Friday, May 30, 2014

Learning how to be a surgeon: interview with specialist surgeon Dr Charles Kuntz

Dr Charles Kuntz, from Southpaws Specialty Surgery for Animals, in the office.
Dr Charles Kuntz gave such a great talk on Monday at the AVA conference, that SAT had to interview him. What I found particularly interesting as a general practitioner was learning how a great surgeon develops and hones their skills. 

Can you tell us about your day job?
I am a specialist veterinary surgeon. I try to improve the quality of life in pets and their owners when they present to me with serious (generally surgical) conditions. I have been a specialist veterinary surgeon for 18 years. I started and currently run a “boutique” veterinary referral practice which is growing by the day. My responsibilities are clinical, teaching, marketing and management. I love what I do and can’t imagine doing anything else.

What kinds of surgeries do you perform now and why are they challenging?
I perform nearly any kind of veterinary surgery. Really the only thing I don’t personally do is joint replacement. I leave that to my business partner and associate Dr. James Simcock. I do a lot of cancer surgery which means removal of large tumours. I have sub specialist training in surgical oncology and am an ACVS Founding Fellow in Surgical Oncology. 

I also really enjoy neurosurgery.  This includes removal of brain tumours, decompression of the spinal cord due to disc ruptures, decompression of nerve roots due to lumbosacral disease (which is like sciatica in people) and correction of congenital brain abnormalities. I find neurosurgery particularly enjoyable because it is very technical and requires a lot of concentration. Also, the results are usually great which is rewarding. 

I do a lot of orthopaedic surgery for ligament injuries in the shoulder and knee. I also do surgery for developmental diseases of elbows and hips. We don’t do much trauma surgery because of the good leash laws in Australia. 

I also really enjoy soft tissue surgery for urinary tract, respiratory and intestinal problems. Again, they are fairly technical and require a good knowledge of anatomy. If I could design my perfect surgery day, it would include a brain tumour removal, a lung tumour removal, a disc rupture, a shoulder ligament replacement and an adrenal tumour removal.  [Ed: My perfect surgery day would be WATCHING that!]

Dr Kuntz: good trainers keep training.
Were you always good at surgery? Did you always do something with your hands?
I was pretty good at surgery in veterinary school. I always found the technical part of surgery pretty straight-forward. The challenge for me has been learning the perioperative care - learning when to cut, how to minimise suffering before and after surgery and how to maximise the outcomes with good patient care. 

I have always done stuff with my hands. Early on, aged 10-14 it was taking apart radios and things, 18+ it was playing guitar and I have always enjoyed woodworking although I have been banned by my wife due to a stupid and pretty serious injury which occurred about 18 months ago. I was using a very sharp chisel and cut three tendons, two nerves, two muscles and an artery in my left hand. I had three hours of microsurgery and was operating again (against doctor’s orders) 48 hours later. I was what was called a “very motivated patient” with respect to physiotherapy and have had an excellent recovery with no residual deficits. 

How does someone become an expert in surgery? 
The most effective way to become an expert in surgery is to do an internship, surgical residency and specialisation. A residency is a 4-5 year program which involves extensive training, supervision and examination under the guidance of other established surgical specialists. During my residency, I experienced long hours and performed about 1,000 surgeries. 

I read thousands of articles and about a dozen surgical textbooks, on which I had intensive examination. I also did a Master’s degree at the same time and published several articles. Even with all that training, I was most certainly not an expert when I was finished (although I thought I was). In the 18 years since the completion of my specialisation, I have continued to learn actively every day by observing other surgeons on youtube and in human hospitals, intensively reading the literature, continuing to publish and developing new techniques. 

One of the best things I have done to develop my skill has been supervising surgical residents. I have mentored two residents through their programs from veterinary school all the way through specialisation and currently have two more in different stages of their programs. Having residents around forces me to be consistent and honest in my approach to surgery. It also forces me to keep up with the relevant veterinary literature and to justify my decisions. 

That being said, I know of lots of great surgeons who have not done surgical residencies. It is much more difficult because the training has to be more self-directed and self-motivated. Resources can be hard to find and it can be challenging to go home and read for three hours after a big day in the clinic if no one is forcing you to do it. Continuing education is great in the form of attending lectures and reading articles and textbooks. Also, one must be completely honest with one’s self about successes and failures in order to improve. I had a mentor who said that no matter how well a surgery went, you should be able to pick three things you could have done better. You should never settle for “good enough.”

Why is it important to do things differently when you can? 
It is always important to constantly question what you are doing and to never settle for status quo. I am always challenging myself to improve my technique. I never accept that the current way of doing something is necessarily the best way. I try to keep up with the veterinary literature and always question if there might be a better way. 

What continuing education/training do you do?
The most rewarding continuing education I do is training surgical residents. I have been really lucky with the residents I currently have in that they are really hard-working, clever and technically gifted. They are also really great people to be around. We always have a laugh at work. I also try to foster an atmosphere where they can challenge me and are welcome to question my decision making. They do not accept “Because that is the way we have always done it” as an answer. 

We also have interns which are graduate veterinarians who are hoping to specialise in some discipline. They are usually with us for a year. We have been really lucky in getting our interns placed in residency programs. I am an academic associate with several veterinary schools and frequently have veterinary students at our practice. It is really exciting to have these young and enthusiastic people around who are looking for guidance in their careers. I especially enjoy recognising that “spark” in a few of our students that suggests that they are going to be the leaders in veterinary medicine in the future. 

I lecture frequently locally, nationally and internationally and find this aspect of continuing education enjoyable. I try to make my lectures practical and fun, and try to inspire people to be the best vets that they can be. I also do newsletters monthly which are both educational and provide marketing for our practice. I also do continuing education every day with our referring vets. I try to make cases a learning experience for them in hopes that they can carry some of the information that they learn from the case at hand onto their future patients. 

I also actively teach nurses and encourage them to ask me questions in surgery and in the treatment room. It is important that they understand the decisions we make. Again, “Because that is the way we have always done it” is not an acceptable answer to their questions. I have a very active youtube channel with around 90 videos. We have had around 200,000 views from 183 countries. It is rewarding to me to have vets in developing countries watching and learning from our videos in an attempt to provide options for their clients when referral is not an available. 

You recently incorporated a 3D printer intp your practice – how do you use it? 
I love technology. I incorporate new technology into my practice any way I can. One of our latest acquisitions has been a very high-quality 3d printer which was partially supported by a grant from Royal Canin. With it, we can easily print plastic bones of patients which have been scanned on our CT scanner. We can use these bones to practice a surgical procedure (like fracture repair, tumour removal or repair of a congenital bone abnormality) on a patient prior to the actual surgery, pre-contour plates, better explain a disease to clients and referring vets and use as a marketing tool.

What resources can you point readers to?
Veterinary Information Network is a great resource for vets who may feel isolated in private practice. It is a subscription-based service which allows searching of forums on discussions in numerous different fields (like neurology, orthopaedic surgery and soft tissue surgery). If you are feeling brave you can post your own questions and have several responses within 24 hours from experts in the field. There are also proceedings from conferences and access to abstracts from veterinary publications. 

We have the SouthpawsVet youtube channel which has around 90 videos of different surgical procedures [Ed: I am watching these as soon as I get home from AVA!]. There are also thousands of human surgical videos on youtube which may provide some ideas for treatment options. Specialists are also a great resource because we are expected to keep up with our area of expertise. 

We welcome questions from primary care vets whether they are about potential referrals or about general knowledge. I also read medical history books and biographies because they inspire me to advance my abilities and sometimes give me ideas on how I can better treat my patients.

Are there any non-humans in your life and what have they taught you? 
We have two very silly male black Labradors. They live for the moment, love unconditionally, are not embarrassed about being really excited and are extremely loyal. They don’t stress about the future and don’t seem to worry about the past. I really admire those qualities about them.

Thank you Dr Kuntz for taking time out of your schedule! We're truly inspired.

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