. Why should the status quo change? Isn’t our specialty OK?

The answer is no, because our patients don’t look like we do, and neither do medical school classes.

Currently, only 6.1 percent of practicing orthopaedic surgeons are women, and 4.8 percent are underrepresented minorities. Unfortunately, orthopaedics is still the least diverse specialty—by a notable margin. At present, more than half of all medical student graduates are women. Where does that leave orthopaedics in attracting the most capable future surgeons who will serve patients and grow our specialty? Is it possible that we are selling ourselves and our patients short? Could our lack of diversity be stifling creative solutions to the challenges facing our profession and patients?

How can we attract females and underrepresented minorities in orthopaedics? I suggest through the same phenomenon that is required for maintaining health and excellence for all orthopaedic surgeons: culture. I am talking about a development culture that builds up those around us, works as a team, prizes inclusivity, and fosters creativity and innovation. This culture also facilitates personal well-being and care for colleagues, both male and female. In an era when burnout is an epidemic for half of orthopaedic surgeons, we need to rethink how we organize our lives and practices. Collaboration to an authentic level may not come easily to many of us; after all, competitiveness is what got us into this specialty.

What if we committed to be developers of people (minorities, women, men) in our daily lives? Looking back, the reason I went into orthopaedics is because some forward-thinking men invested in me. Their kindness and professionalism were notable and gave me the ability to imagine myself serving patients in this role. As orthopaedic surgeons, we need to turn on our radar and begin to recognize the potential of those around us, embracing their gender and ethnicity, with the understanding that we are stronger as a specialty when all viewpoints are represented. After all, the well-being of our profession and patients is depending on us.

This post appeared originally in AAOS Now and was written by Dr Kollias in response to the article “The Pregnant Orthopaedic Surgeon: Risks and Precautions,” which was published in the July 2018 issue of AAOS Now.