Most people imagine a surgeon’s skill lives in the hands. Dr. Leila Haddad thinks it mostly lives in the hours before anyone picks up a scalpel. Over two conversations in Geneva, she explained how she prepares, how her teams communicate and what she looks for in the surgeons she trains.
This interview has been edited for length and clarity.
Rehearsal
You’re known for rehearsing operations in unusual detail. What does that look like?
Leila Haddad:The night before, I walk through the operation from the first incision to closing, step by step, out loud. Not in general terms — in the specific order of every action. Where will I be standing? What will I ask for, and when? If I can’t describe a step precisely, that’s a step I don’t understand yet.
A child’s heart can be the size of a walnut. There is very little room for improvisation, so I try to do my improvising the evening before.
Does that change when something unexpected happens?
Leila Haddad:That’s exactly when it pays off. If I have already imagined the three most likely complications, then the moment one appears, I’m not starting from zero. I’m picking up a plan I made when I was calm.
“Skill is what you do when everything goes to plan. Judgment is what you do in the seconds after it doesn’t.”Dr. Leila Haddad
The quiet room
You’ve said the best operating rooms are quiet ones. Why?
Leila Haddad:Noise usually means people are discovering things in real time. In a well-prepared team, the nurse hands me the instrument before I ask for it. The perfusionist tells me a number before I need it. When a room is quiet, it’s because everyone already knows what comes next.
The one exception is concern. Anyone, at any level, should speak up the moment something looks wrong. I would rather stop for a false alarm ten times than miss a real one once.
Three practices from the operating room
- Rehearse the work out loud, in sequence, before you do it.
- Plan for the three most likely complications while you are calm.
- Make it easy for the most junior person in the room to say “stop.”
Fatigue and judgment
How do you know when you are too tired to operate well?
Leila Haddad:You often don’t, and that’s the problem. Tired people are the worst judges of their own tiredness. So I don’t rely on how I feel. I rely on rules I set when I’m rested: how many hours, how many cases, when a colleague takes over.
Teaching the next surgeon
What do you look for in a young surgeon?
Leila Haddad:Curiosity about their own mistakes. Technical skill can be taught; almost everyone gets there with enough repetition. What’s rarer is someone who leaves a successful operation and still asks, “What could I have done better?”
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