YouSaid · the spoken record

Dr. Sarel Vorster

lines on the record: 61
first: 2019-12-23
most recent: 2019-12-23
sittings or episodes: 1
sources: podcast

Every line below is reproduced as it was said and linked to the record it came from. Nothing here is summarised or generated. Directory · Search · Corrections

“I wish earlier in my life I paid more attention to detail. I wish I can remember more about things I did or that I wish I appreciated things more if I think back now on a ski trip or on this or on that I wish I could remember more detail and I wish I paid more attention because life is short and time whizzes by and before you know what the children are grown up and everything goes so fast so I wish that much earlier in life I was more grateful and more attentive and more appreciative of things around me so that when I get older and still on the porch I had more to think back on.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“My dad passed away about two years ago, and as it goes with sons and dads sometimes you know, we played a lot of golf and so on, but there's not a whole lot of talking going on. Besides maybe a birthday card and so on. But he wrote me a note which has become quite precious to me, and on the note he says Dear Charles, I love you, you know proud of you, and then he says Take care of your stuff. You know in one line beware of debt. And time will tell Love Dad and they know initially when I read that I thought well that's kind of interesting, you know, just this moment where your dad imparts his wisdom on you. But this idea of taking care of your stuff and avoiding debt and time will tell actually has a lot of wisdom as you ponder on it.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“Not recently, but what I've learned is that people have become more and more distracted. It's fascinating when you if you just go to a dinner with people, I've realized that most people are not paying attention, basically. People are extremely distracted. I don't know if it's a sign of our times or stress or cell phones or maybe it's always been like this. But it's very noticeable to me that people are not remembering, hearing, or listening or internalizing and talking past each other. And hearing actually requires a bit of mental work, you know, seeing of the perceptive senses seeing goes straight in. You just see things without it. You don't have to decide to see something. But hearing, you have to decide to listen to somebody. And doing that and not just thinking of what you're going to say back and so on. It requires a bit of mental work. And that is something that I've really noticed as I communicate with colleagues or with you or with”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“While I read my Bible I don't know people offended by that, but that's what I do. I like reading books about philosophy and history, so I have my wife once again, you know, they're ultimately our thermometer that keeps an eye on us as they are our spy of, I shouldn't say my wife, our spouses. In any event, on my bookstand, there's always ten books, and usually about three of them are about the mind and the brain, and maybe there's two or three that's the current reading that we all read. And then there's usually some books on faith based issues and religion in general that interests me.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“I'm getting older now. I'm more perhaps in your world where there's lots of meetings and discussions and so on and something that strikes me as it always annoys me is when there's meetings and people aren't prepared or they don't stick to the agenda. All the variations of that. So meetings and meetings that go over time or people that don't show up on time, that's really something that annoys me.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“That's kind of a funny topic in our home because my wife, I like fooling around with my chainsaw and cutting down brands. And you really shouldn't be doing that. You were a neurosurgeon, you know, and many of my friends are horrified when I do these things. And I say, well, you know, I use other more dangerous power tools. But I do think about it a little bit. I don't like sticking my fingers in things or getting things in my eyes and so on. And I've learned as I get older, your body reminds you, even if you're not thinking of it, you know, you need to, if your back hurts, well, you know, don't do that again because tomorrow when you're operating, you know, you're not my tamper your performance. I'm just a little bit more aware of not doing things where I'm hurting myself unnecessarily.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“Me as a South African, I mean, I love swimming in the ocean and having a barbecue outside. I like being outside. And I've learned to ski a little bit since being here in a different part of the planet, being around water in general is just fun for me and just observing as I said nature and being with my dogs. This has a profound effect on me. And whether I'm walking through it or cycling through it or swimming in it, that's really the main thing. And then I do some sport, but you know, you have to have your stiff back and your sore knee taken into consideration. But I play squash with my son and we play a lot of golf. I like that. We play table tennis when we're at home when it's cold outside. Those are kind of the main things I like doing physically anyway.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“Receptor, which then can stimulate your exoskeleton, sort of like Iron Man or maybe directly on the muscle so that people can think about moving their arm and then move it or perhaps move a cursor or something like that. The more provocative things have to do with trying to see what people are thinking, which of course that's quite nebulous to see if you can make somebody think better or be smarter or think faster or something. There are some very interesting entrepreneurial activity out there, but in its infancy still. I don't think computers are going to take over the world. I think humans will always be in control, but I think there's a lot of excitement about using what computers can do for us. And along with predictive analytics, deep learning, these are the fields I think that will impact us as well.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“I think some of the most exciting fields in neurosurgery is the whole concept of brain machine interface. So people are interested at several levels. The most advanced of these has been deep brain stimulation or spinal cord stimulators which have been aimed at certain types of disease like dystonia or Parkinson's and so on and also to chronic pain and so forth. So this ability to use stimulation and the technology that enables it has been a big change and I think the horizon there would be there are fascinating studies where it has been found for example that the area in front of the motor region in the brain called the supplementary motor area gives a signal before you move so researchers are working on harvesting that if you're thinking of moving your arm it hasn't moved yet that signal can then transmit into a”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“Because many older surgeons act as assistants or maybe though taking some call but not then operating the next day or maybe they're doing consultations and letting the surgery be done by younger people. So there are different career options. I wouldn't propose that surgeons should stop operating at 60 or 70 or 80 or something. I have some colleagues that are amazing people near their 80s that are still doing smaller surgeries and so forth. So I don't think there's a clear answer to it. One has to be realistic with yourself. And people find we all move laterally later in life, I think. So some physicians are finding themselves in I'm spending one day of the week on various committees and research and so forth. So it's kind of a day from a physical point of view where you're not physically stressed perhaps. So I think that's a nice transition as one moves into leadership.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“phase you are, and as you move along and you may be getting more towards a seasoned practitioner like I guess I am, that you should share what you've learnt with the younger people but also be open minded for what they and remember how you were so I think but there is definitely a life cycle to it and then of course the second part of your question of course people always ask are you shaky you know are you getting older can you see well and so on and these things are true I've noticed that I'm less tolerant of being called in the middle of the night and then having to operate tomorrow again when I was a resident before the work hour restrictions and these things we would just go forty eight hours and my body could tolerate that my body becomes less I mean and we all our different health issues perhaps or different things so I think there has to be a realization that there's a point that's maybe now it's difficult to define in surgery”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“I think there is definitely. I think we all are subject to a lifestyle. You know, I think our modern society, we worship youth and vitality and all these things. And I mean, those are valid things to strive for. But I think there is a time in our lives where we more, the young guns are, you know, pushing and we do new procedures and try new things. And I think there should be a counterbalance to that where maybe if more seasoned practitioners are saying, well, you know, we did that in the 60s and this didn't work and we learned this and so on. So I think a healthy balance. I think that healthy balance might be going a little bit currently in my opinion because there's a lot of this fourth industrial revolution as people call it. There's a lot of technology and people are hoping that technology will just solve everything. But I think there is a healthy balance as there always was between seasoned practitioners and young guns. So I think one has to recognize in which”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“Along with that goes a sense of gratitude sometimes that induces where one then sort of count your blessings, count them one by one kind of thing, that helps me to refocus just get back to the reference point kind of thing. My family helps me a little bit with that. My dogs, you know, just simple things. My faith helps me. So different things like that where you just reset the zero basically. I don't think that's the thing that you can sit and do in your office. You need other things that you can lean on count on.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“Or something, you know, and then I just walk back. So that's the way of coping with the emotional rush, which is basically a chemical reaction in our body that we can't, we just can't escape. You can't unlearn it. I think some people have learned to turn that to their advantage in other fields where they use that rush or the aggression or something to their advantage. Now, in my field, that's not really applicable. So you have to just allow it to overcome. The other part is the more the longer term thing. How do you learn to cope? I find solace in nature. You know, I like walking around outside and just seeing beauty and coordination and everything and you know noticing detail, paying attention to detail, you see a bird. And, you know, as we get older, the world becomes gray. We have to look at the world with a childlike kind of. So attention to detail.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“I'll answer it in two ways first of all our emotions and our adrenaline rush and our adrenal glands and all of these things, the stress response, the fight and flight response you can't avoid these things so no matter who you are and how expert you are at what you do you will feel it I think the most seasoned professionals in all fields including mine you will still feel that adrenaline rush you can't unlearn that you recognize it when you feel it the first time you experience that you it kind of shocks you you know well I never thought I'd feel a little shaky now so that helps a little bit and then understanding that you can't avoid it so I sometimes tell people okay mandatory walk around that's what I say and then I step away from the microscope and I walk around the room for what feels like an eternity but it may be five seconds”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“The concept of you need to separate what happened and then move forward because you have important work to do going forward feels quite different from the emotion of being triggered in that. How did you learn, or is it still a process of learning to make that effective for your future patients?”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“The very least you can do, or maybe the most important thing you can do is to learn from it. And that's where the eminence-based, and then share that with your colleagues so that we don't all have to go through it.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“And once you become fearful or hesitant by something that happened to you, it's a disservice not to the patient that was on the receiving end of the problem, but also to other people that now are dealing with a hesitant surgeon. So that's quite difficult to not let previous things affect your future performance as well as you can. And the only way you can do that is back to what I said in the beginning about this very extensive preparation and sticking to the plan is very important because then when things go wrong and you get to the point where you're questioning and you're laying awake at night staring at the ceiling and feeling terrible and not talking to your wife and you know just not wanting to go to work tomorrow, it's an awful feeling. You can find some solace in the fact that you stuck to your plan and you did the right thing. And despite all of that things can still go wrong. And if you didn't and something went wrong,”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“Well, there is also a humorous side to this, believe it or not. When I first started operating in the US, you know I'm South African. I have a bit of an accent, you know, and for us, when the patient wakes up, that's the moment when you see whether they can still talk and move and so on. Whereas maybe with some other types of surgeries, they just have to wake up from their anesthetic. And I would go up to somebody and say, well, show me two fingers, squeeze my hand or something in no response. And then somebody with an American accent came to the patient and said the same when they would do it. So that's kind of a scary moment for you. So I've learned to ask the anesthesiologist to give the commands because maybe the patients understand them better. But things go wrong. You're right. And I think one has to have a way in which you handle this because you have to think not only of the unfortunate person, of course, and the incident, but you have to think of people you're going to be operating on next week and next month.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“A serious note, I've had two colleagues who've committed suicide over bad outcomes on elective surgery where somebody goes in and has some type of complication unavoidable there's no real malpractice involved, but things happen at neurosurgery. So these things are very, very difficult. So one has to understand the field you're in. But the way I cope with it is”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“To keep in touch with your colleagues, you can't be isolated. If you get isolated, you know you're always at the risk of drifting a little bit this way or that way. Now no two surgeons do something exactly the same. There is a circle, there's not a dot as I like saying, but I mean this circle. well defined. So I go to a lot of conferences, I listen, I speak, I teach, I learn, and in all of these processes you know you constantly testing yourself. It's an international family. There aren't that many neurosurgeons in the world. So when I speak to colleagues from Brazil or India or South Africa, they may know things or they may have encountered something that I have. And so there's a lot of communication. We also like doing conferences where there's a small group because large conferences are not always personal.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“One way of making it this is kind of an indirect question is defining your metrics better because what is a successful operation? So we've gone through this for example let me give an example like let's say with back surgery we all know you just have to go to a barbecue and there will be somebody who had back surgery Either they're very happy or they've had seven surgeries. So in other words the metric of what you use of what success is. So if surgeons use the metric you know there's a solid fusion that has been achieved with instrumentation. That metric might not directly translate into what the patient was hoping for which was to play tennis with his children or something. We're becoming a bit more aware of that I think in previous eras we were more interested in achieving the surgical result the tumor is out but oh by the way the patient can't you know there's some dysfunction or something or the fusion”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“So, I think ownership is the answer. And as our teams and the complexity gets bigger, that becomes more and more of a challenge because people are switching out, people on brakes, people go on holidays. So I think the ownership of actually knowing who the patient is and introducing in the beginning, some of the timeouts we introduce, this is Sally. She is the scriptic and this is John, the rib from some company, and this is Dr. from China who is visiting us today and this is so when we do that everybody seems to have ownership and that ultimately I think is really the way of getting them to do their job.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“But I think what happens in the operating room there are people of different ages, backgrounds, different levels of education. And we're all wearing masks and hats. It's kind of an interesting situation, but we're all in the room and there's one patient. And so you have to get people from completely different backgrounds on the same page now, including with the music. I mean, I sometimes, well, you obviously won't like country music. And if somebody, people will say, no, I hate country music, well, then we listen to reggae or something. When it comes to the point of accountability, I think the idea for me anyway is to have people understand ownership of what they're doing. Because even if you're the guy that just goes and gets stuff every time the nurse needs something, that's very important because you know where is the jull foam? Well, Bob ran out to go get it from the long is it going to take. But if Bob realizes he's off to go get it and we're waiting for him, you know what I mean? And maybe he thought already before he knows doctor Vorster wants that we will know where it is.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“You mentioned something in talking about that that was sort of direct accountability to someone on your team where you said you are doing this. Are there lessons that you've learned over your experience or tricks that you employ in? Help you manage the team of people around you.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“You have to remind yourself, what are we doing here? And this is where we try and stand in several, right? Rather than harm this person, maybe we should pull back a little bit. Let's leave the last little bit of the tumor. We always say most accidents happen near home, you know, so don't go after that last little, just stop before things really get bad. And that's hard to do for a surgeon. You know, we trained to, we're in there, we're going to do the job completely, but you have to then force yourself to say stop. And that's where you're back once again to the original preparation where you have to have a clear plan of what it is you're doing. Otherwise, if you're constantly... changing or sort of winging at as people say that's when you get in trouble whereas if you have a plan it's easier for you to stick to the plan”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“Maybe we overemphasize it, but I don't think you can overemphasize it because it just heades your bet, basically, that when you get to the point where something does happen, at least you have the first 80% covered. Now then when it does happen anyway, you still have the last 20%, but at least you're in a better situation. And even an experienced surgeon like myself, I mean, you do feel that a little rush of adrenaline and as you're holding the suction and it's bleeding everywhere and you know you can't see you feel the little tremor in your hand and so on and that's when you just have to stop because of course if you're the leader right so everybody else is watching and they're even more nervous and then we usually now go again through our okay let's get second suction let's have the temporary clips turn off the music you keep quiet please these kind of things so once again you have to stick to your process as well as you can and at this point”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“Well, things happen, yes, the main thing in neurosurgery, it's kind of a thing we say don't know where I heard this first, but one of my mentors told me first we set the table, then we eat. And you know it sounds sort of simple maybe, but it's very true, especially in a field like neurosurgery, because most of the surgery, if you say four hours, there's maybe a half an hour in the middle where really the important things happen. So there's a lot of opening and positioning and all that, and at the end, there's a lot of closing again because we're going into it's not like a mole in your skin, you know, so there's a whole approach and then going out again. So the best way to avoid these spikes, sudden bleeding or over the anesthesiologist has some concern or whatever things happen, is the preparation is extremely important. That's where this, let's say, at the table thing. So you can't afford to rush into because, you know, the devil would love this once we're at the important part, that's always when it starts bleeding. Or that's when the phone rings in your assistant's pocket, or that's when...”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“These processes. And you have to think, okay, when you're going through a multi-hour procedure and you don't exactly know what will happen, there's all kinds of modifications. How do you work your way through that process as things don't go as you might have anticipated?”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“It referred to the content expert basically. So if it's a neurosurgical problem, then that section head will look into it and maybe talk to that person or recommend that they go for a refresher or something. Or are they having problems? Maybe you should take a week off or something like that”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“Something, so it's just maybe a silly way, but to remind me that the patient that's there under all these drapes is actually a person, of course, but you know, in the maem of it all, one can easily, and that tends to focus your thoughts and makes you remember. Measuring variability, we look at outcomes and of course big hospital systems, all hospitals have systems that can look at outcomes. We have what's called, I used to call them M&M conferences, which meant morbidities and mortalities where if things go wrong, you know, people discuss and, I mean, really do root cause analysis and all kinds of things. And there's processes that go through. If somebody's thought to have done something, and we don't wait for things to go wrong, we even try and get what we call near misses or anything. Then we review that and we say, well, maybe next time we should do this or we shouldn't have done that. And obviously if somebody's outside of the circle, then that...”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“It does vary, we know that. It's hard to measure specifically, but you know on some days you know yourself you might not feel as sharp or something like that, and you have to be more careful. Now fortunately we work together, you know, so assistants and other people will ask you look a little don't you want to go out and have a cup of coffee or something? That happens rarely, but those are more the extremes that everybody can notice or somebody's just annoyed or they're going through some personal things or they're just recovered from illness or something, you know. So I think those things are well taken care of. The part that's more nebulous is how do you know that somebody is just going through the motions or whether they're really involved and so on. And my way of making sure about that is also just small little things. Sometimes when I operate on people, I talk to them, even though they were asleep. So I'll say, come on, Ted, help me out here. Stop bleeding.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“Well, sometimes I have little quirks because remember there's a team and I'm the leader of the team for these few hours and I'm in the room. And so I have to make sure that all these people are motivated and attentive and so forth. So I try to read the room, sometimes we talk about, I mean we're human. We're talking about, you know, how was your weekend or something? But when there's a serious part of the case, usually, for example, when we bring the microscope in, I would say we'll turn the music off. Let's just get everything ready now. So then we stop and now equipment's being moved around. We turn the music off and you know, oh, somebody's standing in for somebody else who had to go for the lunch break. Well, who's this? Okay, what we're doing now and so on. So that's when we stop the music. And then sometimes at the end of the surgery, I have this little quirk where I put on the old song by Roy Rogers Happy Trails to You because that's sort of an old-fashioned ring to it and it has a”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“Confirm this is what we're implanting, this is the expiration date, these kinds of things. And at the end, there's the last one. So there's four. There's a sign out where we say, well, what we did was this, and we put this drain was inserted, which is going to drain afterwards. And the patient received this blood product or didn't. And there was a specimen that needs to be sent to pathology or did somebody actually do that, or has it been sent? And then we end off with, is there anything we could have improved or done better? I'm annoyed that my drill was a little blunt. Or make sure that gets sent in for so there's four levels of these checklists in my situation.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“So that's the huddle, and we make sure we know any details about u that might be forgotten. Everybody forgot the allergy or something. And then when you were asleep, before we do the surgery, we stop and recall this time out. And the idea of the timeout is that everybody in the room stops what they're doing because there's constant activity. So doing this timeout usually led by the surgeon or somebody that I say, well, why don't you do the timeout? We go through, well, this is, you know, the patient's name and this is what we're doing and is this ready? Is that plugged in, etc? Has the antibiotics been given? Do the compression stockings work? All these other things that might have nothing to do with actually procedure, but all the parts of it that's important. And then in the middle of the case, if we do different implants or things, we have a pause with the operating room team. So everybody.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“While the organization I'm involved with that I work at, we're very safety oriented. So these checklists have been a mixed blessing for physicians, of course. It takes extra time and effort, but we think it's worth doing. So there are several levels of this. And I think it's become necessary because of the increasing complexity not only of the equipment and so forth, but also because of the team. We like to think of ourselves as teams, teams of teams. So there's teams of anesthesiologists and teams of everybody involved. And so you have to make sure that everybody's on the same page. And so this checklist era is, I think, yet to stay and ever expanding. So it starts with what we call the huddle. So before the patient's asleep and some families around the bedside, we do a huddle where we make sure that you actually agree that the surgery you're having is the one that you thought you were having.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“We walk through some of the things you highlighted. So with all of these equipment and preparation, it just seems like there's a lot to do. How much of that gets codified on a checklist, like the classic Atulguande Manifesto, and how much of it is just you know to do this?”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“And things are really getting focused. What I like to do, my little quirk, is I listen to 90s country, believe it or not, because I do practice in Ohio and everybody likes country, and so do I. And what I find is it's just lively enough to keep us going, but it's not too lively. So 90th country, everybody knows the music. So we play music, and it's actually been studied that makes surgeons more effective. So it's not distracting, it's soothing. And then we put all the imaging up because in a brain you can't look around. We're operating on the brain in front of you, but the imaging is on the wall or on a computer. So we make sure the appropriate images are up.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“Obviously, by the anesthesiologist, but we might be turning somebody over to their stomach, or we would immobilize their head in what's called a Mayfield head holder, because for us the approach is very important. The angle that you go. So you can see we're not even near the surgery, and already I've told you many things. And then, of course, there's all the equipment. All these tables full of equipment. And so now I walk up to the people that are controlling this. Is the microscope balanced? Is the image guidance machine ready? Is the ultrasound machine ready? Do we have the irrigating bipolar? Do we have the ultrasonic aspirator? There's so many different aspects to all of this. Do you know how it works? Is the rep here that brought in this new machine we got last week in case the computer program doesn't work? So endless preparation. So now the patient's asleep probably.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“But now I'm trying to hone in my thoughts on this particular patient. I have a little ritual where I take off my wedding band and I tie it to the scrubs I've sort of a drawstring on the front so I tie my ring in there because I don't want to worry where I left it and I turn off the pages, you know, I tell the assistants take your pages and phones off and put them on the table because somebody's phone rings in their pocket when we're operating. So all these little minutiae, you might say, are extremely important when you're in the heat of the battle. And then when I go into the opering room, I walk around and there's teams of people in there. There might be ten or twelve people in the room, and most of them I know, but there were also this one is a stand in and there's a student and so forth. And I make sure that they know what I'm trying to do and what we're achieving. For example, somebody gets put to sleep on their back.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“Well for us it's all about preparation, you know, neurosurgery is one of these things we really have to prepare properly and you have to go through the steps. You just can't afford to cut any corners. Maybe I should take you through just my own process. First of all, you know, I tried to show up early on the day that I operate. We don't want to be rushing through the traffic and so forth. Sometimes patients ask me because we sign consent forms just before they go in. Doc, we hope you had a good sleep, you know, and it's true. So the preparation and the risk and all this starts with me. So I try to make sure that I'm there early and relaxed. Go to the bathroom. You know, it sounds silly, but our surgeries are long, right? So we've been there for hours. Make sure you add a little something to eat. I've got my own little ritual I go through. I put on my scrubs and I'm starting to focus on the patient and not really on all the other things going on because we get calls all the time. There's lots of other patients.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“Early and be done with it. For example, if you have a small slow growing lesion, say in your brain, you have the option of observing this, we call it expectant observation, so you scanning the person every few months and you're seeing if they so some people would prefer that. They would do everything not to have surgery they're afraid and for good reasons of course. Other people are more like I just want this thing out Now of course the difficulty is if you allow the decision completely to the patient I mean they're not the expert But I tell them listen I'm on the blunt end of the of all of this and you on the sharp end so I mean you can't you can't avoid their input and you really want it but ultimately you have to guide them into what you think the right decision is and there I mean all you can do is would I do it myself sometimes people say well would you do this to your own family member and so on and those are just really the questions you go through as you”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“That is very difficult, you know, we're all different and patients are all different, so some people are more risk averse. Others are more things I often use people say, well, I'd rather take care of something.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“So when we were talking before, you said something that really struck me, which was that, and this has to do in this area of effectively incentive alignment, where if you had a group of surgeons in a room and went through an example, and maybe 80% of them would say, yeah, I would recommend going ahead with that surgery. And then you ask the question of, well, what if you were the patient? And you said, oh, it's actually flipped. Only 20% of them would go ahead. Talk some about your as the surgeon your own personal involvement in those recommendations.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“find out what they're willing to subject themselves to ultimately, and try and be as clear as you can about what you think you can do for them. This is really a moment where you have to be honest with yourself because, I mean, we are neurosurgeons, right? So people put us on a pedestal, we put ourselves on a pedestal probably. But this is where you have to be honest with somebody and tell them, and you really have to follow. The patient plays a big role in the decision making here.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“Ultimately, a very human interaction, right? So, for us, I think protection of function and maintaining quality of life is really the first thing. Before we unleash all the wonderful technology and machines and medications that we have on a person, we really want to just come back to basics and say, well, you know, is this really going to improve the patient's quality of life? And I'm sometimes surprised. You know, people say, well, I really don't want any of this. I'd rather spend my time with my grandchildren. And other people are the opposite. You know, it's quite surprising sometimes. They say, well, we want everything done. We don't mind if dad's on a ventilator. We would just like you to do everything because that's the kind of guy dad was. You know, he would have wanted us to, we're helped a little bit nowadays by the presence of advanced directives and living wills and so on, which makes this situation a bit simpler. You really get the full spectrum of what people would accept. And you have to try and...”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“So that means before nineteen seventy six you and I were already on the planet. There was something in your brain we didn't really know where it was. It's very recent, actually. The information that's available now is fairly new, so we don't have long-term outcome studies yet and all the other tools of science. So we stand on the shoulders of giants where people have discovered this is what you can do and that's what you can't do. I like calling that eminence based medicine rather than evidence-based. So eminence-based, in my mind, means if somebody with a lot of experience and skill did something, we can learn from that. We would be foolish to ignore that. On the other hand, we have to marry that with newer data and genetic testing and other things. But that's kind of the combination that we use.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“Medicine, we're trying to be more and more evidence-based. I mean, society requires that from us, we require that from ourselves, science requires it from us. We want to do things with data. We really want to incorporate data into what we're doing. And I think that's the way forward. However, data isn't always available, especially in brain surgery, because you can't do double blinded tests, for example, where somebody gets a placebo and some don't, and so then you can develop a kind of an algorithm or a plan for your blood pressure medication or something. So with surgery, I sometimes think we stand on the shoulders of giants. I mean, I can't imagine 100 years ago, neurosurgeries, by the way, one of the newest fields in medicine, not too long ago. To put it in context, CT scans were started in nineteen seventy six, I believe, and MRIs around nineteen eighty four.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“So I show them on the scan, I point out the abnormality, and I point out how we would get there and how all the equipment we use works. For example, the stereotactic image guidance machines that guide us through the lesions, I explain all these things to people. And then so you get to the point where, all right, we're going to do the surgery now. And then, of course, that gets scheduled so other people come in, nurses and assistants and so forth and start organizing just like any other surgery, but of course with the big difference, it's now the brain or the spinal cord.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source
“This is the much more common situation you're describing, and in this era of information, people often come with piles of photocopied things from the internet and various things they've read and so on. So people come very informed quite often because you can find anything on the internet as you know. Now we have to try and explain the things, their questions. Give people the opportunity to answer their questions and for what it is that they want to know. So this is a slower type of process and there's more questions and the decisions are often more complex now because in the emergency room it's kind of a black and white thing. You know somebody has to go to the operating room now. But in these elective situations things are a bit more complex or different. So here one has to follow a different type of approach. My approach once again is to get everybody on the same page and review the scans. I like showing people nobody's really seen a brain scan.”
2019-12-23 · Capital Allocators · Dr. Sarel Vorster – Conducting Brain Surgery (Capital Allocators, EP.117) · IDENTIFIED FROM THE TRANSCRIPT · source