A physician’s ‘Ten Commandments’

Beyond residency: Lessons learned from a career in surgery

I thought residency would prepare me for a career in surgery. I was taught all kinds of useful things about surgery, like how to make an incision, or how to put in an IOL, or how to take a 2-minute nap while assisting in surgery without jostling the microscope.

I didn’t realize that being able to do surgery was just a small piece of what one needed to know to succeed as a surgeon. The rest I had to learn in the school of hard knocks.

I’ve listed here “Maloney’s Ten Commandments” of a career in surgery. These will be obvious to any of you over the age of 50. I offer them to you young ’uns out there, in the hope that your post-residency education will be less painful than mine.

I. Thou shalt treat your scrub nurse with respect. Maybe next time, she won’t keep her mouth shut when she sees you about to make a mistake.

II. Thou shalt listen attentively to your patients and patiently answer their occasionally crazy questions. Then they will still love you even when you make the mistake your scrub nurse neglected to warn you about.

III. Thou shalt not treat your spouse as if she/he is your scrub nurse. Your spouse is nowhere near as inclined to obey your orders (although your spouse is much less likely to keep his/her mouth shut when you make a mistake).

IV. Thou shalt not complain that the world is the way it is. Yes, the government sucks and “Obamacare” is a disaster. Suck it up and move on. You can’t breathe under water, or teleport to your next vacation, or live to 150. You aren’t complaining about that every day, are you?


V.  Thou shalt keep your patients close. Thou shalt keep your patients with complications closer. Emotionally difficult though this is, your problem patients need your support and are far less likely to sue you if they get it.

VI. Thou shalt cultivate humility. There art old surgeons. There art bold surgeons. There art no old, bold surgeons.1 Just because there is no other option doesn’t mean surgery is an option.

VII.Thou shalt not operate on a dying patient. Your operation won’t improve their quality of life. Does it really matter if the IOP is 32 mm Hg?

VIII. Thou shalt make five major mistakes in learning any new operation, no matter how much preparation and training you have done.2 Until you’ve made all five, you aren’t good at the operation.

IX. Thou shalt not be a hero. When an operation is going badly, cut your losses and get out.

X. Thou shalt not manage your own investment portfolio. Does your certified financial planner perform eye surgery in his spare time?

Beware the eleventh commandment

If you follow these, of course, you aren’t guaranteed to meet a young, handsome, fabulously wealthy, sensitive, caring man who is just like the guy in Fifty Shades of Grey, or the female equivalent, depending on your preference. But you will have a long and satisfying career-although not as long as you would like. I forgot to mention the eleventh commandment:

XI.   Thou shalt retire before your colleagues notice you are slipping.




1. Personal communication, Kerry Assil, MD, sometime in the late 1990s.

2. Personal communication, Doyle Stulting, MD, sometime in the early 1990s. Did I mention anything about wisdom coming at the expense of recall?


Subscribe to Ophthalmology Times to receive the latest clinical news and updates for ophthalmologists.