Surgeon George Brennan, MD, talks about why he likes general surgery and practicing at Group Health.
As a general surgeon, do you perform all kinds of surgery?
The popular perception is that we only do gallbladders and hernias. But general surgery is an extraordinarily broad field of care. We do all kinds of abdominal surgery. We also focus on the endocrine system, and take care of thyroids, adrenal glands, vascular disease, and do breast surgery and breast cancer care.
That is very broad. Is there anything else?
We're also the critical care wing of surgery. We cover critical care issues such as surgical nutrition for gravely ill people who need nutritional support. For instance, patients who need to receive nutrition via a feeding tube or intravenously.
It sounds like you frequently deal with very sick people. Is that emotionally difficult?
It's true that we see people daily who are in severe circumstances. There certainly are heart-wrenching situations, but there are also tremendous avenues available for us to help many of these people. We do a lot of work in the management of medical problems, and in communication with the patient and their families. We offer detailed explanations of medical conditions to help educate patients and family members.
What steps do you take to make sure patients have the best possible result and a positive experience? We follow a wide spectrum of measures on a proactive basis.
Some are based on national benchmarks and some are our own "in-house" measures. These allow us to pick up on variations in care and results, and address those issues quickly and constructively. We're not just focused on the objective data, however. We're also very focused on the quality of the interactions between physicians, staff, and patients.
Do patients have a role in making that interaction a good one?
Above anything else, I'd like patients to connect with a surgeon who they feel is their advocate, and who they're comfortable working with. It surprises me how often they don't follow that path. They don't feel that they have the ability to request a second opinion. Having surgery is often terrifying for the patient and their family. There is high emotion involved. We do our best to match every patient with a surgeon they feel comfortable with.
I understand that you came to Group Health after being in private practice. How is Group Health different?
I was in private practice for 10 years, and it took me awhile to understand the Group Health model. The revenue stream here is different. We don't get paid per case — we're on salary. So we don't have economic pressures riding over our heads, as doctors do in private practice. The charge from our administration is simple: Do the right thing for every patient. We recommend surgery when a patient genuinely needs it. As a patient, that's the most reassuring thing on earth to hear. The Group Health model is remarkably different, and it serves our patients well.
What's the training for a general surgeon?
We are trained as internal medicine doctors with the additional capability of being able to provide surgical care. We train, on average, for six years after medical school, with additional years for subspecialties.
How important is it to have a surgeon with subspecialty training?
It's very important. Subspecialists are best able to handle surgeries involving complex medical issues because they do more of these surgeries. And as a result, the outcomes are better. At Group Health, we have general surgeons with subspecialties in thoracic surgery, vascular surgery, bariatric surgery, breast surgery, and endocrine surgery. There have been many times when I have told a patient — I can do this surgery, but I haven't done it for years. It would be safer to have one of my subspecialty colleagues perform this surgery."
Why did you decide to become a general surgeon?
In my third and fourth year of medical school, I discovered that general surgeons were the group of people I admired most. They were broadly capable, excellent internists in addition to being excellent surgeons. I realized they functioned as the "go to doctors" when things became really problematic for patients. I had a hard time imaging myself referring my sickest patients to someone else. I wanted to be the guy who could help them.