Principle one
"As master chef, I set the highest standards for my cuisine,
my menus, my wine. In the centre of the art of my cuisine
is my guest. I set the same high standards for my surgeon:
for knowledge, for ability and above all, for a deep personal
understanding of me and my illness. He has fulfilled my
expectations. I would put myself in no one else's hands.
He has changed my life for the better."
Jacky Donatz,
master chef,
Restaurant Sonnenberg, Zurich
As a surgeon, I am a physician. As such, I do not operate simply on a hernia or something more threatening. I always operate on a person. People are unique. They are part of a family, whose members cherish them.
Families, their living together and the interactions of the different members, the various cultures of the world, social differences, professional strengths, understanding of medical connections or lack of understanding for the physician – how different and fascinating are the personalities we physicians encounter daily. We must deal with completely different life situations: young people who have their whole life ahead of them, who suffer from a malignant tumour react differently to a large operation than older people, who already have a large part of their lives behind them and are also often winding up their lives.
To meet all of the expectations of every single person, to understand him and to try to grasp his situation, with all his fears, concerns and hopes – how demanding is the task of surgery. How difficult it is to understand that there are also people who reject our knowledge and art and do not undergo an operation.
Scientific knowledge, technical ability, appropriate indications – everything is important; without these arts there is no medical activity. But all this pales besides the trial to understand the person sitting opposite. It is important to understand not only a suffering, help-seeking patient, but an entire human being with all his rights and integrity as a patient. The physician must not only sit across from his patient; he must stand on his side. With this, comes the physician's medical obligation not to impose his own value system on those seeking advice ("What would you decide in my situation if it were your wife?"). Today, it is completely frowned upon to exercise a certain medical power, which relies on additional knowledge, preventing the patient from freely arriving at his own decision, but to try to impose his own will and his own value system onto the patient. These factors become particularly important in malignant diseases which suddenly become more important than the rest of the medical art. The questions as to why: "Why me? Why now? Where does the disease come from?" fade very quickly compared to the much more burning questions which concern us deeply in the long run: "How long will I live? How will I die and where does my way go?" Questions as to the sense of life, the sense of our birth and death suddenly become more important than anything else. In these uncanny questions, not the scientist, nor the technician, nor the good surgeon with clear indications is called upon, but the physician in his entire humanistic view caring for the patient in his most basic function. In these circumstances, one looks for the healer, the shaman and poses questions from the area of transcendence.
Here the challenge to the surgeon and physician is almost too great. The topics become difficult; they affect our most ancient darkest fears. In this situation, discrete, compassionate answers must be given to provide hope. In the long run, the most important art of the physician and surgeon is to be truly humanistic. Therefore, it is also true today that the physician's profession should be a true calling.
In 20 years as an active surgeon, I have performed abdominal surgery on over 5000 patients, advised and treated even more, I try to reflect today on my activities and to propose a basis of generally accepted principles. I have learned these principles in the course of my professional activities in working with my surgical teachers and have further developed them on my own. They are the focus of my professional and life experiences. They govern my activities and my understanding for humans, who entrust themselves to me as patients. They form the foundation of my activities and assure the optimal operative treatment of injured, sick or even seriously ill patients.
In my practice, I treat both men and women with equal attention and respect. To simplify the readability of the text, I have used the masculine form in the text.