George S.M. Dyer, MD is an associate professor of orthopaedic surgery at Harvard Medical School and an attending upper extremity surgeon on both the Hand and Upper Extremity Service and the Orthopedic Trauma Service at Brigham and Women's Hospital in Boston. He graduated from Harvard Medical School, the Harvard Combined Orthopedic Residency Program and the Upper Extremity Fellowship of the Brigham and Women’s Hospital and Children's Hospital, and has served in both the U.S. Air Force and the U.S. Navy.
Please talk a little bit about your career. You started in the U.S. Air Force. Did you serve as a doctor?
I was not a doctor in the Air Force; medicine is my second career. In the military, I worked in intelligence. In 1992, Hurricane Andrew devastated Miami and there was a lot of focus on medical needs. This was right after the end of the Cold War. The United States had a multi-million-dollar satellite investment floating in space, and I wondered if there was any way to use it to assist in the recovery. I wrote a master’s degree paper on the topic. Along the way, I learned more about trauma and injuries. Eventually, I realized I was more interested in injured people than I was in satellites, and I decided I would be happier to switch tracks and become a doctor rather than staying a spy.
I hadn’t studied pre-med, so I went back to school to take the necessary science classes. I didn't start medical school until I was 30 years old. I went in with a very direct intention of becoming a trauma surgeon—orthopaedics in particular—although I had no idea what that really meant at the time. I probably wouldn’t have become a doctor if I hadn't first been in the Air Force and become interested in trauma.
Being slightly older than your peers, do you feel your experiences as a student were different?
My experience made me very goal-directed. I knew exactly why I was there, and I didn’t have any questions like “Why do I want to be a doctor? Or do I really want to do this?” All of those things were behind me.
And the other piece of it…and maybe a little harder to explain…I was a little more grown up. I was married, I had a mortgage, I had lived in the adult world for a while. Many of my classmates were incredibly bright, but they’d only ever gone from one class to the next, to the next A and the next achievement. I think my experience helped me build a rapport with patients early on. If someone was out of work because they're injured and may not be able to work or pay their mortgage, I understood what that could feel like.
On the flip side, the drawback was that my classmates would stay up all night on call, operate the whole next day, and then want to go out the following night. And I just said, "I am going to bed."
You've also done some work in Haiti. Is that correct?
I was privileged to be in the first group of surgeons that went there just four days after the earthquake in 2010. What I saw just absolutely shook me to my core. Not just the degree of devastation and number of injured people and the scope and scale of need in the wake of the emergency, but also the realization that the whole medical system was just not prepared to deal with it. Haiti has very bright doctors—very dedicated people—but the support wasn’t available to make that talent functional at an adequate level.
Then and there, I dedicated myself to trying to help educate our Haitian colleagues. I don’t in any way want to claim that that was original to me…many of us heard that call to help. And now I'm really proud of what Haiti has achieved in those now 12 years since the disaster. A high watermark for me was just about a year ago, when there was another earthquake in Haiti—quite a big one—and that generation of young Haitian orthopaedic surgeons we’d been working with were able to take charge and manage the situation. I visited and toured one of the major trauma centers, and in many ways, it was reminiscent of the earthquake in 2010; the difference being that everything was being expertly carried out by Haitian medical teams.
How many times have you been there?
I’ve kind of lost count. Well over 20. I used to go all the time, sometimes twice a year. One of the few upsides of the pandemic is that we've learned we can do a lot remotely. And so, a continuing medical education conference that I started in Haiti 10 years ago has continued forward as a virtual conference.
There is a vibrant community of young Haitian orthopaedic trauma surgeons who did not exist in the same way prior to the earthquake. Through community engagement, many OTA members have built up a team of colleagues there. To be honest, my goal from the beginning was to put myself out of the job of going to Haiti. Not that I don't love going there, but my dream, and it's essentially come true, is that one day my Haitian friends would simply be colleagues just like my British or German or Japanese colleagues.
You've also done work on resident burnout.
For 10 years, I was director of residency for orthopaedics at Harvard. I started my training before there were work hour limits, but residents still work very long hours. I’d say the difference between then and now is that also I spent more hours in the hospital, I actually worked less hard and did more “real doctor’s” work. There was a fair amount of downtime, which the old timers won't admit. Now, every patient admitted to the hospital is sicker, and every patient either just arrived or you're getting ready to discharge them. There's an immense amount of paperwork and care coordination, which existed before, but on a much smaller scale. It can be very demoralizing for today’s trainees.
Work hour limits is definitely an issue that people have opinions on. Do you have any thoughts on them?
I feel that the social contract between the resident who's trying to work and the attending surgeon who's trying to teach them has gotten a little frayed, because everybody's so busy and squeezed for productivity. Of course, there are many faculty who are still super dedicated to teaching, but the residents have become a little alienated as they have been turned into factors of production.
I still firmly believe that today’s residents are supremely dedicated to their own educations. They'll walk through broken glass for you as long as they know you care; that you're all-in on their development. And so the answer is as simple as that, I think: we need to make it worth their while.
Do you have an overall philosophy for how you approach medicine?
Francis Weld Peabody was a famous Boston physician who authored a paper called The Care of the Patient. He said "the secret of the care of the patient is in caring for the patient." It's really profound. Every patient is somebody's mother, somebody's daughter, somebody's son, somebody's wife. If you can simply care about them—care about what they're thinking and feeling—it makes your interaction a healing experience for both of you. And the same is true for educating: if you just can make it clear to the trainees and the patients that you care, the rest of it falls into place.