New Consultant in Vascular Surgery: Ithaca in Odysseus' Journey

  • George A. Antoniou
    Surgical Offices, Phase 1, The Royal Oldham Hospital, Rochdale Road, Oldham OL1 2JH, UK.
    Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
    Division of Cardiovascular Sciences, School of Medical Sciences, University of Manchester, Manchester, UK
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Open ArchivePublished:June 05, 2018DOI:
      When you set out on your journey to Ithaca, pray that the road is long, full of adventure, full of knowledge.
      • Kavafis Constantinos P.
      Poems 1897–1933.
      Constantinos Kavafis, 1863–1933

      Odysseus' Myth and Surgical Career

      Odyssey, Homer's epic poem, describes Odysseus' journey home after the Trojan War. The journey back to Ithaca would be long and full of difficulties. During Odysseus' absence, his wife, Penelope, had remained faithful to him. However, a host of suitors had taken up residence in Odysseus' palace, behaving insolently toward Penelope and her son, Telemachus. Returning to Ithaca would be a great achievement for Odysseus, only for him to find yet another struggle to overcome. He approached the palace disguised as a beggar, slaughtered the suitors, and cleansed the palace (Fig. 1).
      Figure 1
      Figure 1Odysseus shooting Penelope's suitors (Christoffer Wilhelm Eckersberg, 1814).
      Does Odysseus' myth resemble a career in vascular surgery? The undergraduate studies are the Trojan War. Following this victory, there is a long journey ahead: vascular training. Becoming and working independently as a consultant vascular surgeon and establishing a successful career resembles Odysseus' aspiration to reach Ithaca and instate his kingdom. Vascular surgery is Penelope, the queen in the surgeons' life. The suitors are the difficulties in the early independent career of a consultant.
      Becoming a consultant and establishing an independent practice is a landmark in a surgeon's career. It is perceived as the fulfilment of long-standing endeavours to achieve expertise in surgery. Even though all surgeons go through (often not without difficulties) a transition from training to becoming an independently practising consultant, little attention has been paid to role models and guidance for newly appointed consultants, or for consultants who commence an independent clinical practice.

      Early consultant career

      New consultants are expected to achieve outcomes corresponding to national standards.
      • Browning D.
      • Mills S.
      • Tan E.
      • Warren O.
      Can newly appointed consultants achieve national standards in colorectal cancer surgery?.
      They have to set up their own autonomous practice or work efficiently within and, probably, be followed up by an experienced team. Furthermore, a consultant's role has evolved and is about much more than simply being a good clinician. New consultants are encouraged to take on management and leadership roles. To make their role even more multifaceted, they are also expected to take on training, academic, and quality improvement activities.

      The 10 Commandments

      Practical advice for new consultants who set out on their independent clinical practice can be synopsized in the following Decalogue.
      • 1.
        Select your surgical cases carefully. A prudent approach in early independent consultant career steps would be to (whenever possible) select cases that will probably have a successful outcome. It would not be inappropriate to ask a senior, more experienced colleague to take on the care of a challenging patient.
      • 2.
        Plan your surgical cases carefully. Mental labour reflects the mental efforts that a surgeon is making to plan a surgical procedure or manage a patient's clinical condition. A vascular surgeon needs to devote time and thought to clinical planning. For new consultant vascular surgeons who commence their independent practice, the lack of a lengthy consultant experience is offset by consideration of all eventualities and bailouts, so mature clinical decisions are reached and stressful situations avoided.
      • 3.
        Seek advice from colleagues. An invaluable element of comprehensive surgical care is obtaining an opinion from colleagues. One will be surprised to see how one's approach to clinical management may change merely by having an informal discussion with a colleague. Such discussions can be a preparatory work preceding a formal discussion within the context of a multidisciplinary team meeting.
      • 4.
        Get a multidisciplinary team involved in the care of your patients. Vascular patients often have complex disease and significant comorbidities. Careful work up, health optimisation strategies, specific measures to enhance peri-operative care, and pre-operative risk stratification are examples where input from other specialists may make a substantial difference to surgical outcomes.
      • 5.
        Communicate well within the team. Interpersonal skills have been described as vital for success as a new consultant. Being friendly, diplomatic, supportive, reliable, flexible, and resilient are important features ensuring effective functioning within the team. Being ready to accept constructive criticism is a sign of efficient engagement.
      • 6.
        Communicate well with patients. Patients want an active collaborative approach to their treatment. They perceive this attention when you pay them a visit (outside of the context of a formal ward round) in the ward during the post-operative period.
      • 7.
        Find a mentor. In Greek mythology, Mentor was a close friend of Odysseus, who was given responsibility of Odysseus' son, Telemachus while Odysseus was away at the Trojan War. Mentor became Telemachus' counsellor and protector. For new consultants, the role of mentor should comprise counselling on personal and professional development, career guidance, boosting consultants' capabilities, and helping them realise their potential. Proper mentoring ensures job satisfaction and psychosocial wellbeing, and provides a framework that encourages autonomy and self development.
      • 8.
        Maintain good record keeping. We live in an “evidence oriented” era. Good record keeping reflects a professional medical practice. Apart from ensuring patient safety and quality of care, good record keeping can protect from legal proceedings. Benchmarking results against national clinical registries and local colleagues is also a sign of maintaining good clinical practice.
      • 9.
        Continue to be a learner. New consultants should adopt the attitude of a lifelong learner. Being prepared to embrace new technologies, techniques, and clinical practices, and being able to implement them wisely in your own surgical life is an indicator of a highly promising consultant career.
      • 10.
        Be patient with your aspirations. New consultants aspire to implement new ideas. Goals such as setting up a new clinical service or developing an academic/research network can be achieved when systematically working on a long-term strategic plan based on clearly defined principles.


      The transition from surgical training to an independent consultant career is not without difficulties. Ithaca is not the end of the vascular surgeon's long pathway. The end of the journey is rather the fulfilment of life-long endeavours to develop a complete personality and become a better doctor, a better surgeon, and a better person. Vascular surgeons have to learn how to live with obstacles and challenges through their career journey, expecting that this journey may be long.


      The valuable comments of Mr Stavros Antoniou and Mr Richard McBride are greatly appreciated.


        • Kavafis Constantinos P.
        Poems 1897–1933.
        Ikaros, Athens1984
        • Browning D.
        • Mills S.
        • Tan E.
        • Warren O.
        Can newly appointed consultants achieve national standards in colorectal cancer surgery?.
        Int J Surg. 2016; 36: S31-S32


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