Translating bumblebee dialect…
This article is a synopsis of an invited lecture that I gave in Rome, Italy, on September 28, 2024, and a compilation of my thoughts from several lectures after 3 decades in an academic orthopaedic practice. I want to express my sincere appreciation to my wife and partner, Trish; my 5 children; and many colleagues, students, residents, and coworkers, who have all been instrumental in shaping my experiences and expertise. While I do not have all of the answers in medicine and life, the positive feedback I have received after presenting these concepts in various parts of the world inspired me to share this version of my story. As I reflect on the past 5 years since the COVID-19 pandemic began in late winter of 2020, there has been substantial focus on physicians’ work-life balance in the United States and globally. While all groups were affected by the virus, the field of medicine has historically neglected work-life balance. Our orthopaedics group at The University of New Mexico (UNM) had always focused on improving the lives of all those involved in patient care in Albuquerque, but our COVID experience led to many new thoughts on work-life balance1. Don’t Forget Who You Are The first 3 decades of my life were interesting and culturally vast. I was born in Texas, and I moved to Colorado at age 10. When I was 20 years old, I attended medical school in the newly minted BA-MD program at Johns Hopkins University in Baltimore, where I also completed my orthopaedic surgery training. While in Colorado, I always remembered my Texas roots and took a lot from both states, although very different locales. In Baltimore, part of my success came from being a Westerner in an Eastern environment. Spending my first 2 years of medical school at the University of Colorado before transferring to Johns Hopkins was critical, I believe, to my academic success. My public education at Roaring Fork High School in Carbondale gave me a huge advantage in life. I often joke that my application photograph, with my longer hair, indicates that Johns Hopkins was looking for someone different from the typical Ivy League student (Fig. 1). If I could offer one piece of advice to medical students, it would be this: be yourself and be true to your culture because those experiences will add to your training, patient experiences, and other learners’ experiences.Fig. 1: Schenck application on December 1978, with a paystub from my PGY-II in October 1985. The “Not Negotiable” on the pay stub is the call schedule from my internship year, which was every other night for 12 months. I often quip that that was the “non-negotiable” piece.Although lessons learned can seem straightforward, they can be difficult to implement for many of us. I believe that the 3 tenets for a successful career are (1) tell the truth, (2) give credit to others, and (3) be humble. While these are 3 essential tenets for success, there are several details that must be added to create a happy life. I like to use stories from my career and split them into 3 concepts that contribute to a balanced lifestyle: (1) “no pobre yo,” meaning “no poor me,” (2) patience, and (3) friends. Life Isn’t Fair “Life isn’t fair” is often one of the hardest truths for us to accept. However, it is important to avoid saying “poor me” (or as I say it, “no pobre yo”) when reflecting on the obstacles we face. We must acknowledge that we will often be given the short end of the stick, and unless we take action, that might be all we ever get. When I feel unlucky, I ask myself 3 questions: (1) “What did I do to cause this?” (2) “What am I going to do about it?” and (3) “Is there any way I can harness this to make a positive out of the negative?” I was reminded about a typical call night as an attending in 1995 (Fig. 2), when I had to operate through the night until 5:30 a.m., after which I had to spend the next day in clinic feeling exhausted and frazzled. Clearly this type of schedule is not ideal or safe when caring for patients. In this example, the patient’s treatment was complex, requiring, at that time, the rarely used spanning external fixator technique. But at the end of the next day, I was (inappropriately) criticized for my work. Although the patient outcome was superb and the patient was grateful enough to grant me HIPAA (Health Insurance Portability and Accountability Act of 1996) approval to use her injury as an example, I realized that my work-life balance was not sustainable. While some of my mentors advised me to quit academics, I sought to create an academic practice that was doable for anyone who wanted to teach, perform research, and care for patients from all walks of life.Fig. 2: A 14-year-old patient who had been hit by a drunk driver required surgery from 12:30 a.m. to 5:30 a.m.After that night, I realized that I needed to implement changes in the physician culture, which meant I needed to improve my leadership skills. When you hear the term “leadership,” you may assume that it only involves telling teams what to do. However, genuine leadership involves using your influence and persuasion. I began researching topics beyond orthopaedic surgery to improve my leadership skills, placing focus on active listening and pursuing good mentors. To rebuild a healthy work-life balance, I also made it a priority to include my wife as a partner in my goals. Good Reads John F. Kennedy was known for many things, including his commitment to reading several periodicals daily. Although I am no JFK, I make it a habit to begin my mornings reading The New York Times and The Wall Street Journal (WSJ). I read the Mike Ullman quote focusing on truth, humility, and giving credit to others in the WSJ2. For aspiring leaders, it is essential to stay informed through varying news formats; however, it is equally important to read for continued education. Below, I have listed several books that were crucial in building a solid foundation for continued study of this topic, and I strongly recommend them. Clearly, there are also many ways to learn with audio and video, and how you best learn will determine what media you choose. Carnegie Dale Carnegie’s (D.C.’s) “How to Win Friends and Influence People,” which was published in 1936, is still relevant in today’s world3. Although the writing style may differ from what we see presently in 2025, the concept of active listening—listening without interruption, asking questions, and seeking to understand—was key to D.C.’s business approach. While we teach this in medical school, it is equally important to understand someone’s story and values in the field of business. Although learning a patient’s name is foreign to many physicians, D.C. advises us to “Remember that a person’s name is to that person, the sweetest and most important sound in any language.”3 As a rebuttal to this concept, virtually every physician will state that they are not good with names. As a counter to that rebuttal, I pose this question: You can remember the 12 cranial nerves, but you can’t remember the names of people you see every day? Although it requires effort, if you do not take the time to learn people’s names, I don’t believe you are really in the game. Collins “From Good to Great,” a book by Jim Collins (J.C.), served as my guide in evaluating the flawed systems that shaped our surgical and medical practices in the 1980s and 1990s4. This book focuses on 3 main areas: taking an objective perspective, the power of humility, and acknowledging the importance of giving credit to others (looking out the window versus looking in the mirror)4. When I became chair at UNM from 2005 to 2006, I independently and objectively examined the strengths and weaknesses of the department I had inherited. Our residency program at that time was superb. However, I found that we operated at night without proper support for the next day, which prompted my advocacy for the creation of a trauma room (which now extends to the use of 4 trauma rooms daily). I noticed that we treated each other poorly, which led me to implement a culture of professionalism for all. Lastly, I recognized that we were inadequately compensated, and I took an active part in improving this. We dedicated the next 17 years to improving patient and physician experience, encouraging respect among staff, and, above all, enhancing the resident experience. We achieved many successes, but it is essential to highlight the importance of giving credit to others. These successes were not my own—they were a result of the outstanding colleagues and residents who greatly contributed to building such a strong team. J.C. introduced the important concept of “window versus mirror”: when experiencing success as a leader, you should look out the window and give credit to others4. If the focus shifts to your own contributions, you should simply acknowledge that you were lucky. On the other hand, when faced with challenges, leaders should look in the mirror to reflect on their own contributions to the team’s failures. In other words, give credit to others for your successes, and take responsibility for your group’s failures. This approach fosters a strong culture of teamwork and helps develop strong future leaders. Lincoln There are several books exploring Lincoln’s remarkable leadership, but they all boil down to 3 key qualities: humility, humor, and persuasion. Abraham Lincoln adopted a humble approach to success, as highlighted by J.C. and Donald Phillips4,5. The goal was not about receiving credit, but about achieving goals. Lincoln’s humor was always self-deprecating, and his stories usually had a humorous ending5. Although it requires practice, embracing self-deprecating humor is an effective leadership approach. Lastly, Lincoln embraced the concept of persuasion in leadership. As a leader, it is important to recognize that you will not be able to consistently direct people to act5. Instead, your efforts should be focused on persuading others to achieve goals together. Additionally, through active listening, I have found that collaborating with my teams allowed me to identify the most effective strategies, rather than relying on my own ideas. These group solutions are often highly effective, especially when developed in collaboration with those who are directly affected by the issues. Leadership in academia has various effects, but when analyzing successful chairs, the Association of American Medical Colleges (AAMC) highlights the importance of emotional intelligence; business acumen; and a thorough understanding of your group, university, or department culture. Several short-term chairs or leaders were unsuccessful because they failed to recognize the subtleties of a geographic or university culture. At the start of my tenure as chair, I prioritized transforming the department’s culture. I approached this change gradually, using persuasion and remaining patient, celebrating small victories along the way and hiring colleagues who shared similar philosophies. It is essential to focus on improving your interpersonal skills, study business and finance, and understand the culture of the group you lead. I believe that the most effective leaders serve as catalysts for the successes of the faculty, residents, staff, and learners. The Journey As you progress in your career, you will experience several highs and lows, but it is crucial to remain patient and understand that things are never as bad as they initially seem. Additionally, success requires you to be patient and calm, which is often difficult to put into action. I often share a story from 1992, when I was 33 years old. As I prepared to perform an anterior cruciate ligament (ACL) reconstruction in a college athlete, I was called to one of the trauma operating rooms6. A senior vascular surgeon, who had already scrubbed in, asked, “Bob, can you scrub in and help me?” The patient had sustained a knee dislocation (KD) after being struck by a tractor trailer truck (HIPAA permission was granted to share this story and its images). Entering the operating room, I saw a knee exposed for a vascular repair and a single lateral radiograph (Figs. 3-A and 3-B)6. Fig. 3-A: Posteromedial approach after revascularization of a dislocated knee (KD IIIMC [ACL/PCL/MCL-corner and arterial injury]). (Reproduced, with permission, from: Walker DN, Rogers W, and Schenck R C Jr. Immediate vascular and ligamentous repair in a closed knee dislocation: case report. J Trauma 1994 Jun;36(6):898-900.)Fig. 3-B: Lateral radiograph of the knee injury from the emergency room. (Reproduced, with permission, from: Walker DN, Rogers W, and Schenck R C Jr. Immediate vascular and ligamentous repair in a closed knee dislocation: case report. J Trauma 1994 Jun;36(6):898-900.) While requests for assistance are quite common, I have frequently been met with responses like “no” or asked, “What’s the favor?” For this specific request from a colleague, I said “yes,” and I returned to the holding area to speak with my patient and his family, explaining the delay, and then I updated the head nurse on the situation before scrubbing in with the vascular surgeon. I repaired 2 of the 3 ligaments, stabilized the knee, performed the fasciotomies, and then scrubbed out to start and complete the scheduled ACL surgery, approximately 90 minutes behind schedule. By the afternoon, I reflected on the radiograph (Fig. 3-B) and found that the standard classification for KDs (i.e., based on position) did not apply to this case. Reflecting on my understanding of the topic, I realized that “classification” could also be based on the torn ligaments, and I quickly sketched what would later become the “Anatomic Classification System” (Fig. 4)6.Fig. 4: The Anatomic Classification System.The paper took 2 years to publish, and I faced rejections from 2 prestigious journals. I was extremely grateful when it was finally accepted for publication in 1994 in the American Journal of Knee Surgery. This example from my academic journey highlights the importance of the “3 As”: availability, affability, and ability. If I hadn’t made myself available, I would have missed the opportunity to learn and discover a new concept. That morning, it required a spirit of affability to pause my scheduled case, while ensuring that I completed all of my tasks. Although ability is important, it becomes irrelevant without first being available and demonstrating professionalism (affability). We continued to follow the grateful patient and later published a long-term follow-up on his outcomes. Despite my belief that the KD classification concept was an important idea, there was little initial interest, and the classification was largely ignored in the orthopaedic field. It was not until 2000, when I was in a busy clinic, that I received a phone call from Dr. Bill Clancy. When I answered the call, Dr. Clancy expressed interest in the classification and wanted to discuss it further. Following our discussion, he presented it at our annual sports medicine conference later that year. From then on, the concept gained global acceptance, leading to numerous publications discussing KDs, all arising from that classification system. 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