Bedside manner, humility and more — essential skills for spine surgeons


Four spine surgeons discussed the skills that help spine surgeons become better caregivers.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.

Next week's question: Are you participating in bundled payments? If yes, what are key lessons you have learned?

Please send responses to Anuja Vaidya at by Wednesday, July 10, 5 p.m. CST.

Note: The following responses were edited for length and clarity.

Question: What is the most underrated skill for a spine surgeon?

Vladimir Sinkov, MD. Spine Surgeon at New Hampshire Orthopaedic Center (Nashua): Good bedside manner is a key to establishing proper patient-doctor relationship that can foster better communication and compliance with clinical recommendations. While it is an obvious skill to have, it is often lacking in clinical practice nowadays. Proper bedside manner involves good listening skills, ability to display empathy and ability to project professionalism.

Most patients coming to a spine surgeon's office are in pain and apprehensive, or even scared about what will be told to them. They often have trust issues and will cross-reference the surgeon's recommendations and diagnosis against Google searches and advice of their friends. Excellent bedside manner can put most of these concerns at ease. As you gain the patient's trust, they will be more willing to give you the information you need to establish proper diagnosis, and they will be more willing to comply with your treatment plan. This, in turn, will lead to better clinical outcomes and higher satisfaction.

Joshua Schwind, MD. Orthopedic spine surgeon at Hoag Orthopedic Institute (Irvine, Calif.): I doubt that it is underrated, but I believe the most important clinical skill for a spine surgeon is spatial orientation. This term refers to the ability to identify the position or direction of objects or points in space (Benton and Tranel, 1993). As it relates to spine surgery, the ability to correctly identify surgical landmarks in multiple planes, sometimes without direct visualization or with altered anatomy, is critical to safely and efficiently performing a variety of surgical maneuvers and techniques.

Issada Thongtrangan, MD. Orthopedic Spine and Neurosurgeon at Minimally Invasive Spine (Phoenix): Listening and humility. There is a difference between 'hearing' and 'listening.' I have a deeper and better connection with patients when I am listening and trying to understand what they are telling me. I feel empathy for them, and I am not minimizing their problems or concerns, so they know that I care, and I will do my very best to help them.

Patients want to feel that they are in good hands. What does it take to be a doctor who patients trust? A great physician knows how to make a patient feel as though they are being cared for, that their concerns are valid and that they are being heard. Patients care more that their doctor actually cares for them than how many papers they've published. Caring can be in the form of active listening and asking open-ended questions.

Another important skill or quality for me is humility, knowing your limits and doing the right thing. For many of us, humility is one of the hardest traits to develop, because it has to start from a recognition that you are not always right, and that you do not have all the answers.

Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: Most underrated skill is being able to connect a patient's chief complaint to their films and history, and to treat the problem as it is. Too often, I am seeing patients having three or more levels of their spine fused, and the underlying problem is a single-level, single-sided foraminal stenosis.

Another is tenacity. Too often, surgeons operate and abandon their patients. I have learned more from following patients for one, two or more years from their surgery to understand different recovery patterns, managing expectations, mitigating complications and what works in surgery.

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