Doc Discussions with Dr. Jason Edwards
THIS is the podcast you have been looking for! "Doc Discussions" are just what the title says they are: physicians from a wide range of specialties, talking about relevant, up-to-date medical topics, not to mention tips on habits to help you live your best life. Your host, Jason Edwards, MD, is a board-certified radiation oncologist with a PhD in cellular and integrative physiology at St. Luke's Hospital in St. Louis, Missouri. Dr. Edwards explores not only diseases but also suggests techniques to optimize mental and physical health for a long and good life. Real people. Real advice. Real good. This is Doc Discussions, with Dr. Jason Edwards!
Doc Discussions with Dr. Jason Edwards
Building Medical Character: How Great Surgeons Are Made
What happens when medical legacy intersects with personal passion? In this captivating conversation, host Jason Edwards sits down with general surgeon Dr. Christopher Cronin, who shares the remarkable story of his grandfather, AJ Cronin—a physician who transformed an illness-induced retreat into a groundbreaking writing career.
The discussion reveals how AJ Cronin's seminal work "The Citadel" critically examined the British health system in 1937, addressing corruption, unethical practices, and healthcare inequality decades ahead of its time. This literary perspective from a practicing physician ultimately helped shape the National Health Service established a decade later. Dr. Cronin's reflections on this family legacy provide a unique window into how literature can drive healthcare reform and professional ethics.
But this episode goes beyond family history to explore the formative experiences that shape surgical careers. Dr. Cronin shares his evolution from aspiring orthopedic surgeon to general surgeon specializing in thyroid procedures—a journey influenced not by his famous grandfather but by the transformative power of mentorship during his training. His compelling account of working in a challenging DC hospital under an inspirational chief resident illuminates how profound these relationships can be in medical training.
The conversation takes a fascinating comparative turn as Dr. Cronin details his year training in Australia, highlighting the stark differences in surgical education systems worldwide. His insights on surgical hierarchy, the art of teaching technical skills, and the critical importance of repetition in surgical training reveal the complex balance between supervision and independence that creates competent surgeons. As duty hour restrictions change how surgeons are trained, these reflections become even more valuable.
Listen as these two physicians discuss the delicate art of mentorship, the trust that develops between surgical partners, and how the best teaching surgeons know when to step in and when to let trainees work through challenges. Whether you're in healthcare or simply curious about how great surgeons are made, this episode offers memorable insights into the human side of surgical training. Ready to hear more? Contact Dr. Cronin's practice at 314-434-1211.
Hi, this is Jason Edwards and welcome to Doc Discussions. I'm here with Dr Christopher Cronin, a general surgeon. Chris, how are you doing today? I'm doing well. So a funny thing happened the other day. I was reading a book that was put together by Reader's Digest called Getting the Most Out of Life, and it was published in 1948. And I opened the book and the very first story is by a guy named AJ Cronin, somebody you know well.
Speaker 2:Well, I can't say I knew him real well, because I really only met him four or five times because he lived in Switzerland and he passed away, I think, when I was a senior in high school. But yeah, he was my grandfather. He was an author, also a physician.
Speaker 1:Yeah, yeah. So the story talked about him you know brief synopsis getting sick and then he had to kind of it was a stress-induced ulcer and he had to go up out to the countryside and when he was there he decided to write a book and it ended up being a raging success. And then he wrote many, many books and I think 19 of them got turned into movies and so he knew people in Hollywood and the whole thing.
Speaker 2:Yeah, he was a pretty famous guy. So he knew people in Hollywood and the whole thing. Yeah, he was a pretty famous guy. So basically the way it all started was he was a physician, grew up very poor, got a scholarship and was able. He chose I was either going to the ministry or medicine. So he said lesser of two evils. So he picked medicine and if you read the Citadel it's almost it's a little bit an embellished life story.
Speaker 2:Yeah, so what happened was he was a successful doctor, kind of specialized in pulmonary type stuff, and then he got this ulcer and I guess back then you took three months off on a milk diet that was what was recommended. So he went to some farm and I've read like a similar anecdote about where he had written half the book and he just thought it was terrible and he just threw it in the trash can and he took a walk and then he runs into this guy who's like clearing a field trying to make it into pasture land. It was like a bog or something. And he kind of knew the guy and they start chatting. He told him you know, I just threw away the book, was terrible. And he's like look, I've been working on. My grandfather worked on this field. My father I'm working on, I'm not giving up and he kind of thought about that and said and he pulled it out of the trash can and he worked it and worked it and then he sent it to a publisher and I guess he kind of forgot about it. And then he sent it to a publisher and I guess he kind of forgot about it, and then they liked it and it was very successful, sold millions of copies. And so then he said forget medicine. And he wrote a few more books and then he published the Citadel, I think four or five years later, and that was a huge success.
Speaker 1:Yeah, it reminds me of. There's a book by a guy named Steven Pressfield who wrote Bagger Vance, called the War of Art. I think it's a play on the Art of War by Sun Tzu, but the book just talks about it's. When you create art, it's you're putting yourself out there and whether it's music or literature, you know you're putting yourself on the line for people to criticize you and it's kind of a man. You know Teddy Roosevelt man in the arena thing. You know it's line for people to criticize you and it's kind of a man. You know a Teddy Roosevelt man in the arena thing. You know it's easy for people to sit in the stands and criticize something, but it's very hard to create work and it takes courage.
Speaker 2:Absolutely Well. You know, the Citadel was very critical of the British health system.
Speaker 1:Yeah.
Speaker 2:So if you, let's say, you go on Amazon and you read the little paragraph about what the Citadel is, they always, you know, say, well, it probably helped bring about the National Health Service. Yeah, and I'd heard that, but it seems to be more kind of established.
Speaker 2:Yeah, that's what I've read too and that came about. So the Citadel came out in 1937. I think the National Health Service came out in 47. And it addressed a lot of things. You of things that he was kind of brought to light in the Citadel the lack of training and then continuing medical education. He was very critical. Some of the doctors out practicing weren't really changing what they were doing. They were doing the stuff that they had been doing 30 years earlier, even though the treatments had kind of changed.
Speaker 2:Yeah, they were doing stuff that they had been doing 30 years earlier, even though the treatments had kind of changed, yeah. So, getting back to what you were saying, it's difficult to create something and then you're being critical of a lot of your peers, so he took a lot of fire for that.
Speaker 1:Yeah, so you know the book itself. There are several themes. It's the corruption and unethical practices within the medical profession. You know, do you do it to make funny or do you do it to make a difference in people's life, or both the conflict between personal ambition and moral integrity. He kind of touched on the social class and economic status of health care and access to health care, because he worked in a very poor mining town and these.
Speaker 1:You know he was very avant-garde, ahead of his time in a lot of these things and I'd read the same thing that this was kind of an impetus to ultimately push the NHS over the line which England is very, very proud of. I remember in the 2012 London Olympics, in the opening ceremonies they even had like an homage to the NHS, oh really, and so I know they're proud of it. But in his other books too, you know, he kind of delves into these deep life questions meaning of life type of thing and obviously hugely successful, and these are things I think, as doctors, we think about too. You can't help but treat patients and you see good outcomes and bad outcomes and difficult situations, and it can't help but make you think about these deeper meanings to life, and I'm sure that's where he got this from.
Speaker 2:Yeah, well, you know you do the best you can and even when you do that, everything seems to go right. And then one complication it can really make you rethink about what you're doing. Yeah, and that, you know, one theme in the Citadel was, you know, he was working with this surgeon. He really respected the guy and he was doing an anesthetic. That was they didn't have anesthesiologists. You just kind of do a little bit of ether and uh. So then he finally saw the guy work and he realized how incompetent this guy was and that's sort of is sort of the big dramatic change he had in the book he's he. He realized, you know, he kind of had the, the morals that he had started out with when he started, you know, was going to medical school and things he wanted to do. Then he realized, sort of with that one seminal event, that he had changed and he needed to go back to, you know, his morals and his ideals, you know when he started, yeah, so yeah.
Speaker 2:And I think medicine will do that to you. You know, because you know things happen and you take it personally and you got to rethink about what you're doing.
Speaker 1:Yeah, for sure. Did him being a physician push you into becoming a physician or not really?
Speaker 2:Not really. I didn't really know him well enough. He would come over now and again. Like I said, he lived in Switzerland and visit and then we visited him a few times on vacation. Yeah, so he didn't really have an impact like that. I guess my mom kind of respected him a lot and maybe if anyone pushed me into that it was her.
Speaker 2:I mean, the short of it was I got to college I realized I'm really not good at a lot of things. It's like I'm pretty good at science and so I'd started taking some science. You know the preliminary and did well and liked it, and so that's the other thing most people don't realize. You know you go into medical school. You really don't know what I mean. Most people don't really know what they want to do, don't really know much about medicine. I mean some guys you know dads are doctors, so they know more, but for the most part you really don't know what you're going to end up doing and a lot of it's just the mentors that you meet. You know the chief resident that you respect or you know you have one attending that kind of you know you like or takes interest in you.
Speaker 2:And that can swing you into what you want to do.
Speaker 1:Yeah, I agree, and in fact I worry about somebody who comes in as a first year medical student and says they want to do this profession because they don't know the ins and outs of it. You know, they're kind of biased in a way that they shouldn't be, and so was that the experience with you. You were in medical school and you did the surgery rotation.
Speaker 2:Yeah, absolutely A hundred percent.
Speaker 2:I was ortho all the way, I just seemed like a cool thing to do and kind of like the jockey type doctor. And so I remember I did a rotation with a guy when I was a first year. Didn't really think the guy he was saying the same thing every time you know, and say you know, we can either grease it or you know, or send you physical therapy. That was the same for anyone with a bad knee. I was like this is boring. So anyway, fast forward. We had these acting internships.
Speaker 2:I don't know if you did that AIs, yeah, ais. You did six weeks in medicine and surgery that you had to do and I had done my preliminary in orthopedics. Didn't love it. The guy I worked with, the resident, was kind of a jerk and didn't really seem to care that I wanted to do orthopedics and so I did my surgical acting internship and I had a guy named Steve Evans who was just outstanding. It was a DC general which was as tough of a city hospital I think it's since closed but it was bare bones. We were really needed.
Speaker 1:And you took the indigent population.
Speaker 2:It was primarily indigent a lot of trauma and very few services.
Speaker 1:So the medical students. We were drawing blood.
Speaker 2:We were putting IV, we were doing a lot of stuff. Which is great as a student, absolutely.
Speaker 1:Yeah.
Speaker 2:And the patients were appreciative too. Yeah, because we're taking care of them and the residents really worked with us. And I remember this guy came in like 30 nights in a row. He had a trauma like every night and you'd never know it. He was always like teaching and so like teaching and and so, uh, anyway, I was like I really respected this guy and that's when I was like I want to be this guy.
Speaker 2:Yeah, and it's interesting because he ended up going on. He went to gw, he finished his training, went to gw, was there for five years and, um, they brought him back to georgetown and within like 10 years he was chairman, yeah, and now he's head of the med star, which is like the whole medical system. I think he may have just retired. How about that? Yeah, I had some patient who was a lawyer and he looked me up and said, oh, you went to medical school at Georgetown. You know Steve Evans. I was like kind of weird. He was my chief resident. How would you know him? He's like well, I'm a lawyer, I work with him at MedStar, he's. So I guess the guy I picked was pretty good, because he became very successful.
Speaker 1:You know, talking about him coming in 30 nights in a row. I very much remember my surgery rotation in medical school and then I did my first year of training in general surgery. It was part of the program and it's an attitude. It's an attitude and a standard that comes with general surgery and it's like don't complain about it, just soldier on. You might not feel great, you might be tired, but it doesn't matter. The more you talk about you know, you don't talk about it at all, you just keep going. And I feel the same way. My chiefs I loved them and respected them. I would do anything for them. You know just and it wasn't that they necessarily did anything for me, I just respected the hell out of the standard that they had.
Speaker 2:Absolutely yeah, and you know, you always remember those guys. I remember you know, when I was an intern, you know the five chief residents we had. You know some of them I respected more than others. But there was, you know, they had the long coats. It's a little different in surgery coats. It's a little different in surgery At WashU. We had to wear white pants. So we had basically a uniform and then the short coat until you became a chief resident.
Speaker 2:So, by the time you're a fourth year, you were considered a chief on some services, so they let you have the long. But it sort of was demeaning because all the medical residents had long coats. There's sort of a status thing. But it made sense. Someone explained it to me once that hey, if there's five of us coming up here, they know the guy with the long coat is the guy in charge, so they can just come up to me if there's a problem.
Speaker 1:Yeah, and there's a very clear hierarchy, absolutely, it's not only an age-based hierarchy, but a competence-based hierarchy, which is very necessary in difficult situations.
Speaker 2:Yeah, I think it works really well. You know, I did a year of training in Australia. So my fourth year a chairman called me up, or I guess it was the end of my third year. I was a PGY-5 because I did two years of lab time so I did some research but they had a spot in Australia and so he's like look, you got like 48 hours and let me know you can go over there for a year. So I said what the heck? I'm going to do it, and which is a lot, because, like you said, there's a hierarchy. I'd been there. People kind of know your level of competence. So if I'm calling and attending at 2 in the morning, look, this guy needs to go to the OR. They know me, they'll respect what I have to say and you know, you kind of build up your credibility.
Speaker 2:So it was difficult going over there because they didn't know who I was. But you know that worked out. But it's a totally different system because they have what are called registrars and it doesn't really matter. You know, it's a four-year training program. They rotate every six months on a different service so you could be on start on the battle billary service as your first rotation. You're obviously not going to do nearly as much, but you're kind of considered the same.
Speaker 1:Okay.
Speaker 2:It's it's so I. I much preferred our system because there is a hierarchy and it's just. You get better training that way, yeah.
Speaker 1:My wife did a a rotation in Africa with other international students and it's from her perspective. The training was much better in the United States. I don't know, you know, that was just her experience as a single person, but she said she said that it was more rigorous, which is good, you know.
Speaker 2:Yeah, no, I. I for sure you know we had a. I remember we had a surgery resident come over from Ireland.
Speaker 1:He had already completed his training.
Speaker 2:He was fully trained, yeah, and he was maybe like pgy3 level, yeah, and out of five. So out of five, which is, yeah, not super functional but you could like yeah kind of a mid-level resident you know, generally a chief resident at least back when I was training can operate independently. Yes, they don't really let you do that anymore, but they, you know, you, you sort of have reached that level of competency.
Speaker 1:Yeah, and I think this whether it's sports or surgery, reps matter, your repetitions matter and the more training you do, the more times you do anything, the better you're going to be at it, whether it's hitting golf balls like your son, who's an excellent golfer in college, second in state, is that right? Second in state. So whether it's hitting golf balls or doing surgery, reps matter. And this is a thing that's come up with the duty hours restrictions. You know it used to be kind of take the bridle off of it. There's 167 hours or 168 hours in a week. You know you work 100 hours and sleep, you know, and eat the rest. They're very strict about that. They throttled it down to 80.
Speaker 2:It's down to 80. And you know you could be doing a case and if you're going to violate it, I mean you have to get someone to come in and relieve you. Basically, which?
Speaker 1:was unheard of. So you get less reps, which means more people are going into fellowships, which is additional training after the residency. Now did you do a fellowship for neck surgeries? Because, unlike most general surgeons, you do abdominal surgeries but you also do some neck surgeries too.
Speaker 2:Yeah. So when I went over there I spent so they rotate every six months. I had no idea what they're like. Well, there's a, the chairman. There was a thyroid expert, so that's Dr Wells. He was an endocrine surgeon, mainly did thyroid. So he knew this guy just through international meetings. Lee Delbridge was his name. Great guy, I mean great surgeon. So I really learned a lot from him, but that's all he did. He did thyroids and parathyroids. We did like one or two insulinomas and then a couple adrenals and I was better because I had learned from Dr Brunt. He was doing laparoscopic and these guys were way behind us. But that's a whole other story.
Speaker 1:So you were great in the abdomen, but you learned from him yeah.
Speaker 2:So at Wash? U because of Wells, you didn't do anything until you were a chief resident. So he would have a second year. You'd hold retractors, the chief would scrub with them and he'll let the chief do the case. So it's like a thyroid at WashU. Maybe not at another place was because you know Dr Wells, the chairman you know, chief resident every time.
Speaker 2:So, and that was your time with Dr Wells, you had, like you know, usually it was about eight weeks and you were sort of the administrative chief at the same time. Yeah, so, yeah, we, I, we did six months so and this guy was super busy. We get every thyroid in New South Wales practically, so we're doing maybe like 10 a week.
Speaker 2:Yeah, we do six in a day sometimes. Yeah, and then I had my own clinic. He would like just send people, you know. Getting back to the national health service, it's a little bit different in Australia but similar. They had, you know, sort of 01 and 04. So 01 were the private patients, 04 were public, so he would send those to me which I thought was kind of weird, but that's just the way they did it.
Speaker 2:So I learned a lot about doing thyroid surgery. I think I did over 130. In fact, when I applied to get my boards they flagged me. They're like there's no way you could have done this many of my thyroids and parathyroids. They sent it back to me there's a typo here and I said I had to have Wells call them and tell them no, I had done that many. And then actually the second six months was even more. I worked with these two guys in private practice and this one guy was probably one of the best surgeons I ever worked with. This guy could do anything Did ERCPs, did laparoscopic, we did whipples, we did everything.
Speaker 1:And he was a really patient, good guy.
Speaker 2:So I was really lucky that the time I spent over there because we had, I think, two or three other residents follow me and some of didn't have like nearly the experience that I had yeah, yeah, for sure, and, and, and.
Speaker 1:You know we all owe a lot to our mentors. You know people we love and respect. Um, you know, for teaching us, you know how to be good doctors absolutely.
Speaker 2:It takes a lot of patience to take, you know, to allow someone do something. You're watching them, I mean, you're still kind of guiding them through the case and everything. But not everyone can do that. It's difficult sometimes. You know someone's struggling, you've got to like let them kind of struggle a little bit, but not too much.
Speaker 1:Yeah, you've got to figure it out. When I graduated there was a poem written about the SR-71 Blackbird, which is the fastest airplane. The SR-71 Blackbird, which is the fastest airplane and kind of the basis of the Palm, is as a mentor, even when you want to jump in and help, sometimes you've got to let people kind of work their way through it Correct, and that's hard, especially as a new attending, to do.
Speaker 2:I think Well, it builds confidence. If you've got to help them every time, they're going to lose confidence. You've got to be able to kind of do it. So and we've got a new just right out of training, a new associate, and so you know, there's some, we do some hard cases out here and sometimes she's wow, this is difficult and we got to go in there and you got to sort of help but you don't want to do too much.
Speaker 1:Yeah, and you guys work your, your team works together. You just got out of a surgery with one of your partners and it's sometimes it's helpful to have another set of hands in there.
Speaker 2:Yeah, I mean having two experience. I mean I think that it you know if me and one of my senior partners doing a case together, it's better than certainly like down at Barnes when you've got a fellow, you've got two really experienced guys. Been working together for 20 years. Yeah.
Speaker 1:It makes a difference, makes a big difference.
Speaker 2:We can move a little bit quicker and we just you kind of know each other. Yeah, there's always that familiarity. So when you're rotating through constantly all the time, it sort of takes a little time to trust somebody. Yeah, and by the time, once you build that trust, then they move on.
Speaker 1:And it's there with your partners and the techs who help you during the surgery, and the nurses and the anesthesiologist, and that's the nice thing about St Luke's being kind of a smaller hospital. Yeah Well, chris, thank you for sharing your story with us. You're a general surgeon. The phone number to your clinic is 304-434-1211. And so if anybody's looking for a great general surgeon, give Chris a call. Thanks for coming on, hey, thank you for having me.
Speaker 2:I really enjoyed it, thanks.