“I’d like to see a bit of a paradigm shift in how we treat people with chronic headaches. Right now, there are many practitioners with their hearts in the right places, but who seem to be working on their own islands in the sense that they know what they know and very little else. I’d like to create a center where there is a multidisciplinary approach to this condition and where each of the practitioners learns from the other. I’d then have that center be a model for other similar centers throughout the US and the world. In that way, I think you could make a real difference to the more than 36 million people who suffer from this condition in the US alone.”
I had the pleasure of interviewing Dr. Ziv Peled, a board certified plastic surgeon based out of San Francisco. Peled does perform the typical procedures associated with plastic surgery. However, he has made it his mission to help migraine patients find permanent relief with Peripheral Nerve Surgery that has proven to be life changing for patients.
I was born in Israel and emigrated to the United States with my parents and younger sister when I was 5 years old. I grew up in Connecticut and fell in love with medicine after seeing a Nova special on open heart surgery in the 7th grade. During medical school I became interested in plastic surgery because of the varied nature of the operations these surgeons were performing and because they seemed to be the happiest people in the hospital. I was introduced to peripheral nerve surgery almost by accident when I ran into a colleague of mine (now a very good friend as well) from Harvard who had done extra training in this nascent field. I immediately knew it was what I was meant to do when I saw the profound impact it made on people’s lives. I have developed my skills in headache/migraine surgery as a natural progression and extension of the field of peripheral nerve surgery which at this time is so full of promise.
One of the first things that comes to mind is a woman who came to see me with longstanding chronic headaches who wanted to have a child, but was so incapacitated by her symptoms she didn’t feel she could take care of herself, much less a newborn. After surgery, she was essentially cured of her headaches and in one of her last follow-up visits, came to see me with her new baby. It is in moments like those when you feel you make a real difference in your patients’ lives.
Anne is a very progressive breast and plastic surgeon and is very much at the forefront of breast reconstruction techniques. We are currently working together on a procedure that will give mastectomy patients not only a beautiful aesthetic result, but minimize the number of reconstructive procedures they will need and hopefully preserve or even augment sensation to the nipple and areola which has heretofore never been done.
I think one element missing from modern medicine is the ability to look at the person you’re treating holistically. What I mean by this statement is that physicians are often focused solely on treating a particular disease or medical condition and not so much the person who is suffering from that condition. Therefore, my advice would be to take a few moments with each patient and really ask them, not only about the problem for which they came in to see you, but also how it is affecting them and their loved ones. In doing so, I’ve been struck by how many patients really open up about their lives and concerns and simply engaging them in a conversation really strengthens the physician-patient relationship.
I’ve been surrounded by some impressive people in my lifetime, but topping that list would have to be my wife, Anne. She was recently diagnosed with breast cancer at age 37, but instead of folding she completely focused. Remarkably she has not skipped a beat in terms of her duties as a mother to our three children and now has an even more poignant way of relating to the many breast cancer patients she already treats with such compassion, humility and grace. Talk about making lemonade out of lemons. It has truly been one of the most amazing things to watch and makes me think anything is possible.
I think Steve Jobs by Walter Isaacson was pretty influential in my thinking about my career. I can relate to his drive for making every experience incredible, but also to his perseverance in the face of failure and his return to Apple to turn it into one of the most influential companies on the planet. My favorite story in the book is when Steve Jobs relates a story his father, who was a carpenter, told him about making a piece of furniture. He apparently told Steve that even if you make the most beautiful piece of furniture that is to go against a wall and you make the back of the piece of furniture out of plywood since no one would ever see it, you would always know that the back was not as beautiful as the rest of the piece. Mr. Jobs goes on to say that it was that experience that drove the relentless desire to make every Apple product beautiful from inside and out. That drive and desire to do the very best in every situation has remained with me to this day.
I see the field of peripheral nerve surgery as a primary vehicle for the treatment of chronic headache and perhaps pain in general. Ultimately, like we have for certain malignancies, I’d like to see a multimodality approach to the treatment of chronic pain in the US and across the world. My goal each and every day is to help at least one person improve or eliminate their pain and return to their lives.
The hardest year of training is your first year in practice. I heard this phrase in 2009 after two years in practice and it resonated so profoundly with me that I recall it to this day and wish I had heard it two years prior. Many trainees think that as soon as they finish their residency, they will be on easy street, but nothing could be further from the truth. Once out on your own, the prospect of building and creating a practice from scratch that fits your vision of how people should be treated can be quite daunting, especially in today’s medical environment. While its not so sexy to say, the good news is that with perseverance, hard work and a clear sense of purpose, anything is possible. I’d like to think my practice serves as an example for this ethos.
You continue to learn how to treat patients every day — embrace that opportunity. During training one often learns a lot about how to treat various medical conditions. Less obvious and easy to grasp is how to treat the patients presenting with these problems. It is critical to search out physician mentors who are not only good practitioners, but good people. That is where the secret to being a good doctor lies. After all, the patients you treat are people — sick people who need not only your knowledge/skill, but also your empathy and compassion. Being there for them in this myriad of ways is truly the best medicine, regardless of the outcome. I learn things about life from them each day and continue to learn how to be a better doctor because of them.
Taking care of yourself allows you to take better care of your patients. As physicians, we are trained from the beginning to endure long hours and practice self-sacrifice. However, eventually there is a price exacted for self-neglect. Being mindful of the stresses that your practice takes on you and being honest with yourself about your limitations and needs as a person are critical to avoiding burn out and maintaining a positive outlook. Doing so allows you to truly enjoy the physician-patient interaction which is one of the most profound connections possible.
Know what you don’t know, but find the answer when you don’t know something. It is tempting when you start out to try to do everything, but one soon realizes that doing everything well is nearly impossible. While there is certainly an argument to be made for taking calculated risks, innovating and pushing your abilities, one of the most important lessons I’ve learned is to recognize when you don’t know something and be honest with your patients about it. They will appreciate the honesty in and of itself, but especially when you also help them find the answer to their dilemma, even if it is with another physician. I have had many patients over the years return to my office simply to thank me for sending them to a trusted colleague who treated them well. Doing so also builds a good rapport with neighboring physicians who will most certainly return the favor in time.
Take care of those who take care of you. One should always be proud of their accomplishments when they are the result of hard effort and diligence. However, you must be careful not to laud your accomplishments too much because in reality, they are not all your own. Every success story, certainly mine, would not be possible without the unwavering support of loved ones and friends. I am forever indebted to my surgical mentors for the knowledge and skills they shared, my children for the joy they bring to my days, my friends for being sounding boards and reality checks when I needed them, my parents for teaching me the things I needed to be a man and especially my wife Anne for all of the above, her patience and for being 100% present in my life ever since I finished my residency and began my practice. I try to remind myself how grateful I am for their gifts to me every day and I try to let them know often.
The poem “If” by Rudyard Kipling. Pretty much the entire work is a lesson on how to live your life. My father gave me a copy of that poem on parchment paper when he returned from India many years ago and it remains framed in my office to this day.
I’d like to see a bit of a paradigm shift in how we treat people with headaches. Right now, there are many practitioners with their hearts in the right places, but who seem to be working on their own islands in the sense that they know what they know and very little else. I’d like to create a center where there is a multidisciplinary approach to this condition and where each of the practitioners learns from the other. I’d then have that center be a model for other similar centers throughout the US and the world. In that way, I think you could make a real difference to the more than 36 million people who suffer from this condition in the US alone.
I would probably say Atul Gawande. It seems to me that he has a very clear vision for a better healthcare system and is also able to articulate that vision in such a way that he has earned the ear of some of the most influential people in finance, business and politics who will likely provide him with a platform to execute on that vision.
Originally published at medium.com