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The Team Behind the Surgeon: Efficiency Lessons From Canada · AHF Podcast

• 0:22
  Joseph M. Schwab: Hello and welcome to the AHF podcast.
• 0:25
  Joseph M. Schwab: I'm your host, Joe Schwab.
• 0:27
  Joseph M. Schwab: Today we're joined by Dr.
• 0:29
  Joseph M. Schwab: Sebastian Rodriguez-Elizalde.
• 0:32
  Joseph M. Schwab: An orthopedic surgeon at Humber River Health in Toronto, and Dr.
• 0:36
  Joseph M. Schwab: Rodriguez has helped build rapid discharge pathways within a large public healthcare system in Canada using anterior approach.
• 0:45
  Joseph M. Schwab: He's also deeply involved in surgical education and the evaluation of emerging technologies, but today's conversation goes a bit beyond technique.
• 0:56
  Joseph M. Schwab: We're talking about what happens after fellowship, how surgeons evolve, how teams can shape your consistency, and how to adopt innovation without losing judgment.
• 1:08
  Joseph M. Schwab: Sebastian, welcome to the AHF Podcast.
• 1:12
  Sebastian Rodriguez-Elizalde: Good morning, Joe.
• 1:13
  Sebastian Rodriguez-Elizalde: Pleasure to be here.
• 1:14
  Sebastian Rodriguez-Elizalde: Uh, really excited.
• 1:15
  Sebastian Rodriguez-Elizalde: It's been a long time.
• 1:16
  Sebastian Rodriguez-Elizalde: Been watching you guys obviously with my involvement with AHF and, and pleasure to be on the show today.
• 1:22
  Joseph M. Schwab: So before we get too technical, I wanna start with something you've said in one of your interviews in the past.
• 1:28
  Joseph M. Schwab: You've described surgery as choreographed, almost like a dance.
• 1:34
  Joseph M. Schwab: And I just want to ask simply what do you mean by that?
• 1:38
  Sebastian Rodriguez-Elizalde: I compare surgery to a lot of things, first of all.
• 1:40
  Sebastian Rodriguez-Elizalde: But yes, I, I've, uh, I do compare it to a dance in terms of when you plan out your day, right?
• 1:46
  Sebastian Rodriguez-Elizalde: So.
• 1:48
  Sebastian Rodriguez-Elizalde: By the choreography, I mean that you've prepared and rehearsed if you will be that practice experience or learning, uh, many different techniques.
• 1:57
  Sebastian Rodriguez-Elizalde: Um, and then you put it all together when a time comes, time for surgery and while every performance, if you will, is a unique experience.
• 2:05
  Sebastian Rodriguez-Elizalde: It's sort of based on that collective understanding, knowledge and experience of the surgeon to get through that procedure.
• 2:12
  Sebastian Rodriguez-Elizalde: And even that day, the whole day is a choreograph, right?
• 2:14
  Sebastian Rodriguez-Elizalde: And if you're trying to move through a large number of cases.
• 2:16
  Sebastian Rodriguez-Elizalde: So, um, that's why I like that analogy a little bit.
• 2:20
  Joseph M. Schwab: Hmm.
• 2:21
  Joseph M. Schwab: So people who are thinking choreography, thinking dance, they're thinking of following a beat.
• 2:26
  Joseph M. Schwab: Are there particular beats that you're paying attention to throughout your day?
• 2:32
  Sebastian Rodriguez-Elizalde: Absolutely.
• 2:32
  Sebastian Rodriguez-Elizalde: And I mean, some of these things are things that, uh, you know, I've learned from witnessing other surgeons in terms of lots of surgical efficiency sort of discussions and, and mentorships that I've gone through and.
• 2:43
  Sebastian Rodriguez-Elizalde: I think the key thing is, is measurement.
• 2:45
  Sebastian Rodriguez-Elizalde: So in terms of those beats that you're talking about, that cadence of, of surgery in a surgical day, I think is important.
• 2:52
  Sebastian Rodriguez-Elizalde: So that cadence involves the preparation and then bringing someone into the operating room, the cadence of getting ready and every step that's part of that procedure, how you're gonna approach that.
• 3:03
  Sebastian Rodriguez-Elizalde: So, um, I think it is important to maintain a healthy cadence, uh, that you're aware of.
• 3:09
  Sebastian Rodriguez-Elizalde: During the surgery and during your day.
• 3:11
  Sebastian Rodriguez-Elizalde: Where am I?
• 3:12
  Sebastian Rodriguez-Elizalde: Where should I be at at this point during the day, assuming everything is going well, um, assuming everything is going well in the surgery, are we, are we near the end of the procedure?
• 3:20
  Sebastian Rodriguez-Elizalde: Are we near the end of the day?
• 3:21
  Sebastian Rodriguez-Elizalde: Am I mentally sort of thinking about the next case and the next patient as we're closing?
• 3:25
  Sebastian Rodriguez-Elizalde: That kind of thing.
• 3:27
  Joseph M. Schwab: And when you're sort of appreciating this choreography throughout the day, appreciating this dance, when you notice it's starting to break down, where does that usually happen first?
• 3:39
  Joseph M. Schwab: Where do you see the, the biggest issues?
• 3:44
  Sebastian Rodriguez-Elizalde: I mean, that can be a lot of thi, I think most important is that you notice it breaks down, right?
• 3:48
  Sebastian Rodriguez-Elizalde: Because previously and before you'd be going through a day and then all of a sudden you realize.
• 3:54
  Sebastian Rodriguez-Elizalde: Hey, I think we're behind by a couple hours.
• 3:55
  Sebastian Rodriguez-Elizalde: Am I gonna finish on time?
• 3:56
  Sebastian Rodriguez-Elizalde: And here in Canada, in a public healthcare system, obviously there's constraints, you know, um, in terms of finishing at a certain time, uh, will your last case get canceled?
• 4:06
  Sebastian Rodriguez-Elizalde: Um, that kind of thing, which, I mean, it could be for, to a lot of my US colleagues.
• 4:09
  Sebastian Rodriguez-Elizalde: If you own a surgical center, you just do whatever you want to do to, to finish the day.
• 4:13
  Sebastian Rodriguez-Elizalde: So.
• 4:14
  Sebastian Rodriguez-Elizalde: You know, in the past, you know, it was very important for us to make sure that we were on time, but without measuring and being aware of it, you could easily lose track of where you were in that day.
• 4:23
  Sebastian Rodriguez-Elizalde: I think now we're much more aware on a per case level where we should be and on, uh, you know, even per procedure level, like how often, how long does it take for me to get to reaming the cup, or how long does it take for me to get to, you know, putting in the broach or to close the wound even.
• 4:38
  Sebastian Rodriguez-Elizalde: So all those little steps you have to be aware of.
• 4:41
  Sebastian Rodriguez-Elizalde: If you notice your day is breaking down a bit and you're falling behind, I think two things is one, don't panic.
• 4:47
  Sebastian Rodriguez-Elizalde: 'cause the last thing you wanna do in surgery is rush.
• 4:49
  Sebastian Rodriguez-Elizalde: You know, you wanna make sure that you know that.
• 4:52
  Sebastian Rodriguez-Elizalde: Napoleon once said, I'm in a rush.
• 4:53
  Sebastian Rodriguez-Elizalde: So go slowly.
• 4:54
  Sebastian Rodriguez-Elizalde: When he was asking someone to get'em ready for war, when they're a surprise attack.
• 4:57
  Sebastian Rodriguez-Elizalde: And my, my dad loved that quote.
• 4:59
  Sebastian Rodriguez-Elizalde: So I think the key thing is if you are falling behind, make sure that you're still prepared and following protocol.
• 5:05
  Sebastian Rodriguez-Elizalde: You don't want to cut corners at any given time.
• 5:08
  Sebastian Rodriguez-Elizalde: Uh, but I think you do have to be aware of, you know, maybe this case is going a bit slower.
• 5:12
  Sebastian Rodriguez-Elizalde: Maybe this patient has a higher BMI or is more muscular, or I'm struggling a little bit more for exposure.
• 5:18
  Sebastian Rodriguez-Elizalde: That's not gonna be every case in the day and understand that, well, you know what, maybe we'll make up that five, 10 minutes on the next one or two patients if they're a bit slimmer.
• 5:25
  Sebastian Rodriguez-Elizalde: So you have to understand that within a day there's guidelines, but there's still variants and flux so that you can go, you know, you can go fast to slow if you need to, as long as the overall average of that day gets completed.
• 5:37
  Sebastian Rodriguez-Elizalde: Um, but the biggest thing you wanna do is just make sure that those, those.
• 5:42
  Sebastian Rodriguez-Elizalde: Mileposts, if you will, that you establish for yourself are are being respected.
• 5:46
  Sebastian Rodriguez-Elizalde: They don't have to be adhered to a hundred percent, but respected to the point where you can be like, okay, well I know I have to get to point B from point A, uh, we're a bit behind.
• 5:55
  Sebastian Rodriguez-Elizalde: Then the next one will be a little bit faster.
• 5:56
  Sebastian Rodriguez-Elizalde: That's all.
• 5:57
  Joseph M. Schwab: Hmm.
• 5:58
  Joseph M. Schwab: And how important is it to you, um, when you're looking at those, those mileposts that you talked about?
• 6:05
  Joseph M. Schwab: How important is team rhythm in keeping a, a adhering to what you wanna accomplish for your day?
• 6:12
  Sebastian Rodriguez-Elizalde: I think that's paramount to your success.
• 6:13
  Sebastian Rodriguez-Elizalde: I think what we've really learned in the surgical efficiency work that we've done here at Humber is that the success is not surgeon success.
• 6:20
  Sebastian Rodriguez-Elizalde: The, you know, the surgeon can be captain of the ship.
• 6:23
  Sebastian Rodriguez-Elizalde: The ship still has an entire crew, which makes it run, and, and in that we, the more you understand that everyone has to be motivated and understand the goals of the day and be the leader in that front, I think.
• 6:36
  Sebastian Rodriguez-Elizalde: That is the key takeaway that we have learned.
• 6:38
  Sebastian Rodriguez-Elizalde: Um, if, if your surgeon is unaware of time, uninterested in time savings, uninterested in efficiency, um, you know, or unaware of what's going on during the case, you can't expect the team to be able to all of a sudden help you out from that perspective.
• 6:52
  Sebastian Rodriguez-Elizalde: You have to be the leader in that regard and, and set the pace and having people that are all understanding what your goals are for that day.
• 6:59
  Sebastian Rodriguez-Elizalde: And our goals are, let's say, to treat 10, 12, 14 patients in, in an eight hour window.
• 7:04
  Sebastian Rodriguez-Elizalde: Safely here at Humber and get them all home that same day.
• 7:07
  Sebastian Rodriguez-Elizalde: Everyone understands that before they walk into the operating room and everyone picks up where we are going on.
• 7:12
  Sebastian Rodriguez-Elizalde: Sometimes it involves our assistant helping take out the garbage.
• 7:15
  Sebastian Rodriguez-Elizalde: Sometimes it involves having an extra pair of hands to clean.
• 7:19
  Sebastian Rodriguez-Elizalde: Um, sometimes it involves, you know, uh, for one of the cases, maybe the staff person will close that wound and not the fellow or not the learner, if they wanna make sure that we're done on time.
• 7:28
  Sebastian Rodriguez-Elizalde: So those little modifications, the entire team understands.
• 7:32
  Sebastian Rodriguez-Elizalde: But having that.
• 7:33
  Sebastian Rodriguez-Elizalde: Team first philosophy, I think is paramount to success.
• 7:36
  Joseph M. Schwab: Hmm.
• 7:37
  Joseph M. Schwab: And we're gonna get a little bit more into your team philosophy in just a little bit.
• 7:41
  Joseph M. Schwab: But you did mention, you know, you're working within the constraints of a public hospital system in Canada and a lot of surgeons, a lot of people listening might not fully appreciate what that means.
• 7:53
  Joseph M. Schwab: So can you tell me a little bit about what sort of real constraints you deal with on a daily basis?
• 8:02
  Sebastian Rodriguez-Elizalde: So I often think, you know, there's this huge misunderstanding of the Canadian healthcare system versus the American healthcare system, right?
• 8:08
  Sebastian Rodriguez-Elizalde: The reality is actually they're much more similar than people will give credit to or understand, right?
• 8:13
  Sebastian Rodriguez-Elizalde: The Medicare world and the OHIP or Ontario health insurance plan, as we call it here in in, in Ontario, at least in our province.
• 8:20
  Sebastian Rodriguez-Elizalde: Are not dissimilar.
• 8:21
  Sebastian Rodriguez-Elizalde: So in this case, this is a, a taxpayer system where everyone contributes taxes to have a healthcare system whereby healthcare is provided, you know, for free, but really it's taxpayer funded, so it's nothing is for free in this world, as you know.
• 8:35
  Sebastian Rodriguez-Elizalde: What that means is the hospital is allotted based on regional populations, a volume of procedures to do during a given year.
• 8:42
  Sebastian Rodriguez-Elizalde: Within that volume, there's still some variance that happens year to year where you're allowed to do more procedures or less procedures based on performance incentives if they have more money from another budget.
• 8:52
  Sebastian Rodriguez-Elizalde: So that number is not set on ironclad stone.
• 8:56
  Sebastian Rodriguez-Elizalde: That being said, generally speaking, OR days run at a set time, so it's not a surgical center where you can run overtime and pay people more if you want to.
• 9:05
  Sebastian Rodriguez-Elizalde: Things like overtime for staff, we're sensitive to.
• 9:08
  Sebastian Rodriguez-Elizalde: Prices of implants we're sensitive to.
• 9:11
  Sebastian Rodriguez-Elizalde: Additional technologies and their costs we're sensitive to, so the per case cost in Canada until recently was not well understood or analyzed.
• 9:19
  Sebastian Rodriguez-Elizalde: A lot of these financial sort of motivations and, and, and understandings are now coming to light about how we can be more efficient and, and more time saving and more economical and the procedures that we do.
• 9:30
  Sebastian Rodriguez-Elizalde: So it's not necessarily at.
• 9:32
  Sebastian Rodriguez-Elizalde: Surgeon discretion at any given time, what they're gonna be able to do.
• 9:35
  Sebastian Rodriguez-Elizalde: You can't put a ceramic hip in an 89-year-old meal.
• 9:38
  Sebastian Rodriguez-Elizalde: That's, you know, so you have to understand that there's give and take in the system overall with the mindset of being that the more fiscally responsible we are, the more people we can help treat, which translates to the more volume of cases that can be done globally as a, as a system.
• 9:52
  Sebastian Rodriguez-Elizalde: So all that being said, we have constraints in terms of the day and when it finishes constraints, uh, from some of the technologies that we used and mean.
• 9:59
  Sebastian Rodriguez-Elizalde: These are all fiscal things, right?
• 10:01
  Sebastian Rodriguez-Elizalde: And in terms of the implants that are used, and you have to have generally good scientific backing or understanding of why you're gonna change any one of those things.
• 10:09
  Sebastian Rodriguez-Elizalde: Be that for research education purposes or a younger patient needs a different type of implant, or I feel a robot or an additive technology makes me a better surgeon, that kind of thing.
• 10:20
  Joseph M. Schwab: So as you were starting to increase efficiency and maybe push the envelope of the number of cases that you could do in a given day, what was the hardest part of sort of pushing change in this type of system?
• 10:36
  Sebastian Rodriguez-Elizalde: I think it's inertia, right?
• 10:37
  Sebastian Rodriguez-Elizalde: Because I, I think any system change, especially, you know, a bureaucratically run provincial healthcare system here in Canada is, is, is like dealing with your government, if you will, right?
• 10:47
  Sebastian Rodriguez-Elizalde: So any change at a government level is hard to implement.
• 10:51
  Sebastian Rodriguez-Elizalde: And then the other thing is, uh, having a proof of concept, right?
• 10:54
  Sebastian Rodriguez-Elizalde: Because, uh, you know, whenever you do more volume or try to look at efficiency, that generally translates into more procedures per given day.
• 11:01
  Sebastian Rodriguez-Elizalde: The number one thing for resistance that we encountered was a lot of safety concerns is can you do these procedures safely in a shorter time span and more in a day?
• 11:10
  Sebastian Rodriguez-Elizalde: And are you as a surgeon still able to guarantee, you know, responsible clinical outcomes?
• 11:15
  Sebastian Rodriguez-Elizalde: Is your anesthetist feeling safe enough to be able to deal with these patients and, and the nurses who discharge these patients don't feel so rushed that this is unsafe?
• 11:24
  Sebastian Rodriguez-Elizalde: So we, we addressed a lot of the safety concerns individually.
• 11:27
  Sebastian Rodriguez-Elizalde: I think a lot of that brought.
• 11:29
  Sebastian Rodriguez-Elizalde: Stakeholders to the table to say, Hey, what are you worried about?
• 11:32
  Sebastian Rodriguez-Elizalde: Because often, and I, I was guilty of this, seeing something from my lens as a surgeon, I didn't understand why other people were so resistant to this idea.
• 11:39
  Sebastian Rodriguez-Elizalde: To me, it seemed like a great idea, but you have to understand what it is that their motivations are and what their concerns are and address those.
• 11:45
  Sebastian Rodriguez-Elizalde: And maybe they're not important to you as a surgeon, but you have to understand that these are all barriers in the system that if you don't address, you won't be able to progress forward.
• 11:52
  Sebastian Rodriguez-Elizalde: So I think, you know, addressing.
• 11:55
  Sebastian Rodriguez-Elizalde: All the potential roadblocks and barriers, be it anesthesia, nursing, administration, um, even things like porting EVS or housekeeping in your room.
• 12:04
  Sebastian Rodriguez-Elizalde: You have to be able to talk to all those stakeholders and understand what it is that you need to do your job safely.
• 12:09
  Sebastian Rodriguez-Elizalde: Is there a way that we can potentially be more efficient or do it better or potentially do it faster, um, without causing undue stress?
• 12:17
  Sebastian Rodriguez-Elizalde: And, and trim the fat, if you will, out of any system.
• 12:20
  Sebastian Rodriguez-Elizalde: And when you break down any process into all those little pieces and look to see how you can make each part of it better and talk to the stakeholders that are in the best position to understand the problem, you can really make a lot of change.
• 12:34
  Joseph M. Schwab: Hmm.
• 12:34
  Joseph M. Schwab: Was there a moment during this process where dealing with that inertia felt too difficult?
• 12:42
  Sebastian Rodriguez-Elizalde: Yeah.
• 12:43
  Sebastian Rodriguez-Elizalde: Every step, obviously.
• 12:44
  Sebastian Rodriguez-Elizalde: I mean like inertia is inertia like you have to be.
• 12:47
  Sebastian Rodriguez-Elizalde: You know, like I tell my fellows and residents, you can't be a small wave.
• 12:51
  Sebastian Rodriguez-Elizalde: You know, that's just crashing against the shore.
• 12:53
  Sebastian Rodriguez-Elizalde: It makes a lot of noise.
• 12:54
  Sebastian Rodriguez-Elizalde: You have to be that one tidal wave, which is just a slow moving but immovable object that's constantly moving forward.
• 13:02
  Sebastian Rodriguez-Elizalde: And that's what you gotta be, is just you have to keep going, um, and start low and slow and it builds to a point where you realize you just can't change the change of that tide, if you will.
• 13:12
  Sebastian Rodriguez-Elizalde: And so inertia is one of those things.
• 13:15
  Sebastian Rodriguez-Elizalde: I think I learned number one is you can't get frustrated, right?
• 13:18
  Sebastian Rodriguez-Elizalde: Because I think as surgeons generally, don't say we have short fuses, but we have, you know, we like to fix things in orthopedics, we like to fix things quickly.
• 13:26
  Sebastian Rodriguez-Elizalde: Some of these things take time and you have to let some ideas pollinate and gain traction.
• 13:32
  Sebastian Rodriguez-Elizalde: Have proof of concept.
• 13:33
  Sebastian Rodriguez-Elizalde: You won't convince everyone all at once is the other thing I learned.
• 13:36
  Sebastian Rodriguez-Elizalde: You have to convince a few key stakeholders create proofs of concept.
• 13:41
  Sebastian Rodriguez-Elizalde: Uh, be able to expand those ideas and make them scalable.
• 13:44
  Sebastian Rodriguez-Elizalde: And I think that's really what I learned about change was that you're not gonna convince everybody on the first day, but by the 10th time you've done it, or on the hundredth day, you'll realize that this is the new standard of care.
• 13:55
  Joseph M. Schwab: Hmm.
• 13:56
  Joseph M. Schwab: Did you come out of your fellowship training with this sort of plan in mind that you were going to be seeking this kind of efficiency?
• 14:05
  Joseph M. Schwab: Or was this something you developed after you became sort of fully independent?
• 14:09
  Joseph M. Schwab: I.
• 14:11
  Sebastian Rodriguez-Elizalde: Definitely after I became fully independent after my last fellowship here in Canada, we do several fellowships, as I'm sure you're aware, you know, and I, I went through the rigors of three actually in, in trying to land on the right job, I did my master's in health administration and essentially that's a parallel stream to an MBA, if you will, with a lot of healthcare.
• 14:29
  Sebastian Rodriguez-Elizalde: In the second year, that's when they really got a new appreciation of.
• 14:34
  Sebastian Rodriguez-Elizalde: Especially in Canada, system change because you have to be able to talk to administration and politicians and people that, as surgeons clinically, we're not educated on that.
• 14:45
  Sebastian Rodriguez-Elizalde: You know, we're educated on how to be technically very good, how to learn, but anything that extends beyond the O operating room.
• 14:51
  Sebastian Rodriguez-Elizalde: But to the care of the patient, we're not well versed in.
• 14:54
  Sebastian Rodriguez-Elizalde: So my Masters of Health administration gave me a lot of tools to, to speak about what, what is a business case?
• 14:59
  Sebastian Rodriguez-Elizalde: How do you put together the business case?
• 15:01
  Sebastian Rodriguez-Elizalde: Who do you talk to when you have a business case?
• 15:03
  Sebastian Rodriguez-Elizalde: Um, where do proposals go and how do you affect change?
• 15:06
  Sebastian Rodriguez-Elizalde: A lot of that came from my master's in health administration.
• 15:09
  Sebastian Rodriguez-Elizalde: Um, and then from experience.
• 15:12
  Sebastian Rodriguez-Elizalde: And then finally for efficiency, it came from the Anterior Hip Foundation.
• 15:15
  Sebastian Rodriguez-Elizalde: I mean, a few years ago we had a talk on, on efficiencies, and I was up there listening to, you know, Charlie and Kristoff, and they're talking about banging out 14, 16, 18 cases in a day.
• 15:26
  Sebastian Rodriguez-Elizalde: I.
• 15:27
  Sebastian Rodriguez-Elizalde: I was like, holy shit, I'm fast, but that's really fast, you know?
• 15:31
  Sebastian Rodriguez-Elizalde: And so I, I, it led to emails and conversations and then, you know, and surgical site visits, um, and bringing our surgical team to those visits.
• 15:40
  Sebastian Rodriguez-Elizalde: So it wasn't just a surgeon saying he or she wants to do more.
• 15:44
  Sebastian Rodriguez-Elizalde: It's about the entire team understanding that we can be better and that that's all they challenge people to do is like whatever we're doing, we have to constantly.
• 15:53
  Sebastian Rodriguez-Elizalde: You know, seek to evolve to be a bit better version of ourselves.
• 15:56
  Sebastian Rodriguez-Elizalde: And if everyone takes that mentality, you can achieve amazing things.
• 16:01
  Joseph M. Schwab: When you were thinking about those efficiency tactics and, and sort of reflecting on what Charlie was doing and what Kristoff was doing, was there a case or a moment not necessarily.
• 16:12
  Joseph M. Schwab: The hardest case that you've done, but one that changed how you started to think about efficiency or how, uh, a case that maybe reshaped your judgment about this whole process.
• 16:25
  Joseph M. Schwab: I.
• 16:26
  Sebastian Rodriguez-Elizalde: What really reshaped, to be honest, was probably when I visited Charlie, I remember.
• 16:30
  Sebastian Rodriguez-Elizalde: The thing that I took away the most was Charlie.
• 16:32
  Sebastian Rodriguez-Elizalde: I mean, and Charlie has an amazing practice and I think everyone should go visit Charlie if you're in the US, to get an idea of efficiencies in the, in the surgical setting, uh, was, you know, the software and how we mapped out.
• 16:44
  Sebastian Rodriguez-Elizalde: Measuring every process of that.
• 16:46
  Sebastian Rodriguez-Elizalde: So, you know, I'm not sure if we can use like, you know, but it was basically an, an Ospitek or you know, a one team type solution, if you will, that broke down the surgery, had the entire surgical plan on a board for everyone to see and timed each part of the procedure whereby you had your average time for that procedure and then your average time for each part of that procedure.
• 17:06
  Sebastian Rodriguez-Elizalde: And that's when I started thinking about surgery a bit differently.
• 17:08
  Sebastian Rodriguez-Elizalde: I thought not about it as a procedure, but as the, the cumulation or the sum of a lot of small.
• 17:13
  Sebastian Rodriguez-Elizalde: Parts that have to get to you to that next step.
• 17:16
  Sebastian Rodriguez-Elizalde: And when you start to think that way and you start to measure that way, then you become aware of yourself.
• 17:23
  Sebastian Rodriguez-Elizalde: And when I came home, the first thing I did is I got someone to measure.
• 17:26
  Sebastian Rodriguez-Elizalde: I said, look, these, we don't have that software yet, but I'm like, write down all these time points every time.
• 17:30
  Sebastian Rodriguez-Elizalde: And because.
• 17:32
  Sebastian Rodriguez-Elizalde: We as surgeons are always the greatest or the fastest or the best, or never have complications if you talk to any one of us, right?
• 17:38
  Sebastian Rodriguez-Elizalde: But it's very humbling when an objective person will measure you.
• 17:41
  Sebastian Rodriguez-Elizalde: And so we have a lot of data for a lot of the measurements that we do in surgery, and I'm sure they're the same in the US and Canada, if you look at infections or dislocations or reoperations.
• 17:49
  Sebastian Rodriguez-Elizalde: But the pieces of that surgery and to get there.
• 17:52
  Sebastian Rodriguez-Elizalde: Don't really measure or historically have never looked at that, right.
• 17:55
  Sebastian Rodriguez-Elizalde: And so, um, that data to me is quite fascinating and quite enlightening in terms of, um, procedural improvement because based on that, when I even went to go see Kristoff in Belgium, just technique wise, a couple of the things that he did, I started adopting.
• 18:09
  Sebastian Rodriguez-Elizalde: And I realized, you know, in this part of the operation, I'm actually faster and I can tell because even the anesthetist said.
• 18:16
  Sebastian Rodriguez-Elizalde: You know, your, your procedures are faster.
• 18:18
  Sebastian Rodriguez-Elizalde: And we broke down.
• 18:19
  Sebastian Rodriguez-Elizalde: We were able to figure out which part of the procedure I was faster at because I had adopted, you know, new learnings to.
• 18:23
  Sebastian Rodriguez-Elizalde: So yeah, it was very interesting to see the data that I made on myself and be able to make on a procedure to be able to self-improve.
• 18:31
  Joseph M. Schwab: I, I'm gonna get to those, um, efficiency sort of mini fellowships that you did in just a minute.
• 18:37
  Joseph M. Schwab: But before we get there, you didn't start out doing anterior approach.
• 18:42
  Joseph M. Schwab: You started in posterior approach, is my understanding.
• 18:45
  Sebastian Rodriguez-Elizalde: I did
• 18:46
  Joseph M. Schwab: And
• 18:47
  Sebastian Rodriguez-Elizalde: so in,
• 18:48
  Joseph M. Schwab: yeah.
• 18:48
  Joseph M. Schwab: Tell me about that.
• 18:49
  Sebastian Rodriguez-Elizalde: go ahead.
• 18:51
  Sebastian Rodriguez-Elizalde: Well in, I trained in Ottawa, uh, which is the capital of Canada, and Dr.
• 18:55
  Sebastian Rodriguez-Elizalde: Paul Beaule brought anterior approach from Joel Matta there.
• 18:58
  Sebastian Rodriguez-Elizalde: I guess that's now, I don't know, 25 years ago or something when I was in the middle of residency.
• 19:03
  Sebastian Rodriguez-Elizalde: So as we all know, Joel is sort of credited being, you know, the.
• 19:06
  Sebastian Rodriguez-Elizalde: The godfather, if you will, of, of anterior approach, you know, on the west coast of the US And his disciple, Paul Beaule, was actually working in, in California with him for several years before coming back to Ottawa.
• 19:16
  Sebastian Rodriguez-Elizalde: So Paul really is credited for bringing, uh, anterior approach philosophy, uh, and, and that surgical technique, which is sort of experimental and very, you know, limited in all of North America at that time and brought it to Canada, made it part of the residency and fellowship training.
• 19:31
  Sebastian Rodriguez-Elizalde: So we were exposed to that as residents.
• 19:33
  Sebastian Rodriguez-Elizalde: Um, and so I had seen the anterior approach and knew about the anterior approach and the purported advantages.
• 19:40
  Sebastian Rodriguez-Elizalde: At the time, I mean this is so historic.
• 19:41
  Sebastian Rodriguez-Elizalde: Patients were kept in hospital with for four days, right?
• 19:44
  Sebastian Rodriguez-Elizalde: Three or four days.
• 19:44
  Sebastian Rodriguez-Elizalde: So, you know, people seemed to have less pain, but it didn't seem to lead to a faster discharge just'cause, you know, we thought mentally all these patients had to be in hospital.
• 19:52
  Sebastian Rodriguez-Elizalde: Um, and then when I went to HSS, uh, everything was posterior approach.
• 19:56
  Sebastian Rodriguez-Elizalde: So back then they were just starting to dabble in anterior approach.
• 20:00
  Sebastian Rodriguez-Elizalde: You know, Jose Rodriguez and Dr.
• 20:02
  Sebastian Rodriguez-Elizalde: Alexiades.
• 20:02
  Sebastian Rodriguez-Elizalde: A couple guys just starting, but it was still very much in its infancy.
• 20:05
  Sebastian Rodriguez-Elizalde: So I came out trained.
• 20:07
  Sebastian Rodriguez-Elizalde: Is a, a posterior revision and primary surgeon.
• 20:11
  Sebastian Rodriguez-Elizalde: Um, and started my career that way.
• 20:13
  Sebastian Rodriguez-Elizalde: Then it was really in the early days of my career that our administration was, uh, had gone down to Colorado and, and seen a surgical center and they said, Hey, these guys go home the same day.
• 20:22
  Sebastian Rodriguez-Elizalde: They're doing anterior approach hips.
• 20:24
  Sebastian Rodriguez-Elizalde: How come we don't do this in Toronto or in Canada?
• 20:28
  Sebastian Rodriguez-Elizalde: And so administration wise actually approached me and said, can you do this?
• 20:30
  Sebastian Rodriguez-Elizalde: And I said, well, you know, actually I was trained to do that.
• 20:32
  Sebastian Rodriguez-Elizalde: We need a special table.
• 20:33
  Sebastian Rodriguez-Elizalde: Um, if you support me in getting a table and doing a trial, maybe we can start to, to do this surgical technique in Toronto in our hospital.
• 20:42
  Sebastian Rodriguez-Elizalde: So they did, we, we trialed a HANA, a table.
• 20:45
  Sebastian Rodriguez-Elizalde: We, I went back and relearned anterior approach, uh, with some site visits with some colleagues.
• 20:51
  Sebastian Rodriguez-Elizalde: Uh, my first few days they came and helped me out and then started doing everyone anterior approach.
• 20:56
  Sebastian Rodriguez-Elizalde: Back in 2016 or 2015, I guess we just sort of switched and everyone went to anterior at that point.
• 21:03
  Sebastian Rodriguez-Elizalde: So it was relearning something that I was aware of, uh, but I had to get comfortable in again to do it.
• 21:08
  Joseph M. Schwab: So, uh, speaking of that, what part of that was harder?
• 21:12
  Joseph M. Schwab: Was it the learning, the technical learning curve, or was it more the psychological learning curve?
• 21:17
  Joseph M. Schwab: I.
• 21:18
  Sebastian Rodriguez-Elizalde: I think it's both.
• 21:18
  Sebastian Rodriguez-Elizalde: I mean, when you're, I was still a few years out of fellowship, so it was still pretty early on.
• 21:23
  Sebastian Rodriguez-Elizalde: But even, you know, what struck me is at that point I felt like I had refined my posterior technique.
• 21:28
  Sebastian Rodriguez-Elizalde: I felt like I had a very small incision.
• 21:30
  Sebastian Rodriguez-Elizalde: Really?
• 21:30
  Sebastian Rodriguez-Elizalde: Is there a difference between anterior and posterior?
• 21:32
  Sebastian Rodriguez-Elizalde: I'm really good at posterior now.
• 21:33
  Sebastian Rodriguez-Elizalde: That's how HSS trained me.
• 21:36
  Sebastian Rodriguez-Elizalde: Um.
• 21:37
  Sebastian Rodriguez-Elizalde: I was comfortable and I realized that you can very quickly become, you know, we, we always said like, oh, those old guys are novel to change what they're gonna do.
• 21:45
  Sebastian Rodriguez-Elizalde: You know, like I'm a new young guy.
• 21:46
  Sebastian Rodriguez-Elizalde: But very quickly that mentality I had was, you know, you can get very comfortable and see why people don't want to change later on in their careers.
• 21:54
  Sebastian Rodriguez-Elizalde: So it was a struggle because you feel like you're finally, you're very good at one thing and you're going into the unknown.
• 22:00
  Sebastian Rodriguez-Elizalde: So.
• 22:01
  Sebastian Rodriguez-Elizalde: It's an ego hit because you realize you're not gonna be as good doing something new, that you're very good at doing something old.
• 22:07
  Sebastian Rodriguez-Elizalde: You have to promise yourself that you're doing this because at the end of the day, it's gonna be better for patients and, and hopefully better for me as a surgeon to offer better quality care.
• 22:14
  Sebastian Rodriguez-Elizalde: And there's a reason that I'm changing my technique.
• 22:17
  Sebastian Rodriguez-Elizalde: Um, and you have to stay that course.
• 22:20
  Sebastian Rodriguez-Elizalde: Then technically to relearn stuff that you haven't seen.
• 22:22
  Sebastian Rodriguez-Elizalde: And now you're looking at it through the eyes of I'm the attending and not the learner.
• 22:26
  Sebastian Rodriguez-Elizalde: I have to do this fully without someone watching me.
• 22:29
  Sebastian Rodriguez-Elizalde: Yeah.
• 22:29
  Sebastian Rodriguez-Elizalde: Those are big steps and big, you know, anxiety provoking things.
• 22:33
  Sebastian Rodriguez-Elizalde: Um, and as much as everyone, every hip surgeon says, you know, I know how to do a hip, but when you do it from the front, it's, it's like a new operation.
• 22:40
  Sebastian Rodriguez-Elizalde: You can't think of it as like, well, I do a hip, this is the same thing, but I'm just changing a couple of things.
• 22:44
  Sebastian Rodriguez-Elizalde: So you have to really.
• 22:46
  Sebastian Rodriguez-Elizalde: Rethink the way you think about the hip when you do it from the front.
• 22:49
  Sebastian Rodriguez-Elizalde: So those things all caused a bit of anxiety.
• 22:51
  Sebastian Rodriguez-Elizalde: I think part of it was I was young enough and naive enough that I assumed it would be easy and could do it.
• 22:57
  Sebastian Rodriguez-Elizalde: You know what I mean?
• 22:57
  Sebastian Rodriguez-Elizalde: Like.
• 22:58
  Sebastian Rodriguez-Elizalde: I didn't overthink it.
• 22:59
  Sebastian Rodriguez-Elizalde: You know, you, you just sort of do it.
• 23:00
  Sebastian Rodriguez-Elizalde: And that's sort of like, you know, like, like children, right?
• 23:03
  Sebastian Rodriguez-Elizalde: They just adopt a new thing and they just, they don't overthink it.
• 23:05
  Sebastian Rodriguez-Elizalde: Whereas, you know, trying to learn to ski when you're 45, you're gonna way overthink that, right?
• 23:09
  Sebastian Rodriguez-Elizalde: About what if I fall?
• 23:11
  Sebastian Rodriguez-Elizalde: So, um, I think I was still young enough that it seemed like it would, should be easy enough to do.
• 23:16
  Sebastian Rodriguez-Elizalde: And lo and behold, here we are.
• 23:18
  Joseph M. Schwab: So did you ever have significant doubts about the decision to do that?
• 23:24
  Sebastian Rodriguez-Elizalde: In the first couple of days, uh, you know, the first few days that I was operating on, I had Brent Lanting, who was a colleague of mine from London, Ontario, who does a lot of anterior approach hips.
• 23:32
  Sebastian Rodriguez-Elizalde: Good friend.
• 23:32
  Sebastian Rodriguez-Elizalde: He came up and helped me and so I felt comfortable, like he let me do the cases and was there to bail me out, give me tips and tricks.
• 23:39
  Sebastian Rodriguez-Elizalde: I'd been to a variety of training courses, but, um.
• 23:43
  Sebastian Rodriguez-Elizalde: For sure the first day that I was on my own about, you know, you have a bit of a harder case and you're wondering like, why am I doing this?
• 23:49
  Sebastian Rodriguez-Elizalde: This is so much harder, right?
• 23:50
  Sebastian Rodriguez-Elizalde: And then, uh, I made the decision to go wholesale all anterior early because I know myself and I know that if I pick and choose, you can always make an excuse to not do something hard.
• 24:01
  Sebastian Rodriguez-Elizalde: This patient's a bit bigger, this patient's a bit more osteoporotic.
• 24:04
  Sebastian Rodriguez-Elizalde: This patient's overweight, this patient's too muscular.
• 24:07
  Sebastian Rodriguez-Elizalde: We're behind on the day.
• 24:08
  Sebastian Rodriguez-Elizalde: Maybe I should just do it from the back.
• 24:10
  Sebastian Rodriguez-Elizalde: I didn't give myself those crutches.
• 24:11
  Sebastian Rodriguez-Elizalde: I, you know, I burned the ship, so to speak, you know, and I just stayed on the beach and just kept going.
• 24:16
  Sebastian Rodriguez-Elizalde: So, uh, there was no retreat at that point.
• 24:19
  Sebastian Rodriguez-Elizalde: And, but many a time that I have doubts during a case if things were taking longer.
• 24:23
  Sebastian Rodriguez-Elizalde: Um.
• 24:25
  Sebastian Rodriguez-Elizalde: You are gonna be frustrated when you learn something new.
• 24:27
  Sebastian Rodriguez-Elizalde: And especially I think when you're a more experienced surgeon trying to relearn something new because you've spent years honing and mastering that craft that you're very good at doing in one particular way and relearning something has to involve the fact that you are going to make mistakes and be slower and not as good as that guy next door that maybe has been doing it for a long time.
• 24:46
  Sebastian Rodriguez-Elizalde: You have to stay that course.
• 24:47
  Sebastian Rodriguez-Elizalde: And I think for a lot of surgeons, maybe they dabble in anterior approach hip after a weekend course.
• 24:52
  Sebastian Rodriguez-Elizalde: This is too hard.
• 24:53
  Sebastian Rodriguez-Elizalde: Or they have a complication and then they, they bail on it.
• 24:55
  Sebastian Rodriguez-Elizalde: They don't do it.
• 24:56
  Sebastian Rodriguez-Elizalde: You know, and we saw that in Canada and, and even in the us like a lot of people, early adoption, uh, failed.
• 25:02
  Sebastian Rodriguez-Elizalde: And I think that now with better training programs, better support, better mentorship, uh, a lot of those fears are taken away and we're able to support those surgeons better and have better education so they don't fail.
• 25:16
  Joseph M. Schwab: If you are doing anterior hips or if you're thinking about it, let me just say this, a HF events are different.
• 25:25
  Joseph M. Schwab: You won't be sitting in the back of a dark room watching slides all day.
• 25:29
  Joseph M. Schwab: The content is practical and technique driven.
• 25:33
  Joseph M. Schwab: And the A HF is a real community.
• 25:36
  Joseph M. Schwab: You can stop anyone in the hallway and ask, how are you handling this exposure?
• 25:42
  Joseph M. Schwab: Or What are you doing in this revision?
• 25:45
  Joseph M. Schwab: And they'll walk you through it because that's the culture.
• 25:50
  Joseph M. Schwab: If you're early in your anterior experience, there's a fundamentals track focused on technique and complication management that you can use Monday morning in your own or.
• 26:01
  Joseph M. Schwab: But if you're extending into complex primaries or revisions, we're already there having honest conversations about what works and what doesn't.
• 26:11
  Joseph M. Schwab: And we have pre and post meeting anterior hip labs.
• 26:15
  Joseph M. Schwab: For every stage of learner, there's something for everyone.
• 26:20
  Joseph M. Schwab: More importantly, it's a group of surgeons serious about continuous improvement.
• 26:26
  Joseph M. Schwab: A HF 2026 entitled Consensus and Controversy is June 5th and sixth.
• 26:34
  Joseph M. Schwab: You can see the program and register@anteriorhipfoundation.com.
• 26:41
  Joseph M. Schwab: If you've been thinking about coming, come, you'll leave better than you arrived.
• 26:48
  Joseph M. Schwab: I'll see you in Nashville.
• 26:52
  Joseph M. Schwab: So you spoke about this kind of, I would say a bit generally, but specifically was there something you learned about your own ego going through this whole process?
• 27:04
  Sebastian Rodriguez-Elizalde: Yeah, that it's more fragile than I would've ever admitted to.
• 27:07
  Sebastian Rodriguez-Elizalde: You know what I mean?
• 27:08
  Sebastian Rodriguez-Elizalde: Because it's a, I think that's, that's, that's all of us as surgeons, but certainly for, for me, is that like.
• 27:14
  Sebastian Rodriguez-Elizalde: It's humbling, like learning something new, uh, is humbling.
• 27:19
  Sebastian Rodriguez-Elizalde: And I think going through that made me more aware of one as you teach other people things, and two, awareness of myself to be able to adapt to new things as I move forward.
• 27:31
  Joseph M. Schwab: Hmm.
• 27:32
  Joseph M. Schwab: So I do wanna go back, um, now and talk a little bit more about the time that you spent with Charlie and with Kristoff, because not only did you go, but you made sure that your team went with you to see how those clinics function.
• 27:48
  Joseph M. Schwab: So I, I wanna start with why was it important to you that your entire team saw what was happening?
• 27:57
  Sebastian Rodriguez-Elizalde: I think that was key because I've seen.
• 27:59
  Sebastian Rodriguez-Elizalde: So many times surgeons go see something new or have a new technique or toy, and they wanna bring that back to their institution.
• 28:07
  Sebastian Rodriguez-Elizalde: I mean, this happens in Canada periodically.
• 28:08
  Sebastian Rodriguez-Elizalde: And you know, you have to validate it to the administration and say, why?
• 28:13
  Sebastian Rodriguez-Elizalde: Why should we change?
• 28:14
  Sebastian Rodriguez-Elizalde: Or why is this costing more?
• 28:15
  Sebastian Rodriguez-Elizalde: Why can we do this?
• 28:17
  Sebastian Rodriguez-Elizalde: And that relies on the surgeon explaining why he or she has done something.
• 28:22
  Sebastian Rodriguez-Elizalde: Without everyone else understanding that it could be done and could be done safely, I didn't think it would get off the ground.
• 28:28
  Sebastian Rodriguez-Elizalde: And so, because we had a lot of fears of trying to push the boundaries of going from three, four, or five cases in a day to to double or more of that, there was gonna be a lot of friction and resistance.
• 28:39
  Sebastian Rodriguez-Elizalde: And so I thought it was important that the people in the Recovery Bay that take care of these patients, the pre-op nurses.
• 28:45
  Sebastian Rodriguez-Elizalde: Our Zimmer rep, even I wanted him to come administration to come, uh, in, in subsequent visits we've taken anesthesia down because, you know, the anesthetic process that he has there compared to what is normative in some other places is totally different.
• 28:59
  Sebastian Rodriguez-Elizalde: Um, I think it was, and even our scrub nurses and or nurses.
• 29:03
  Sebastian Rodriguez-Elizalde: So the girls that set stuff up for you Right, and, and take things down and just for them to see what could be possible.
• 29:10
  Sebastian Rodriguez-Elizalde: Again, my takeaway wasn't to have the team come back saying, okay, we're doing 16 cases on Monday.
• 29:16
  Sebastian Rodriguez-Elizalde: The goal was to come back and say like, look, we learned that we can measure and be better at what we do, and maybe we can do my, my, my idea is sort of like 20% more, right?
• 29:25
  Sebastian Rodriguez-Elizalde: So if, if you do three, do four, if you do four, do five.
• 29:27
  Sebastian Rodriguez-Elizalde: You know, you know, just be one extra case better and see where that takes you.
• 29:32
  Sebastian Rodriguez-Elizalde: And by having everyone there to see it, um, and I really think that.
• 29:38
  Sebastian Rodriguez-Elizalde: Charlie talks about it, but you have to see it like you have to see how fast things are and how fast things can be and still done at a very high standard and safely.
• 29:47
  Sebastian Rodriguez-Elizalde: Once you see that, it totally changes what you think can be done, and at least for me, part of this process wasn't just if I could operate faster, it involves the entire system changing.
• 29:58
  Sebastian Rodriguez-Elizalde: So we needed people from the system to be there to witness it.
• 30:01
  Joseph M. Schwab: Were there things that your team, um, identified or noticed that you hadn't?
• 30:09
  Sebastian Rodriguez-Elizalde: A hundred percent everything.
• 30:10
  Sebastian Rodriguez-Elizalde: So I'm focused on Charlie and the surgery.
• 30:13
  Sebastian Rodriguez-Elizalde: 'cause I'm trying to feel, what can I do better for my surgical technique.
• 30:16
  Sebastian Rodriguez-Elizalde: But the, the scrub nurses came up to me and they're like, you know, Dr.
• 30:19
  Sebastian Rodriguez-Elizalde: Rodriguez, we, when we come back, we're gonna do this and we're gonna do more and a debt.
• 30:24
  Sebastian Rodriguez-Elizalde: One of my favorite scrub nurses here at Humber said, I'm gonna make sure that you don't ever ask for an instrument, and we hand it to you right when you need it before you even ask for it.
• 30:33
  Sebastian Rodriguez-Elizalde: Every time she's like, we can do this.
• 30:36
  Sebastian Rodriguez-Elizalde: And she's like, we can help do the take down before while you're closing to help get the case done faster.
• 30:42
  Sebastian Rodriguez-Elizalde: Um, you know, uh.
• 30:45
  Sebastian Rodriguez-Elizalde: The nursing and administration all identified areas that, you know, some things could be replicated and some things can't.
• 30:51
  Sebastian Rodriguez-Elizalde: So this is a, a hybrid Canadian version of which you will of, of, of surgical efficiency.
• 30:56
  Sebastian Rodriguez-Elizalde: Um, there's less bodies in the room compared to what Charlie has, if you will, in terms of the number of people.
• 31:02
  Sebastian Rodriguez-Elizalde: So everyone had to pick up extra jobs.
• 31:03
  Sebastian Rodriguez-Elizalde: So our surgical assistants here, um, you know, help with some of those roles.
• 31:09
  Sebastian Rodriguez-Elizalde: So everyone actually identified stuff that.
• 31:11
  Sebastian Rodriguez-Elizalde: He or she could do and brought it back.
• 31:12
  Sebastian Rodriguez-Elizalde: It, it was actually not me dictating it.
• 31:14
  Sebastian Rodriguez-Elizalde: And to be honest, it worked out better than I could have ever thought because it wasn't me telling people they needed to do things.
• 31:21
  Sebastian Rodriguez-Elizalde: It was people identifying like, Hey, we can do this and make it better.
• 31:23
  Sebastian Rodriguez-Elizalde: And I think that level of engagement, I think is really what made the whole program a success.
• 31:29
  Sebastian Rodriguez-Elizalde: 'cause without that engagement, you, you don't have the, you know, a team centered mentality.
• 31:35
  Joseph M. Schwab: And as you're hearing from surgeons nowadays who are trying to implement these sort of anterior uh, rapid recovery discharge protocols, what are the mistakes that you're.
• 31:47
  Joseph M. Schwab: Hearing that surgeons are trying, specifically in terms of if they're not aligning their entire team.
• 31:56
  Sebastian Rodriguez-Elizalde: I think that's big because you have.
• 31:58
  Sebastian Rodriguez-Elizalde: Big resistance in terms of safety, right?
• 32:00
  Sebastian Rodriguez-Elizalde: There's a misperception that's because something is efficient and fast, it's unsafe.
• 32:04
  Sebastian Rodriguez-Elizalde: And I argue personally that look, the, the more you do of something in a day, and the more it's replicated, the more standardized it has to become.
• 32:12
  Sebastian Rodriguez-Elizalde: And standardization is the key to any successful operation.
• 32:16
  Sebastian Rodriguez-Elizalde: I mean, like, that's why pilots have a standardized flight checklist, right?
• 32:19
  Sebastian Rodriguez-Elizalde: And they go through everything at the same time.
• 32:21
  Sebastian Rodriguez-Elizalde: We do a pre-op checklist, but like.
• 32:23
  Sebastian Rodriguez-Elizalde: Surgically, you know, there's a lot of variance.
• 32:25
  Sebastian Rodriguez-Elizalde: And so the more we can decrease that variance intraoperatively and the way we approach things, the safer it'll be, um, to the point where if we're running two rooms, we often make sure that one room's all right side one room's all left side.
• 32:37
  Sebastian Rodriguez-Elizalde: So there's no confusion.
• 32:39
  Sebastian Rodriguez-Elizalde: Um, there's no setting up of the C-arm or moving the tables over from right to left.
• 32:43
  Sebastian Rodriguez-Elizalde: Everything is very seamless, as much as possible in that regard.
• 32:47
  Sebastian Rodriguez-Elizalde: So I think, um, you really have to understand that.
• 32:51
  Sebastian Rodriguez-Elizalde: There's gonna be a lot of resistance, mainly in terms of safety, mainly in terms of, you know, can we get things turned around just as fast.
• 32:59
  Sebastian Rodriguez-Elizalde: But you realize if everyone pitches in, you don't need 35 minutes or 45 minutes to clean a room, you can do something very.
• 33:06
  Sebastian Rodriguez-Elizalde: Safe to the appropriate standards in 10 minutes or 15 minutes.
• 33:09
  Sebastian Rodriguez-Elizalde: And even your anesthesia colleagues, getting them on board and seeing how long a spinal anesthetic lasts, you know, you don't need them to be paralyzed till the next day.
• 33:17
  Sebastian Rodriguez-Elizalde: Like what we used to do, we used to give them such a long spinal for pain control and epidural that they wouldn't walk until the next day.
• 33:22
  Sebastian Rodriguez-Elizalde: So there was no thought processes to How long does this spinal last?
• 33:27
  Sebastian Rodriguez-Elizalde: Now that we're getting people at the same dates, we've reevaluated the role of spinal anesthetics and the medications we use for those and how long they last.
• 33:34
  Sebastian Rodriguez-Elizalde: 'cause we, we need this guy to walk in three hours or in two hours, right?
• 33:37
  Sebastian Rodriguez-Elizalde: So totally changes the way we've approached those things.
• 33:40
  Joseph M. Schwab: So as your system becomes more efficient, are there things that to your mind are not negotiable?
• 33:48
  Joseph M. Schwab: Like what would be your three non-negotiable?
• 33:51
  Joseph M. Schwab: Can't change these, no matter how much more efficient we want'em to become.
• 33:56
  Sebastian Rodriguez-Elizalde: That's a great question.
• 33:57
  Sebastian Rodriguez-Elizalde: I think non-negotiables, number one is I think it is anesthesia.
• 34:00
  Sebastian Rodriguez-Elizalde: You need to make sure that your anesthetist or whoever's providing that is on board.
• 34:04
  Sebastian Rodriguez-Elizalde: Um, and you know, in terms of blocks or per articular blocks or anything that's done by the anesthetist, they have to understand that they, you need to have this person fully mobile and walking within, you know, two to three hours and however long it takes you to establish that preoperatively, be it a spinal anesthetic if you need.
• 34:22
  Sebastian Rodriguez-Elizalde: 20 minutes to do a spinal, then you have to leave the room and get ready for that patient like 25 minutes ahead of time so that you're ready to go.
• 34:29
  Sebastian Rodriguez-Elizalde: So I think having a good relationship with your anesthetist and being able to communicate what you need and making sure that they can deliver that.
• 34:37
  Sebastian Rodriguez-Elizalde: Consistently is the other thing, um, I think is very important.
• 34:42
  Sebastian Rodriguez-Elizalde: Uh, the second thing I think you need in terms of that is having an experienced team.
• 34:46
  Sebastian Rodriguez-Elizalde: It you can do a hip anywhere, at any given time, doing it like you do back home or whatever with your normal team.
• 34:53
  Sebastian Rodriguez-Elizalde: And setup, I think is, is, is like home field advantage.
• 34:56
  Sebastian Rodriguez-Elizalde: So you need to be able to have a core group of people that you work with, be it, you know, a scrub tech in the US or an assistant.
• 35:02
  Sebastian Rodriguez-Elizalde: Some of that makes you better and I think good assistants make you better.
• 35:07
  Sebastian Rodriguez-Elizalde: So that be it, a scrub tech or a nurse or a physician that's helping you, if they can anticipate your next move before you're doing it and help you, that makes you much more efficient.
• 35:16
  Sebastian Rodriguez-Elizalde: So having a familiar face in that regard where you're not having to explain every step of what you're doing and what you need them to do, but they can, they know what it is that they're doing, I think is very important.
• 35:26
  Sebastian Rodriguez-Elizalde: Um, and finally, I think your nursing team that's with you.
• 35:30
  Sebastian Rodriguez-Elizalde: So on any given day, the nurses on the back table.
• 35:33
  Sebastian Rodriguez-Elizalde: The people that understand the implants and how to open them.
• 35:35
  Sebastian Rodriguez-Elizalde: Um, the people that understand that you take every, you know, screw hole out and you need to have that prepared before you put in a cup or not.
• 35:43
  Sebastian Rodriguez-Elizalde: Um, do you have a screwdriver ready, things that are ready on the back table?
• 35:47
  Sebastian Rodriguez-Elizalde: And even beyond that, they have to be consistent and understand your flow.
• 35:51
  Sebastian Rodriguez-Elizalde: So if you have those things like your nursing, your assistant in anesthesia all there, they're on the same page and, and have worked with you and understand what the goal is, you'll have success.
• 36:01
  Joseph M. Schwab: Hmm.
• 36:02
  Joseph M. Schwab: So you did this, um, change of your own practice moving from posterior to anterior, and then you undertook this culture change moving towards a more efficient operating room.
• 36:14
  Joseph M. Schwab: What was harder, um, refining your femoral exposure when moving to anterior approach or changing the culture of your public hospital?
• 36:26
  Sebastian Rodriguez-Elizalde: You know, I think it was both.
• 36:26
  Sebastian Rodriguez-Elizalde: Both have different challenges.
• 36:28
  Sebastian Rodriguez-Elizalde: One is.
• 36:29
  Sebastian Rodriguez-Elizalde: You personally are challenged technically, right?
• 36:31
  Sebastian Rodriguez-Elizalde: How can I become better?
• 36:32
  Sebastian Rodriguez-Elizalde: And anyone who's ever learned to anterior approach also has this aha moment when they realize, oh, how I can deliver the femur.
• 36:39
  Sebastian Rodriguez-Elizalde: I just have to remove this capsule here, and things pop up and I can see it.
• 36:42
  Sebastian Rodriguez-Elizalde: Right?
• 36:42
  Sebastian Rodriguez-Elizalde: You have to go through those iterative changes where you're just like, oh, I, I didn't realize or appreciate that, and now I can do that better.
• 36:50
  Sebastian Rodriguez-Elizalde: So.
• 36:51
  Sebastian Rodriguez-Elizalde: Definitely there's those challenges there that one day either you discover or someone shows you a trick and you're much better at doing it now all of a sudden.
• 36:57
  Sebastian Rodriguez-Elizalde: Uh, there were a lot of those for me personally, obviously over the years.
• 37:01
  Sebastian Rodriguez-Elizalde: Um, and then even after when I went to go see those other surgeons again, you know, really reinvigorated me, Joe.
• 37:06
  Sebastian Rodriguez-Elizalde: 'cause I, I was watching someone else do these procedures again and again.
• 37:09
  Sebastian Rodriguez-Elizalde: I was.
• 37:10
  Sebastian Rodriguez-Elizalde: I never thought of doing that and I started implementing little tips and tricks because even after several years you think you've developed your own technique and is very good, but then you go see a couple other people and you pick up things and if you can adapt that and constantly like learn, I, that was refreshing to me that there's always room for improvement and enlightening to me to be like, you know what, just'cause you've done something well, doesn't mean you can't get a little bit better if you start to adopt or look around to see what else is being done.
• 37:38
  Sebastian Rodriguez-Elizalde: In terms of the system change, that's harder because a lot of that's out of your direct control when you're operating.
• 37:44
  Sebastian Rodriguez-Elizalde: You have direct control of what you're doing.
• 37:46
  Sebastian Rodriguez-Elizalde: When you're trying to get a process and a system change, that's much more challenging in some regards, right?
• 37:51
  Sebastian Rodriguez-Elizalde: Because you're, you're, you're limited if you will, in terms of how much you can convince other people.
• 37:56
  Sebastian Rodriguez-Elizalde: So you have to put your best case forward and, and, but it's out of your power, which is, I think, hard for surgeons to give up because they can't just say change, you know?
• 38:03
  Sebastian Rodriguez-Elizalde: It has to be accepted by all.
• 38:06
  Joseph M. Schwab: A bit of a negotiation sometimes even.
• 38:09
  Sebastian Rodriguez-Elizalde: Life is a negotiation.
• 38:11
  Sebastian Rodriguez-Elizalde: Is, is is.
• 38:12
  Sebastian Rodriguez-Elizalde: Voss told us, I think at the last meeting, so yeah.
• 38:15
  Joseph M. Schwab: So, um, you, you've touched on the use of, um, surgical technology and, and, um, innovation within, um, the efficiency space.
• 38:26
  Joseph M. Schwab: And like you mentioned, in a public hospital, every dollar matters.
• 38:30
  Joseph M. Schwab: So when you're evaluating some new technology, what sort of internal filter do you use?
• 38:36
  Joseph M. Schwab: How do you go about that process?
• 38:39
  Sebastian Rodriguez-Elizalde: You know, I think we, we struggle with this because.
• 38:43
  Sebastian Rodriguez-Elizalde: All new technology and innovation comes with an upfront cost a lot of the time.
• 38:48
  Sebastian Rodriguez-Elizalde: So you have to justify that either by research or by education and understanding that this may not be efficient or save you money upfront, but we anticipate that with this implementation, it will down the road.
• 39:02
  Sebastian Rodriguez-Elizalde: And so you have to get people to buy into the fact.
• 39:05
  Sebastian Rodriguez-Elizalde: Efficiency doesn't mean today in the operating room.
• 39:07
  Sebastian Rodriguez-Elizalde: It means like, what does this look like in two years, five years, 10 years?
• 39:11
  Sebastian Rodriguez-Elizalde: What does it mean at a societal level if we have less revisions and less complications in a public taxpayer sort of scenario?
• 39:17
  Sebastian Rodriguez-Elizalde: Being able to sell that idea and that vision and then being able to make compromise.
• 39:22
  Sebastian Rodriguez-Elizalde: Whereas like, you know, we, let's say we want to use ceramic heads, metal cobalt, chrome heads are, you know.
• 39:29
  Sebastian Rodriguez-Elizalde: Half the price or less here in Canada.
• 39:30
  Sebastian Rodriguez-Elizalde: Um, and using a ceramic, you know, a bearing surface is much more expensive, but we're allowed to do it.
• 39:37
  Sebastian Rodriguez-Elizalde: But to be able to do it on everybody isn't necessarily, you know, feasible, nor is it necessary as we know.
• 39:43
  Sebastian Rodriguez-Elizalde: So it involves making compromises to be like, look, we're gonna use.
• 39:47
  Sebastian Rodriguez-Elizalde: Better implants or newer technologies, but understand that maybe not everyone gets it.
• 39:52
  Sebastian Rodriguez-Elizalde: Um, and be able to make compromises down the road of like, okay, well maybe we'll do a little bit less of X if we wanna really get Y.
• 39:59
  Sebastian Rodriguez-Elizalde: So you can't have everything all the time, is really what it comes down to if you want to use technology or, and innovation.
• 40:06
  Sebastian Rodriguez-Elizalde: Um, so it means picking your battles and it also means being able to create.
• 40:11
  Sebastian Rodriguez-Elizalde: A model where you can prove what it is that you're doing has value to the system.
• 40:15
  Sebastian Rodriguez-Elizalde: Um, it's just hard to see that value for tomorrow or when you're first starting.
• 40:21
  Joseph M. Schwab: Have you ever been really excited about a piece of technology and then suddenly realized maybe it's not the right move.
• 40:31
  Sebastian Rodriguez-Elizalde: Uh, for sure.
• 40:32
  Sebastian Rodriguez-Elizalde: I mean, you know, lots of stuff like we're, um.
• 40:38
  Sebastian Rodriguez-Elizalde: Let me think of a good example of that, but I feel like that's almost every day.
• 40:40
  Sebastian Rodriguez-Elizalde: But yeah, in terms of new technology that we wanted to use, I mean, I don't wanna get into specifics with that because of, you know, companies and devices and stuff like that.
• 40:49
  Sebastian Rodriguez-Elizalde: But for sure, like, you know, the implementation of.
• 40:52
  Sebastian Rodriguez-Elizalde: Navigation technologies and both hip the knee replacement.
• 40:55
  Sebastian Rodriguez-Elizalde: Obviously, you know, I'm a tech guy.
• 40:57
  Sebastian Rodriguez-Elizalde: I love tech.
• 40:58
  Sebastian Rodriguez-Elizalde: Um, and you know, initially when we started doing that, even on the knee side and, and, and navigational technologies, as you know, on the knee side, never really bore out.
• 41:08
  Sebastian Rodriguez-Elizalde: Huge clinical advantages, you know, 10, 20 years ago when we were using them, even though intuitively made sense to be more accurate.
• 41:15
  Sebastian Rodriguez-Elizalde: Um, and then, you know, and, but took a lot longer with some of the early versions of, of, of navigation in knees, if you will.
• 41:22
  Sebastian Rodriguez-Elizalde: Now we have a new generation of robotics where you can, it's a whole different story in terms of what you can evaluate and how you can do it, let's say a knee replacement.
• 41:30
  Sebastian Rodriguez-Elizalde: And so we're being able to revisit that and, and hopefully now have proof and, and show how it makes the surgeon better and the patient better.
• 41:37
  Sebastian Rodriguez-Elizalde: But it's easy to get excited about new technology sometimes.
• 41:40
  Sebastian Rodriguez-Elizalde: And then you're right, you have to take a step back and evaluate like.
• 41:45
  Sebastian Rodriguez-Elizalde: Is it worth it?
• 41:46
  Sebastian Rodriguez-Elizalde: Is the juice worth the squeeze?
• 41:48
  Sebastian Rodriguez-Elizalde: Is the financial cost, uh, involved?
• 41:50
  Sebastian Rodriguez-Elizalde: Is the learning curve, is it all better or not?
• 41:54
  Sebastian Rodriguez-Elizalde: And that can definitely take some honest, reflective feedback that you might not always like the answer to, right?
• 42:00
  Sebastian Rodriguez-Elizalde: Because you invest time and effort and, and, and money to get some of these things.
• 42:03
  Sebastian Rodriguez-Elizalde: And then to realize that you may not actually need them or be, you know, benefiting from I, I think is humbling.
• 42:09
  Sebastian Rodriguez-Elizalde: But I think you have to be open to that.
• 42:11
  Joseph M. Schwab: You know, it's interesting you mention the sort of navigation in total knees.
• 42:15
  Joseph M. Schwab: 'cause um, it, some of the, some people online, certainly and some surgeons that you talk to, would argue that the technology was great, the alignment strategy was what was off.
• 42:25
  Joseph M. Schwab: And you, you know, it's, it might not be that the technology is the problem, but that our understanding is, and what's
• 42:33
  Sebastian Rodriguez-Elizalde: agree with that.
• 42:34
  Joseph M. Schwab: Yeah.
• 42:34
  Joseph M. Schwab: And what's what's interesting about that is, you know, people, I, I think there's a lot of concern going forward about technology replacing surgeon judgment instead of enhancing it.
• 42:45
  Joseph M. Schwab: So as you're looking at different pieces of technology, how do you, how do you think about that concept of enhancing your judgment as opposed to substituting for it?
• 42:59
  Sebastian Rodriguez-Elizalde: Well, I think, I think we're getting there, to be honest with you.
• 43:02
  Sebastian Rodriguez-Elizalde: I mean, um, uh, I think technology is accelerating at a pace that, uh, not many of us fully understand, I would say.
• 43:12
  Sebastian Rodriguez-Elizalde: And the learning algorithms of machines, I think is going to far exceed surgical judgment in my lifetime for sure.
• 43:20
  Sebastian Rodriguez-Elizalde: And, and probably pretty quickly.
• 43:22
  Sebastian Rodriguez-Elizalde: Um, and I say that respecting all our, you know, knowledge of surgeons and our experience, but.
• 43:29
  Sebastian Rodriguez-Elizalde: Any process that's a mechanical process that involves, you know, us doing stuff naturally seems like a navigation or robotically assisted will, will slowly penetrate that market.
• 43:39
  Sebastian Rodriguez-Elizalde: The judgment, I mean, some of these tools to be able to discern, you know, alignment strategies and knees, cup placements, and hips.
• 43:48
  Sebastian Rodriguez-Elizalde: AI is gonna be able to do that a lot better than we are.
• 43:49
  Sebastian Rodriguez-Elizalde: Like, you know, the imaging AI like that they have to read x-rays and cts is, is just now, you know, getting as good as radiologists and shortly will probably be better.
• 43:59
  Sebastian Rodriguez-Elizalde: The natural extension of that is that, you know, for us clinically to make a judgment on positioning soft tissue tension alignment, I think it's natural that these technologies are gonna evolve to the point where they can better.
• 44:11
  Sebastian Rodriguez-Elizalde: Do some of those processes than we are, I think you'll need a surgeon to be able to guide the robot, to make the clinical decision, to approve a surgical plan, to understand the nuances of that patient's.
• 44:22
  Sebastian Rodriguez-Elizalde: But I think very quickly, a lot of those decisions that we were taught, you know, that relied on years and years and years of experience, that's basically all experience that can be fed to a machine and the machine can do at some point.
• 44:35
  Joseph M. Schwab: So you're, um, certainly still young in your career, but you've had enough of a career that you have the ability to kind of reflect back on how far you've come and you're probably at the point where you get to start thinking about what type of legacy you get to leave behind.
• 44:50
  Joseph M. Schwab: So a couple of questions regarding that.
• 44:54
  Joseph M. Schwab: If a surgeon, um, much like you is now just a year or so out of fellowship and in a public hospital, let's say in Canada, and they're feeling overwhelmed with their system, um, and overwhelmed with what they're asked to do to take care of patients.
• 45:10
  Joseph M. Schwab: Is there any advice or anything you would want them to know or anything you would want to tell them?
• 45:17
  Sebastian Rodriguez-Elizalde: I had say one, uh, talk to your colleagues or talk to somebody that's been there, or someone like myself or whoever isn't around your milieu to be able to reach out.
• 45:25
  Sebastian Rodriguez-Elizalde: I don't, I think being frustrated with the system and keeping that to yourself is unhealthy in probably many different ways.
• 45:30
  Sebastian Rodriguez-Elizalde: Um.
• 45:32
  Sebastian Rodriguez-Elizalde: I think understand that early in your career you're gonna have frustrations and your career is not a linear thing.
• 45:37
  Sebastian Rodriguez-Elizalde: Your career go has ups and downs like the rest of our lives do, right?
• 45:40
  Sebastian Rodriguez-Elizalde: And there's good days, bad days, and it's how you deal with the bad days that give you the ability to have success and create more good days.
• 45:48
  Sebastian Rodriguez-Elizalde: And, and really that's what you have to take away from, you know, when everything's great.
• 45:53
  Sebastian Rodriguez-Elizalde: You don't learn anything from that.
• 45:55
  Sebastian Rodriguez-Elizalde: You learn from when things aren't great and what you did to dig yourself outta that hole.
• 45:59
  Sebastian Rodriguez-Elizalde: And so people wanna avoid conflict and avoid stress and avoid setback.
• 46:04
  Sebastian Rodriguez-Elizalde: But that's when our greatest learning happens, when your resilience is built, when you, you can reshape what your goals are in life.
• 46:12
  Sebastian Rodriguez-Elizalde: So I think I.
• 46:14
  Sebastian Rodriguez-Elizalde: Don't, you can welcome those things, understanding that they all play a part in your future development and, and not wanna avoid them, but you don't have to do it alone.
• 46:23
  Sebastian Rodriguez-Elizalde: You know?
• 46:23
  Sebastian Rodriguez-Elizalde: I think that's the biggest thing is that if you are experiencing those things or you have challenges, talk to somebody, talk to the system, talk to the nurses, talk to your administration.
• 46:32
  Sebastian Rodriguez-Elizalde: I think we develop narratives in our own mind.
• 46:35
  Sebastian Rodriguez-Elizalde: Sometimes a surgeon is like, I'm just not allowed to do this, or no one understands me.
• 46:38
  Sebastian Rodriguez-Elizalde: But being able to communicate those things.
• 46:41
  Sebastian Rodriguez-Elizalde: You know, respectfully and meaningfully to the right people and engaging them, I think makes it better.
• 46:45
  Sebastian Rodriguez-Elizalde: And I wish I'd done more of that earlier on in my career.
• 46:48
  Sebastian Rodriguez-Elizalde: 'cause seeing now how it's able to affect change, uh, I've really been able to learn a lot from that.
• 46:53
  Joseph M. Schwab: Hmm.
• 46:54
  Joseph M. Schwab: You, you've said in the past that if you're not expanding your knowledge by, I think you said 5% per year, that you risk becoming a dinosaur.
• 47:04
  Joseph M. Schwab: So what's the 5% you're chasing right now?
• 47:07
  Sebastian Rodriguez-Elizalde: So, first of all, I learned that from Chit Ranawat, God bless.
• 47:11
  Sebastian Rodriguez-Elizalde: You know, he was the one who said, like you, he said, um, you know, Sebastian's like, you gotta be expanding your mind like by, by one to 5% every year, otherwise you're falling behind.
• 47:19
  Sebastian Rodriguez-Elizalde: And I.
• 47:20
  Sebastian Rodriguez-Elizalde: You realize that later on, like with everything, if you're not moving forward, you're, you're gonna fall behind a little bit.
• 47:26
  Sebastian Rodriguez-Elizalde: And I think that's important.
• 47:27
  Sebastian Rodriguez-Elizalde: I think, you know, we like to be comfortable.
• 47:30
  Sebastian Rodriguez-Elizalde: Being comfortable often means not doing anything right, but that's inertia.
• 47:33
  Sebastian Rodriguez-Elizalde: And I think you have to constantly challenge yourself, be it professionally, uh, be it a technique, be it socially, be it, you know, in your hospital system of how you can do better.
• 47:44
  Sebastian Rodriguez-Elizalde: think that if you just adopt that mentality, I think generally in life, you know, that's what lets you go to the gym and try to be a bit better than the next day or, you know, read the paper and become better educated about world events in certain areas that you don't know about.
• 47:56
  Sebastian Rodriguez-Elizalde: Like I think being able to constantly learn, I think is, as surgeons, we all have a level of competency where you've shown academic prowess to a degree, where you're able to learn.
• 48:06
  Sebastian Rodriguez-Elizalde: That doesn't stop when you start practice.
• 48:08
  Sebastian Rodriguez-Elizalde: And I guess when I first started I sort of thought that did like, okay, I'm done, I'm done.
• 48:11
  Sebastian Rodriguez-Elizalde: My fellowship.
• 48:13
  Sebastian Rodriguez-Elizalde: And people always said like, well, you know, medicine is a lifelong learning journey, but you really have to be active in that.
• 48:20
  Sebastian Rodriguez-Elizalde: You can't be passive in that.
• 48:21
  Sebastian Rodriguez-Elizalde: You have to seek out new opportunities.
• 48:23
  Sebastian Rodriguez-Elizalde: You have to seek out, um, things that make you uncomfortable to be better.
• 48:29
  Joseph M. Schwab: What part of your practice are you, let's say, most proud of that your patients never get to see?
• 48:35
  Joseph M. Schwab: I.
• 48:38
  Sebastian Rodriguez-Elizalde: Um.
• 48:39
  Sebastian Rodriguez-Elizalde: I think if the relationship well, they never get to see.
• 48:42
  Sebastian Rodriguez-Elizalde: I think it's sort of like the, the mentality here of the hospital.
• 48:46
  Sebastian Rodriguez-Elizalde: When we first brought in like the, the first Anterior hip program in, in this whole region of Toronto and we brought in the first same day hip program, you know, what I was proud of was that the nurses and people involved were proud of it.
• 48:59
  Sebastian Rodriguez-Elizalde: So everyone from registration at the desk to the nurses to the OR people, they had ownership of that program knowing that they were exclusive in the entire region and that they were teaching other people.
• 49:09
  Sebastian Rodriguez-Elizalde: They had a sense of ownership.
• 49:11
  Sebastian Rodriguez-Elizalde: That, I don't know, makes me almost emotional because they liked the program almost more than I did.
• 49:17
  Sebastian Rodriguez-Elizalde: And it really showed in their work,'cause patients would comment on me, they're like, you know, we go to a lot of public hospitals, or we go here and people aren't.
• 49:24
  Sebastian Rodriguez-Elizalde: As happy as they are to be working where they are or, or notice those things And those kinds of comments really, uh, you know, highlight all the people that are part of that process, uh, for that patient journey.
• 49:36
  Sebastian Rodriguez-Elizalde: But the fact that they owned it and, and love it and are proud of it, I don't think there's any way I couldn't be more happy with that entire process because I can't teach that.
• 49:47
  Sebastian Rodriguez-Elizalde: But to know that.
• 49:48
  Sebastian Rodriguez-Elizalde: They were able to achieve that.
• 49:50
  Sebastian Rodriguez-Elizalde: And it echoes with patients though they don't know why exactly, but they know people are better here.
• 49:56
  Sebastian Rodriguez-Elizalde: That, that I'm really proud of.
• 49:58
  Joseph M. Schwab: And one last question for you, Sebastian.
• 50:00
  Joseph M. Schwab: When your fellows leave your program, what do you hope that they carry with them?
• 50:08
  Joseph M. Schwab: That has nothing to do with implants or approach or even efficiency.
• 50:14
  Joseph M. Schwab: I.
• 50:16
  Sebastian Rodriguez-Elizalde: I think.
• 50:18
  Sebastian Rodriguez-Elizalde: Patient care I think is very important.
• 50:20
  Sebastian Rodriguez-Elizalde: I think being able to have a relationship with a person, I think we forget bogged down sometimes in terms of volume and numbers and, and x-rays and behind.
• 50:28
  Sebastian Rodriguez-Elizalde: Every x-ray is a person, right?
• 50:30
  Sebastian Rodriguez-Elizalde: And they have a life story.
• 50:32
  Sebastian Rodriguez-Elizalde: They wanna play with their grandkids, they wanna go back to work, they want to heli ski.
• 50:35
  Sebastian Rodriguez-Elizalde: Whatever their story is.
• 50:36
  Sebastian Rodriguez-Elizalde: Don't forget that that story is what brought them to you and respect the fact that they're trusting you to operate on them.
• 50:43
  Sebastian Rodriguez-Elizalde: And I think that you, you have to remember behind everything that you do is a person.
• 50:48
  Sebastian Rodriguez-Elizalde: And so you have to have a relationship when you talk to'em in consultation, when you see them in follow up and respect that.
• 50:54
  Sebastian Rodriguez-Elizalde: Everyone recovers and prepares differently for surgery and their experience will be very varied.
• 50:59
  Sebastian Rodriguez-Elizalde: Um, but be open to learn from that and respect the person to try and, you know, you have to remember why they're here and get better.
• 51:07
  Sebastian Rodriguez-Elizalde: Um, and sometimes we say, well, your x-ray looks fine.
• 51:09
  Sebastian Rodriguez-Elizalde: You're fine.
• 51:09
  Sebastian Rodriguez-Elizalde: We have to address what their issues are, their concerns are.
• 51:13
  Sebastian Rodriguez-Elizalde: And that took me a long time to, to realize is that like even if you do something and everything is right, if it's not right for the patient, then maybe we haven't done everything right.
• 51:24
  Joseph M. Schwab: Well, Sebastian, I really appreciate you taking the time to be with us today on the AHF Podcast.
• 51:31
  Sebastian Rodriguez-Elizalde: My pleasure.
• 51:32
  Sebastian Rodriguez-Elizalde: I can't wait to see you in Nashville.
• 51:34
  Joseph M. Schwab: That's all for today's episode of the AHF podcast.
• 51:38
  Joseph M. Schwab: If you found some value in this conversation, I would asked you to share it with a friend or colleague or just drop us a comment to let us know and make sure to connect with us on LinkedIn to join the discussion between episodes.
• 51:51
  Joseph M. Schwab: There's a link to our brand new LinkedIn page in the description.
• 51:56
  Joseph M. Schwab: Find us every Friday with new episodes on Apple Podcasts, Spotify, YouTube, and all major podcast platforms.
• 52:05
  Joseph M. Schwab: I'm your host, Joe Schwab, reminding you to keep those hips happy and healthy and home the same day.