S04E77 Mastering the Craft and Compassion of Neurosurgery: Dr. Christopher Winfree

When the hands of a neurosurgeon meet the heart of a mentor, what unfolds is more than just a tale of medical triumphs. Dr. Christopher Winfree joins me to unravel his path to becoming an associate professor at Columbia and share the personal philosophies that sharpen both his scalpel and his soul.

We venture into discussions about his one-meal-a-day regimen, its impact on his concentration in the OR, and why silence, not music, is his companion during surgery. Chris's journey is a testament to how lifestyle choices resonate through our professional lives, and his meticulous approach to patient care exemplifies the evolution of neurosurgery.

It's not every day you converse with someone who has turned their operating room into a classroom of empathy and innovation. Chris and I reminisce on our formative years, reflecting on the growth from medical students to practitioners who prioritize the patient narrative. His approach marries technical prowess with emotional intelligence, an alchemy that's redefining patient outcomes and care. We also pay homage to the mentors who've sculpted us, the significance of leadership in medicine, and the courage it takes to innovate—like Chris's groundbreaking techniques for nerve biopsies that have altered the pain trajectory for countless patients.

As the scalpel gives way to the fountain pen of personal finance, Chris opens up about preparing for retirement and the importance of financial literacy among surgeons. We explore what it takes for medical students to set their sights on neurosurgery residency and the evolution of mentorship that's shaping the surgeons of tomorrow. Our conversation is a celebration of the relentless pursuit of excellence and the gratitude that grows with each gray hair earned in service of healing. Join us for an episode that stitches together the profound personal journeys behind the scrubs.

#NeurosurgeryInnovation #MedicalMentorship #SurgicalJourney #ColumbiaNeurosurgery #BotoxandBurpeesPodcast #LifeInMedicine #MedicalInspirations #FutureSurgeons #ResidencyLife #DoctorsOfInstagram #SurgeryEducation #podcast #plasticsurgery

00:00:06 Neurosurgeon Dr. Christopher Winfree

00:03:52 Neurosurgery Training and Health Habits

00:12:25 Mentors and Improving Surgical Techniques

00:16:59 Improving Surgical Skills Through Emotional Intelligence

00:23:37 Surgeon Innovations in Nerve Biopsies

00:32:51 Mentors and Role Models in Medicine

00:39:14 Neurosurgeon Reflects on Career and Retirement

00:48:29 Navigating Neurosurgery Residency and Mentorship

01:01:04 Reflecting on Aging and Gratitude

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S04E77 Mastering the Craft and Compassion of Neurosurgery: Dr. Christopher Winfree

TRANSCRIPT

[00:00:04] Dr. Sam Rhee: Dr. Winfree, preeminent neurosurgeon, is someone I have known since the first day of medical school. As I mentioned in the podcast, we were gross anatomy partners. And as he mentions in the podcast, he wanted to be a neurosurgeon at a very early age. I had no doubt back then that he would become a neurosurgeon.

And as I got to know him better, he became a neurosurgeon. I realized eventually that he would be a great neurosurgeon. Because Chris is someone, as former University of Michigan coach Jim Harbaugh would say, attacks each day with an enthusiasm unknown to mankind. And if coach Harbaugh is a Michigan man, then Chris is 150% Just like Dr.

Stephen Strange, the Marvel superhero, Chris stayed at Columbia to train in neurosurgery. But while Dr. Strange is fictitious, the prestige of the Columbia Neurosurgery Program is certainly not. Ranked number one recently by Newsweek Magazine as the best neurosurgery service in the world, Dr. Winfree stayed at Columbia and is now an associate professor.

I think Chris approaches life with a unique perspective and energy. He defies easy stereotyping. Yes, eating only nine meals a week, as he talks about, is definitely something you could imagine a hyper efficient neurosurgeon to do. But unlike Dr. Strange, He never listens to music in the OR, and as he relates in this episode, he was able to figure out not just how to be a great surgeon, but also a great doctor to his patients, which is a maturity and a growth that I would not have easily imagined to see back in our early days of training.

When Chris talks about his mentors and how he mentors others, it is heartwarming to see how important it is to him that he relays his gratitude to those who helped him, and how he can help others in his life. Becoming a neurosurgeon is no easy feat. And as one of the program directors of Columbia's residency program, Chris is very blunt about outlining what you would need if you aspire to perform brain surgery.

But the path to achieving success in anything meaningful is no different, and the advice he gives will work for anyone in any field. I hope you enjoy listening to Dr. Winfree as much as I did, and thank you for watching and listening.

All right. Hi, welcome to another episode of Botox and Burpees, our highlights on surgeons. And I have a very special guest today. This is actually one of the very first surgeons I ever met as, uh, in my medical career. And that was because we were actually gross anatomy partners. For our very first course in medical school, um, this is Dr.

Christopher Winfree uh, let me intro, uh, Dr. Winfree or Chris. Um, I just give you a little bit of his background. So. Dr. Winfree grew up in Jupiter, Florida, attended Dartmouth College for undergrad, and you finished with high honors, very nice, in chemistry. And then, uh, after completing medical school with me at Columbia University College of Physicians and Surgeons in New York, you joined the Department of Neurosurgery At Columbia as a resident and then following residency, you completed a fellowship in peripheral nerve surgery in New Orleans, and then a second fellowship at function in functional and stereotactic neurosurgery in Portland.

And you're currently an associate professor of neurosurgery at the. College of Physicians and Surgeons in New York City at our home institution. And you specialize in peripheral nerve surgery, peripheral nerve cancer surgery, nerve and muscle biopsies, pain neurosurgery, and spasticity. And your research also covers many of those same Uh, and you have a million different, uh, honors in terms of your professional organizations and what you do.

Um, so I just want to thank you, Chris, for, uh, agreeing to do this with me today.

[00:03:57] Dr. Christopher Winfree: Thank you, Sam. It's great to see you. We go way back, and I'd like to thank everybody for listening today. So just to put things in perspective, you know, as we get older and we sort of reconnect with people, you realize the passage of time. And when you and I first met in 1987, um, 1987 was, was 34 years after.

The armistice that ended U. S. involvement in the Korean War, okay? Um, 33 years ago I met you at Columbia. So that, that's the, the time that's passed since then. We started high school, or we started college something like 12 years or 13 years after the Vietnam War. So just to show how old you I have gotten.

But it's good to see you've been working out clearly. Um, you've definitely put on some muscle mass since the last time I saw you. We operated together maybe 12 years ago. And, um, I, I remember you not being quite so muscular, which is good. So you've been, uh, you've been combating the, uh, the, the, the muscle wasting that happens with, with the elderly.

So that's good.

[00:05:03] Dr. Sam Rhee: Well, you've always been a very fit individual yourself. I know you do, uh, uh, your, um, hobbies and what you do outside of the OR has been always super physical. So, uh, for me, I, I picked up CrossFit and I started. And you're right. Like as we get older, you know, we're just trying to stay fit and healthy in whatever way we can.

[00:05:22] Dr. Christopher Winfree: Yeah. And the biggest thing I've done in the past, well, since 2017 is one meal a day. So I ate nine meals a week. So one meal a day, every day. Uh, I operate on Thursdays and I take my residents and students, whoever's operating with me, we always do lunch, like a formal sit down lunch on Thursdays. That's the only day of the week I eat lunch.

Uh, every other day is one meal a day and sometimes we'll do brunch on, on one and sometimes two days on weekends. So I really try to keep to nine meals total per week. No snacking, just black coffee and water. What happens when you do that is your body just transforms. You, all your body fat essentially goes away.

And you turn into this warrior where you're just, you just have tons of energy and you just, during the day, you just can be incredibly focused and energetic. And it's, it's actually a fantastic way to live. It's obviously not for everybody, but, um, but I've been practicing for a long time and it's great.

[00:06:13] Dr. Sam Rhee: how many calories do you take in? Do you keep track? Like macros wise?

[00:06:17] Dr. Christopher Winfree: Nope, I'm not a diet freak. I literally just don't eat. And when it's time for dinner, I drink a glass of Metamucil just for extra fiber. Um, I have a regular dinner. I eat whatever I want. Um, if there's dessert, I'll have dessert. I don't worry about it. I just have a well balanced meal. Make sure it's a, you know, the usual protein, veggies, all stuff that everybody else eats.

I don't care about carbs. I don't care about ice cream. It's all good. And uh, when you do one meal a day, you don't really have to worry about that stuff as long as it's a well balanced. So I don't count calories or any of that stuff. None of it matters.

[00:06:50] Dr. Sam Rhee: You were ahead. of the intermittent fasting trend, it sounds like way before that became popular.

[00:06:57] Dr. Christopher Winfree: Well, that's true, but I was not the first one in my department. There were two of my partners in my department that were actually doing it a couple of years before me and I just modeled it after them. Uh, so I was not the originator of this. I mean, there were people doing it dating way back and they swore by it and I kind of lapsed into it.

And it's so funny. I'll, I'll be talking with people and then a couple of years goes by and I'll, I ran into somebody. Um, I hadn't seen him for a couple of years. He's like, hey Chris, I haven't seen you in a couple of years. I'm looking at the guy and I had no idea who he was. Cause I also have partial face blindness.

I'm not good at recognizing people. And I didn't know what his person was talking about. Turns out I've known him for years. He's like, yeah, the last time we met you didn't, you mentioned intermittent fasting. I started doing it, I lost 150 pounds.

[00:07:40] Dr. Sam Rhee: Wow.

[00:07:41] Dr. Christopher Winfree: 150 pounds. I mean, it's astonishing. That's the other reason why I didn't recognize him.

But the point is, um, you know, there are people out there who are, who are interested in trying some things to make themselves healthier and better. And this is one of a million things you can do, and you can influence people. Not intentionally, like I'm not trying to, you know, But just because I talk a lot.

I'm a yapper. And so, um, sometimes it rubs off and sometimes you can make a difference in someone's life. And, and it's nice when they tell you, you know,

[00:08:10] Dr. Sam Rhee: Yeah, that's awesome. Uh, it, that sounds actually like a very neurosurgery thing to do is just eat once a day. So you're more efficient with everything else that you do in your life,

[00:08:18] Dr. Christopher Winfree: like travel, like there's no, I travel with my family. Like we don't have to shop for breakfast stuff, like you do for the kids. But like when I travel on business, I There's no, there's no time wasted dealing with food in the morning. I don't have to deal with any of that stuff. I don't have to take lunch breaks.

Um, you know, it just, it, it, it, there's an efficiency when you strip out the meals and the snacks and the, the crap. Um, it's better for your teeth. I mean, it just, the list just goes on. You just rid your life of a lot of baggage that's unnecessary.

[00:08:47] Dr. Sam Rhee: Oh my God, I keep hearing you. I'm going to have to, I'm going to start getting convinced, but, uh, let me start with this with you, Chris, um, give me a memorable training experience or something you really remember that sort of. Either put you on the path to neurosurgery or really confirm that for you or something that was just really special for you during that time.

[00:09:07] Dr. Christopher Winfree: Well, here's the thing about neurosurgeons. About half of neurosurgeons are basically born knowing they want to go into neurosurgery or figure it out really early, right? I wanted to be a surgeon since I was in sixth grade, learning first aid and cub scouts or boy scouts, whatever it was. And I remember that exact moment that happened.

And then it was surgery until Middle school or thereabouts. I'm like, okay, neurosurgery. Never knew a neurosurgeon, never met a neurosurgeon, but just knew I wanted to do it. And that's just that. So, you know, it's not like I made some conscious decision. I had no choice in the matter. But during training, neurosurgery training is this really messed up prolonged where it was just, quite frankly, it was a horror show of you just, just years and years of sleep deprivation and constant work and you're just immersed in tragedy and the death and destruction and all of it.

And, um, but during that time, you really figure out, you know, who, what people are made out of. Um, in, in, you know, how, what people's true nature are, and I'm not talking about patients, I'm talking about the people you work with. And, and during that process, I was fortunate to work with a lot of really great people who served as mentors and, uh, both in terms of faculty, co residents, um, and even, you know, even med students you can learn from.

And I had a series of, you know, every resident goes through, and you're training, and you're making mistakes, or you're just having bad outcomes through no fault of your own. And, People can either yell at you and say, yeah, you're doing a terrible job, or they can sit down and they can teach you and educate you and help form you into, um, a competent physician and neurosurgeon.

And I had a lot of people who fall into that latter category. And, and what's really neat is as you get older, you start to figure out what's important in your life. And at some point you figure out that, you know, gratitude's actually important because you see the people around you

[00:10:54] Dr. Sam Rhee: die, right? And

[00:10:55] Dr. Christopher Winfree: Right. And you're like, Oh, man, I should have, I should have said something to that person.

So you start making these mental lists of, all right, I'm going to, when I see somebody, I'm going to tell them, you know, how they, they, you know, what they meant to me and all this. And not that your life is sort of obsessed with this, but when you have the opportunity, show some gratitude. So I actually ran into one of my senior residents, my chief resident, actually.

At a meeting in Jerusalem, because, you know, we're in academics and we travel around the world and give lectures, had dinner with him and we're a bunch of people and one of them says, how do you guys know each other? And I was like, let me tell you some stories. And I went through a list of a bunch of things that my chief resident did to help me in my career and got me through some really hard times.

And it was just like a 3 or 4 minute conversation, but. It just blew his mind. I mean, it was like we had a really nice moment and I, and I just realized how, you know, powerful that can be for somebody. He had no idea. He's like, why didn't you tell me this stuff? I just thought you knew. But when somebody does something for you, show them the gratitude.

Show them what they meant to you. Because people are out there living their lives, often oblivious to things, and you don't know what kind of impact you have on other people. And just take a moment and share it with somebody. How you meant to me or what you did for me that shaped my life. I'm telling you, people love that.

And there's not enough of that in this world because people are so lost in what they're doing. It's all about they want and what they want to project, but take a minute and explain to somebody. Maybe today, you know, if you have, leave your listeners, you can do that this weekend, maybe, or this week. Find somebody that meant something to you in your life and tell them how they meant something to you and the difference they made.

And I'm telling you, that makes a world of difference. Far more than any social media likes or anything else. Tell them face to face, um, what they meant to you. That would be my advice.

[00:12:41] Dr. Sam Rhee: That's really good advice, and I love my chiefs and I remember them well. Tell me one thing that that chief did for you, uh, that you remember.

[00:12:49] Dr. Christopher Winfree: There are so many, like I misinterpreting a film and in a patient that was, you know, super sick and I'm like, Oh yeah, you know, the whatever shunt or something about it looks fine. And, and they sat me down and like, You know, hours later, like, nope, not fine. This person's dying. Here's what you missed. And instead of being like, you're a horrible person.

Why didn't you get that? He sat down and said, you know, here's the imaging study that, that, that you looked at misinterpreted. Here's why you got it wrong. And here's next time how to not to get it wrong. Never made the same mistake again. And you know, it happens in different, different things. And, and sometimes it's not even about making a mistake.

It's just, here's how you could have done something a little bit different. Or, um, here's how just to, to do better. And, you know, it's helping you become a better person, physician, neurosurgeon, whatever. And people that are around you that help you become better. That's who you should be hanging out with.

That's who you should be identifying as, as mentors and, and people that can, that you should ally yourself with. Not people that are saying things to make themselves look better. You know, seek out the people that do the former and um, your life will be much more enriched. But make sure you tell those people At the appropriate times, the difference they made, right?

[00:14:05] Dr. Sam Rhee: As a surgeon, what else did you do during your training or after you finished training that made you a better surgeon? Syvertsen.

[00:14:19] Dr. Christopher Winfree: I shut off the music in the OR. I don't like music. I hate loud noises. I was a guy in college that would go to rock concerts and I'd crumple up the ticket stubs and stuff in my ears. You know, I carry earplugs. I wear earplugs on airplanes and subways.

Like, I'm a huge fan of lack of noise. So, I shut off the music. I learned as a resident that I can't be listening to music in the OR. I was making mistakes and nothing catastrophic, but you get distracted and you're just sloppy. So, get rid of the music, get rid of the sound. I clamp the suction. I don't have suction going in the OR.

I unclamp it when I need it, and I reclamp it. I hate noise. Um, so there's that. Visualization is a huge thing. Any case that's challenging, uh, think about it. Um, I go through it step by step, visualize it. So once you're in the case, you're like, all right, I've already seen this 50 times. You know, I visualized it.

Um, the other thing is you really, I try to put myself Like, what would I want as a patient? And so, peripheral nerve surgery used to involve really, really big incisions, lots of dissection, doing a lot of exposure. Soon as I became an attending, I started limiting those exposures. And there are times where you need to make big incisions.

Like I did last night, I had to make a big incision in somebody. But, um, but smaller incisions hurt less. And, um, Historically, a big brachial plexus exploration is a 12 13 hour surgery. Patients stay overnight, you know, they're often intubated overnight. I mean, it's just, you know, you're putting patients through this, this sort of shark bite kind of thing.

So I said early on as an attending, I'm going to do this in stages. and I would do multiple smaller exposures, each one lasting maybe two hours, and get the patient home, and bring them in in stages, and patients tolerate that so much better. And most of these are young healthy patients, so the repeated anesthesia episodes aren't really an issue.

But, but that's what I would want as a patient. I don't want to have this massive, you know, incision that you're exposing stuff you kind of don't need to be exposing. Doing the smaller. Chunks that are more tolerated, more tolerable, less painful. And I started doing that all over and it's really not a concept I came up with.

I mean, general surgeons have been doing that with cholecystectomies, right? Developing laparoscopic procedures. Patients are outpatient now. They don't stay in the hospital for four days. You, you know, you train in general surgery. You know how that is. Doing that in, in sort of my field is, is, is difficult.

is a thing too. Minimally invasive spine surgery, which I of course am not a spine surgeon, had nothing to do with, but, but it's really transformed the patient experience. Things hurt less, they're less time in the hospital, and, and that's one of the things I did I think to be a better surgeon, is really focus on what I would want as a patient, reducing pain, And getting patients the same outcomes with less invasiveness.

And I think that's a, it all starts with keeping the patient, you know, patient's interest in mind first.

[00:17:16] Dr. Sam Rhee: You've developed a lot, I think, in terms of your emotional intelligence. You've, like, I just remember us as very eager first year medical students, but then, in order to become a better surgeon, it wasn't about, uh, surgical skill, which we all have. Need as a prerequisite, you know, like great hand eye coordination or be able to sort of see what's going on in a surgical field.

But it sounds like a lot of what made you a better surgeon was developing, like you said, emotional intelligence and knowing what someone would want and then working towards that, which is so weird. If you think about what a typical surgeon, quote, stereotypical mentality would be, right? It's just, you know, do the most you can, be as aggressive as you can, do it all at once.

Like, those are the kind of things that you would imagine what a surgical, like what a typical surgeon would do.

[00:18:24] Dr. Christopher Winfree: Not being hyper aggressive, because, you know, a lot of bad stuff can happen in surgery, and neurosurgery in particular. And part of your job is to help protect patients from bad complications.

And, and that doesn't mean denying people treatment, but being, you know, judicious in the treatments you offer and not offering stuff that you probably shouldn't be doing just because you can do it and just because nobody really understands what you're doing. And I could probably offer all kinds of crazy things that patients would say, okay, I'll do it.

You really shouldn't be doing. And so, you know, I see a lot of providers out there cause I work in the medical legal space and I see a lot of stuff that other providers do. And I'm just left wondering what is going on? Like what, what were they thinking? And, and patients just show up and like, yeah, we'll do it.

Whatever. We'll pay cash for it. And I just said from day one, I'm not going to do that. I'm a Columbia, I'm on salary, there's no financial incentive. I can just practice great medicine as best I can. But I will say also, to your point, about the emotional intelligence, I was an emotional misfit, you know, growing up.

I didn't really have Wasn't particularly emotional, but really didn't have good EQ at all. And that's been a work in progress. And I constantly struggle with it because even, you know, until pre pandemic, I mean, the 2000 teens, I would still get these health grade reviews where Dr. Winfree doesn't listen and he's just, you know, arrogant, all this stuff.

And, and I find it helpful to read that stuff because I really try to sit down and figure out what's happening. And so what's interesting is the pandemic happened, and everything went to telemedicine. And we also, at Columbia, switched to Epic, which is an electronic medical record. And what was really neat is when I would see a patient now, or during the pandemic, I would read through their chart in Epic, so I knew exactly kind of what's going on, their history.

And instead of having a patient sit down in front of me and kind of rigorously go through this algorithmic history, and I'd interrupt them because they'd go out of order, and it was just, I was really not being a good doctor. I was just trying to get this list of stuff done so I could get through to the imaging and then what can I do to treat.

And it was really not a great way of doing it, and I had no idea. I didn't realize how bad a doctor could be.

[00:20:40] Dr. Sam Rhee: a doctor.

[00:20:41] Dr. Christopher Winfree: I'm not saying I was a bad surgeon. I was a good surgeon, but a bad doctor. Like, it just wasn't a person you'd want to go see in the office. But I didn't really realize that until, A, I would read the health grades, and then I'd sat and thought about it.

And then once telemedicine happened, I could actually sit there and just listen to patients. I can just hear them tell their story, and I don't have to interrupt them, because I have Epic. It has all the information there, and yeah, I can fill in the gaps, but I give patients 10 minutes, 15 minutes to just talk, and um, which is hard for me, because I talk a lot, but

[00:21:10] Dr. Sam Rhee: I talk about

[00:21:11] Dr. Christopher Winfree: once the pandemic ended, we started seeing patients in the office,

[00:21:14] Dr. Sam Rhee: a whole new

[00:21:15] Dr. Christopher Winfree: like, I try to do the same thing.

I just go in and, hey, what's going on? Let them talk, because it almost doesn't matter what they say. They can go off on tangents. Doesn't matter, because I already have the story from Epic. I already have pretty much everything I need, and if there is something missing, I'll ask it. Um, I don't need to do a super rigorous physical exam like when I was training, like, my peripheral nerve.

They're like, you gotta strip the patient's naked, you gotta look everywhere, they're doing all this invasive stuff,

[00:21:39] Dr. Sam Rhee: world. They're

[00:21:40] Dr. Christopher Winfree: and now we've got high resolution nerve imaging that can show us just about everything we need to see. Like, it's not that I don't ever examine patients. I still do

[00:21:50] Dr. Sam Rhee: I still do examine the closest things. Like,

[00:21:52] Dr. Christopher Winfree: I don't have to have patients take off all their clothes and do all this, because patients don't really want to do it. They want you to sort of examine what needs to be examined. They don't want,

[00:22:00] Dr. Sam Rhee: do you do?

[00:22:01] Dr. Christopher Winfree: they don't want to be creeped out. I don't know, it's just, there's, the medicine has changed. We have diagnostic capabilities we didn't have before.

And you can practice just as great a medicine. And mostly it consists of listening to a patient, let them tell their story, because a lot of patients just want to be heard. And that is a recent thing for me. I've been in practice for 27 years, as have you, and I'm still learning stuff, right? And I think I was a bad doctor five years ago, and I think I'm a much better doctor now.

And that's, you know, I'm a late learner, you know, but I think if you, as long as you keep learning. I think that's the key.

[00:22:34] Dr. Sam Rhee: I think that's pretty awesome because I do know a lot of surgeons who never get to that point in terms of, like you said, great surgeon, not so great in terms of a doctor aspect of it. And the fact that, you know, we turn the corner, it doesn't matter when, as long as we get there, like, That's really, that's really awesome.

I love that. Um, great advice. Um, let me ask you this. What is one of your favorite surgical procedures that you, you still really enjoy doing at this time?

[00:23:05] Dr. Christopher Winfree: So I like, it's kind of funny, but I, um, one of my specialties, as you mentioned before, is, is nerve and muscle biopsy. So I actually developed a number of new procedures. It's, it's fun inventing surgical procedures. Now, these are not inventions like I invented an artificial heart. This is not like that.

These are sort of technical variations of, of nerve surgery. Like for example, patients who have Motor neuron disease. So someone's suspected of having ALS, PLS, some of these diseases that affect motor neurons. Our neurology group at Columbia is really busy. We have a huge neuromuscular centers and I see a lot of patients who need nerve and muscle biopsies.

And historically there was a motor nerve biopsy. So these are peripheral nerves that supply muscles. So normally when you do a A nerve biopsy, you take a sensory nerve so you don't cause weakness. But some of the plastic surgeons actually, some of your colleagues, invented a motor nerve biopsy at Columbia years ago, 30 years ago or something.

And I started doing it to help diagnose some of these patients. And it was this hard kind of, it's a gracilis motor nerve biopsy. So it's up in the groin area and it's sort of an awkward place. And it's not a place that neurosurgeons really know how to get to. So I started thinking about ways of doing this better.

And I developed one that involves. The perineal nerve down by the knee. Much easier. It's a classic peripheral nerve exposure that you know, any hand surgeon, any, you know, nerve surgeon knows how to do. You can do it in your sleep. But anyway, I developed a motor nerve biopsy there. Much easier. I can do it in awake patients under local anesthetic and it's just super straightforward.

And that's fun. I love doing that procedure. Um, I invented it and, you know, it was, he published it and it was, it was kind of cool. Recently did another one, um, a ephemeral nerve. Motor branch biopsy. And again, uh, in the process of publishing that and I, I can do that. So doing surgeries that I've actually invented is really cool.

My favorite one also involving the biopsy is, you know, a sterile nerve biopsy. You cut out a piece of the sterile nerve, you send it to the lab, and the patient's got numbness for life in their, in their foot. It's, you know, not a huge deal, but kind of a drag. So I started doing nerve reconstructions back in the mid 2000s where I would harvest the nerve and then repair the nerve with a sterile off the shelf kind of conduit.

And over the years that's evolved because there's better, you know, allograft repairs now. And so I did it so that patients could get sensory recovery. Turns out that's not the big advantage. I've done a thousand, you know, almost a thousand of these. It turns out, uh, uh, one of my colleagues, uh, published, the real advantage is that when you do a nerve biopsy, there's a, 26 percent chance that patient's going to get a horrible nerve pain syndrome, a painful neuroma, which can be debilitating.

It's awful, right, when it happens. Patients are in agony. It's terrible. So it turns out repairing the nerve after the biopsy reduces the incidence down to 4%. It's almost an order of magnitude drop. So of all the, you know, and this is the way people are doing biopsies now. So this procedure has actually saved hundreds, if not thousands of people from getting these horrible pain syndromes.

And it wasn't even the intent of the procedure. It's just one of the sort of the happy sort of accidents, uh, to quote Bob Ross. Right.

[00:26:09] Dr. Sam Rhee: Right.

[00:26:10] Dr. Christopher Winfree: It's one of these things that just happened and people are out there benefiting from it. Um, and it wasn't like I was a smart person and kind of figured out that I'm going to save people from getting pain.

It's just coincidence or just a fortunate thing. But, but I still do like a couple of these a month and I do it and, and it's, and it's great. And it's kind of fun to, yeah, I, I'm the one that figured this out and, and, and we're helping people with it. And it's, and it's pretty cool. And so I still enjoy their simple procedures, but I enjoy doing them.

[00:26:37] Dr. Sam Rhee: In order to be able to develop these procedures, you actually need what I don't think a lot of neurosurgeons have, which is a really deep knowledge of the anatomy of the rest of the body. That's not what we're The brain. So like, how did, how did you figure, like, did you have the anatomic knowledge before you started figuring it out?

So, or did you like, say, go back and say, listen, let me look at these areas. Let me look at the anatomy and try to figure out better, better ways of doing this.

[00:27:04] Dr. Christopher Winfree: I honestly, I mean, I respectfully disagree. I don't think it has anything to do with anatomy. I mean, I loved anatomy and you gotta have some basic anatomic. You're just, it's an attitude of trying to find a better way to do something. Like, um, and it's true in all aspects of life. Like, Like, I'll, my wife will give me grief about this, but I'll get a piece of dive gear or something and I'll just immediately start taking it apart and rebuilding it to make it exactly, because I cave dive and that's a real specific type of diving and it's, it can be super dangerous and you sort of have to have your gear customized for exactly what you need in whatever environment you're in.

And my wife's like, look, professionals are building this stuff and you're just taking it apart and redoing it. What makes you think you can do it better? I'm like, well, cause I can do it better. And my life depends on it. And I'm just, that's just the way it's going to be. And, and it's this sort of stubborn, um, attitude that I can make something better.

And so I see ways of doing things in that people are doing in the operating room. And just because they're doing it doesn't mean that's the best way to do it. There are definitely better ways. That doesn't mean, if you don't know what you're doing, you should just go reinvent all the surgeries that you're learning in a residency.

Not saying that at all. But there are definitely ways to improve things. As long as you're open to that, and you're open to maybe making some modifications, there's no reason why you can't push the field forward. And I don't think, I'm not unique in that. I mean, this, There are a lot of surgeons out there doing stuff.

And there are a lot of people pushing the envelope way beyond anything I've done. I mean, there are people inventing new ways of, of treating, you know, patients. And forget surgery, I mean, who came up with mRNA vaccines? I mean, that's a totally different way of thinking about vaccines. I mean, this is, this is modern medicine.

This is engineering. This is medicine. There's people out there pushing the envelope, thinking about different ways of doing things. And I think, um, it has nothing to do with anatomy. I think it just has to do with embracing that attitude of, of trying to do something better. And, and just, and just making it happen.

[00:29:08] Dr. Sam Rhee: I think a lot of surgeons have, um, particular aspects of their setup or routine or their procedure that they do that's almost like a ritual or something's habitual. Is there anything that you do in the OR that you have to do or you find that's super important? Maybe not everyone does or, or maybe it's unique to you or just something that you have to do every time you, you, you step foot, uh, doing a case.

[00:29:32] Dr. Christopher Winfree: I'm definitely aware of the whole ritual thing. I'm not like that. I, um, I like creating an environment that is conducive to good work. So having a good relationship with the anesthesiologist, having a good relationship with the nurses, the residents, making sure the equipment is set up ahead of time, but I'm not actually fanatical about that.

I use it more as a teaching moment for the residents. Like a lot of cases I do involve fluoroscopy. So I have the residents set up the fluoro and it's got to be perfectly straight every time. I can't start with it crooked. Um, but I don't. I don't do something where I have to go scrub a certain way or it's, it's not really like that.

I don't have a thing where I make everyone do something like during the timeout. I don't, because I don't want to mess up other people's game. For me, it's an internal thing. Um, like yesterday we were, I had a couple of complicated cases. And, you know, at the start we were talking about some things. But as soon as the case started, I'm like, I gotta focus on the case and this conversation's over.

And I wasn't, you know, being a dick about it, but I was just like, we'll resume this later, but right now I gotta focus. And so for me, it's not about controlling the outside environment. It's about controlling my inside environment, what's in my head. Reducing extraneous noise. Reducing extraneous conversations and focusing on the work.

And so for me, it's about that, not so much an external ritual. I, there are definitely surgeons out there that, like I said, have to scrub a certain way. They have to not talk for two minutes or whatever. Um, nothing like that.

[00:31:12] Dr. Sam Rhee: Hmm.

[00:31:12] Dr. Christopher Winfree: That's okay.

[00:31:14] Dr. Sam Rhee: It is, I think you are, uh, in the minority in terms of people not playing music in the OR. I think, I think you're right. I think reducing distractions is really important. And if, if music or external noise or any of that is, is, uh, is a distraction, then that should definitely be stopped. When did you, did you figure that out early?

Like as a resident, like, because a lot of, yeah. Cause a lot of surgeons will play music. I mean, I've, I've heard it louder than some concerts sometimes the way some people like have it going in the OR.

[00:31:41] Dr. Christopher Winfree: So here's the thing. I'm not in the OR to be entertained. I'm in the OR to do a job and to get a patient better. That's it. To some extent, I'm there to help train residents, med students, You know, but I'm there to help patients. I'm not there to listen to music, be entertained. It's that's just, that's just reality of it.

And I learned that long time ago. And if over the span of my career, one patient gets hurt because I'm distracted listening to music, it's not worth it. All those years of entertainment for me, not worth it. So I just abandoned it. Just not going to happen. No music in my aura. That's it. Hard stop.

[00:32:15] Dr. Sam Rhee: That's a good start. That's, that's awesome. Um, who is really important to you? Anyone else in terms of your practice? Is there any one person or persons that you feel has been indispensable for you in your practice? In the, OR as part of your team at this point?

[00:32:32] Dr. Christopher Winfree: No, I would say that the indispensable people were my mentors. Right. And I mentioned some, um, I in, I still have the advantage of right next door to my office is literally adjoining to one of my earliest mentors, Don Quest, who was my med student advisor. And then, you know, I mentored throughout program director and residency.

And, and then my chairman, Sandra Connolly has been, um, a great mentor for me also. He, um, was a junior resident when I was a med student working in the neurosurgery labs at Columbia. And then he stayed on as faculty. He helped, I think he was pretty much instrumental in helping me get a residency spot. And then he, um, I'm sure was instrumental in helping me get hired as faculty.

And I'm still on, you know, he's chairman now, I'm still on as faculty. He's been an outstanding mentor. is much through his work ethic. I mean, he literally works harder than anyone else in our department and has just done an amazing job in, you know, not just a mentor and a friend, but a role model, right?

Um, and you know, there's so many people like that at Columbia, but, but he's probably been the one person who's been most important for my career. Um, not that he's in the OR or helped me do cases. It's not about that. It's a much more macro type, um, mentorship than that. Um, you know, cause I'm the, I'm the peripheral nerve surgeon in my department.

Nobody knows, nobody has any idea what I do. I, it's, it's just, they come in and they're like, what are you doing today? Oh, that's great. What is, what part of the body is, they have no idea, right? And that's fine. You know, that's not their thing. Um, but this is more, you know, a structural long term mentorship over decades.

And being in a place for so long, you can take advantage of things like that. You know, if you're moving around a different job every three years, you are literally on your own. You got nothing unless you have outside mentors, but then they're not really applicable at work. But staying at Columbia for 30, what, 33 years now, you have this longitudinal Because Columbia keeps people, right?

There are people that have been at Columbia longer than I have. 50 years, 40 years. And, you know, you can, you can have relationships with these people for decades on end. And there's something so incredibly valuable about that. It's hard to explain.

[00:34:43] Dr. Sam Rhee: You know, I remember Dr. Quest when I was a medical student and as a resident, I would see him and the one thing I would say about him is he just radiates. Leadership or just something ineffable. Like you can't really describe it, but that guy had dignity and just an amazing presence. Like you, like, I don't, I wouldn't want to say royalty cause he doesn't seem like he's standoffish or anything, but he just, he all, he was so, I mean, everyone respected that guy, like, and not because of anything that he was like outlandish or anything.

Like it was amazing how, uh, How you just knew, um, how special that guy was. And then the other person, Sandra Colony, I remember him, uh, as a medical student when he was a resident. And, uh, he was pretty quiet. Like, he, he wasn't someone who was, like, really, like, out there or had, like, a crazy personality or anything.

It's, I can't believe that he became head of your, of, of Columbia Neurosurgery.

[00:35:44] Dr. Christopher Winfree: Well, he's not out there. He's not crazy. He's, um, incredibly hard working. And it is, it is I think the smartest person I've ever met, in all honesty. Um, in terms of, not in terms of remembering stupid trivia, but in terms of like, technical knowledge, institutional, how institutions work, how people work. It's astonishing the level of, you know, The levels on which he operates, like I'm, I'm trying to figure out how to, you know, arrange my schedule and how to, you know, manage a couple of people in my office.

And that's what occupies, he's operating on a completely different chess board. Right. And I just. It's astonishing and it's just amazing to watch. It's not something I could ever do. Like, I never want to be a department chair. Like,

[00:36:27] Dr. Sam Rhee: I agree.

[00:36:28] Dr. Christopher Winfree: you're going to ask me about where I want to go in nursery. It's not a department chairman.

I can't stand managing people. I detest it. And Don Quest has this magnetic personality. He's just one of these people. Do you remember that scene in Apocalypse Now? Where Robert Duvall's character, Captain Kilgore, um, and then Martin Sheen's voiceover, he's talking about how this guy has this magnetic personality, nothing will ever, he'll leave Vietnam without a scratch.

Well, that's Don Quest. He served in Vietnam as a fighter pilot, left without a scratch. And the guy just has this personality that when you meet with him, and I see this because his office is right next to mine. He meets with these med students, both virtually and in person. He makes them feel like they're the center of the universe when they're with him.

And it's amazing, he has this way with people. And it's not something I could ever do. I just, I don't have that gift. Um, I can entertain people, right? I can talk to people, and funny or sarcastic. He's got the gift where people really want to be with him. in his orbit. And it's really, really cool. And it's not just about that, because there are plenty of magnetic people out there that are selfish.

He actually helps shape people's careers. He makes those people not only want to be with him, but he helps them get to where they want to be in life. And that's what's so cool, because anybody can have a magnetic personality. It's what you do with that personality. Like, are you helping people with it, or are you just serving yourself with it?

He is definitely the former category. And it's amazing to watch and he's relentless with it. He never, he never stops. He's still in there. He was in there all day yesterday, meeting with students and helping them get forward in their, with their lives. And it's, it's just incredible. He's such an incredible resource for Columbia.

[00:38:12] Dr. Sam Rhee: What do you think it takes to be a successful neurosurgeon? Anything in particular? Like, you've seen so many people, you've trained with them, you work with them, you are one. Like, what is it like, but there are a variety of different people in neurosurgery, obviously, but is there anything in common, some core? thing that they have. Hmm. Hmm.

[00:38:39] Dr. Christopher Winfree: to. You have to be able to work in incredibly difficult environments where um, you're doing your best and patients are still dying because they've got horrible diseases and people are struggling and they're coming to you in the most desperate times of their lives and you're trying to help them but you're trying to balance that with with with life things and you know your family and and other things and and I I think you have to At the core, you gotta be a doctor, right?

You have to be in it to help people to some degree. I know it sounds a little corny, like every college student says that in their medical school interviews. And just parenthetically, I mentor a lot of people and a lot of people come to neurosurgery, they don't know why they want to be neurosurgeons. And they have difficulty with that question.

I say, look, half the neurosurgeons you're talking to when you interview, they were born neurosurgeons. They don't know why they want to be neurosurgeons either. So don't worry about that question. That question, you tell them that you've always wanted to be a neurosurgeon, they'll say, I get it, me too. You gotta have a good answer for why you want to be a doctor, right?

And because being a doctor is a lot different than being a neurosurgeon. Being a doctor involves a lot of things like the, the, sacrificing your time and ability to help people, and all this other stuff, the, the, the medical thing. And that's where it starts. Being a neurosurgeon is a totally different kind of thing.

It's not that you're not a doctor, but it's a type of medicine that has to, It has to put its claws into you somehow. I don't think you can just say, well, I think I'm going to be a neurosurgeon just because I like the nervous system. I don't think that's going to fly. I think it sort of has to find you in a really fundamental way.

Whereas you can come up with a list of reasons and you really should have a list of reasons for why you want to be a doctor. Because you can't just casually go be a doctor. And of course you can't casually go be a neurosurgeon either. But, but being a doctor and being a neurosurgeon are different. And um, I don't know if that answers your question.

But, but you gotta be a doctor first. And then for whatever path you get to neurosurgery, maybe you like the nervous system, maybe you like doing stuff with your hands. That's fine. Um, but I think it's something fundamental where it just, it grips you and you can't, you can't shake free of it. Um,

[00:40:54] Dr. Sam Rhee: remember you told me you were going to be a neurosurgeon like almost the first day I met you. So

[00:40:59] Dr. Christopher Winfree: And I probably couldn't tell you why. I had no idea why.

[00:41:01] Dr. Sam Rhee: Well, none of us did at the time, but you knew you had an unshakable faith that you were going to become a neurosurgeon. There was no doubt about Um, it is weird. Uh, What are your future goals now?

So you've had a 20 some, almost 30 year career. What is your, what are, what are the future things you're looking forward to doing or what, what do you want to do? Like, what is it that you have in your sights now?

[00:41:24] Dr. Christopher Winfree: Well, so, I'm associate professor. I'm one of the program directors. Um, I'm the curriculum, you know, director. Um, I don't know. I'm already kind of doing what I want to do. I don't, I don't really have a lot of, there's nothing left to nourish, which I feel like I have to do. Um, I'll put in my paperwork for formal promotion to full professor, but that's just paper, you know, that's, that's paper stuff that, that doesn't affect me day to day.

It's just, my original stated goal as a kid was to be a professor of neurosurgery, so I'm just satisfying that, but it's really just checking a box. I mean, it's not that, uh, professional goals, maybe You know, be an associate dean a few years down the line. That's a big time commitment, and I'm not ready to give up clinical practice, do that yet, but you know, close to retirement, that might be an option.

But you know, maybe I'm not the person they're looking for, so it's, it's not like I can just decide to be a dean and it happened. You know, it's a process, and if they think I'm a right fit, then, or a good fit, then fine. Um, but again, that's, that's stuff I'm sort of looking forward to, but I spend every day Thinking a little bit about retirement, right?

I, you know, I, I, I teach a personal finance course to neurosurgeons. It's not a, I don't, it's not an online thing. I don't do it for money. It's just, I, when I'm a visiting professor, I, I give grand rounds. I'm doing it this week, actually coming up for one of the neurosurgery programs. I, I, I, I mentor a lot of residents as they are becoming attendings to sort of make sure their financial situation's in, in, in, in line and, and, You know, there are a lot of doctors out there doing that and I'm not, I'm not doing anything formal.

I get nothing in return for it. It's just my kind of teaching thing. Um, it's, it's fun. It's fun for me to think about retirement. It's fun for me to think about, you know, being prepared for that and, and helping get other people straight in terms of, you know, getting their financial lives squared away and making sure they have, you know, disability insurance and life insurance and the right bank accounts and the credit cards and just, you know, trying to have as frictionless a life as possible and being prepared for that.

Living beneath your means. All the basic stuff. I mean, this is not complicated stuff.

[00:43:29] Dr. Sam Rhee: Well, when are you going to retire though? Like in 10 years, 15 years, 20 years? Like, do you have a timeline for yourself at this

[00:43:36] Dr. Christopher Winfree: Well, my mental timeline is five years. Now, whether that actually happens. My goal has always been to retire in my fifties. But what is retirement? I mean, it may be scaling back from a lot of my administrative stuff. Scaling back from a lot of the work travel. Scaling back from a lot of the You know, I'm an editor on the editorial board of a whole bunch of journals.

You scale back from that stuff and just focus on maybe seeing patients in the office one or two days a week, operating one or two days a week, and, and, you know, having some time to do other stuff like reading and watching movies and all the stuff that I don't really have a lot of time for now. Um, but, you know, my family and I travel a ton as it is.

[00:44:17] Dr. Sam Rhee: Yeah.

[00:44:17] Dr. Christopher Winfree: like, oh, I have to retire so I can travel. Like, we're traveling all the time and it's great. And so I'm in a good place now. I don't have to change right now. And I'm not like looking to the next big thing. Like if I could do this for the next five years, that'd be fantastic. And then make some decisions, you know, if, if I still feel like continuing, then fine, but I'm not going to be one of those neurosurgeons, like still operating at 65 or 60, it's not going to happen.

I just, there's no way. Um,

[00:44:47] Dr. Sam Rhee: I was about to ask you that because we have, I've seen both, seen it both ways where there are surgeons who will operate until they literally physically can no longer operate. And then other surgeons who like make a choice and say, you know what, I'm I don't need to operate anymore. I'm going to stop at X point and they might be still at the peak of their careers, you know, surgically, like skill wise.

So where do you sit on that? You do love operating so much that it would be hard to walk away from that.

[00:45:13] Dr. Christopher Winfree: no,

[00:45:14] Dr. Sam Rhee: Okay.

[00:45:15] Dr. Christopher Winfree: there's, I, you know, it's, it's, you know, Like yesterday was a really long, kind of hard day in the operating room and yeah, you're tired and I, I don't know. I like, I still like taking care of patients. I feel like I just learned how to be a good doctor three years ago. And so if I could do a few more years of that and try to make a difference in people's lives, but like, for example, career development, I had a conversation with somebody recently who asked me to be on the board of directors, one of the big, you know, neurosurgery organizations.

And I was like, you know what? No, I'm not going to do it. There's plenty of young, hungry people out there build, trying to build their careers. You got to ask one of them. I just, I appreciate it. I'm honored by the, by the ask, not doing it. And I started saying no to stuff. I've been saying no to stuff for a while.

And saying no is a very powerful thing. And I'm not in the space where I have to do everything and try to be number one and run all these things. Like, I've been president of stuff before. I've run things. It's not my thing. Not interested. What I want to do is, is provide some content for people. Like I, I've organized a few courses that I teach and provide lectures for.

And you can make a difference in people's lives doing that. I don't have to run organizations. I can actually teach people face to face. And one on one or in specific courses and make a difference that way. And for me, I've tried to transition to sort of mentoring the residents, med students. And, and to the extent I do give lectures, it's more on the international circuit.

Like, I've got some international, um, Projects I'm working on, um, the World Federation and things like that. And some of my European colleagues and Australian colleagues, and it's, it's great stuff. Um, but I've kind of gotten out of the, the national meeting grind where it's the same national meetings every six months and it gets kind of monotonous.

I've kind of pulled back from that and same with surgery. Like, I don't feel like I have to, you know. Just operate and bang my head against the wall all the time. Like, I would be happy scaling back, you know, in a few years. But we'll see. Maybe I won't. I don't know. Maybe scaling back is not an option.

Maybe Columbia doesn't want me to do that. I don't really have a choice. And you know, that's, that's fine too, but I'll worry about that later. But 59 is when I got to start thinking about,

[00:47:17] Dr. Sam Rhee: Hmm.

[00:47:18] Dr. Christopher Winfree: age 59 is when I start thinking about stuff. I don't have to worry about it now. I'm in a good place now, I think.

[00:47:23] Dr. Sam Rhee: Yeah. Um, it's really illuminating to hear your, your path over the years and decades.

Uh, the experience that you've gained, and uh, it's, it, it's mind blowing. It's really gratifying to see how many surgeons at our point have sort of gained so much perspective and, uh, from their life experiences. Let's finish by talking about anything else you would say for someone who was listening to you and says, I want to do what that guy does.

I want to be like that guy. Like. You clearly are not the same person you were when we started medical school. Like there's a whole lot that happened between then and now. So what do you say to someone who's in the beginning of their path? Like they can't have the perspective you have. Like what kind of things would you be able to say to them?

I mean, what do you say to the medical students, to their young residents, like when, when they're coming in to help them sort of get to where you are?

[00:48:23] Dr. Christopher Winfree: Well, you got, so there's certain things you have to do to get here, right? I, like, it's, it's going to be of marginal utility for me to spend time telling a med student about my journey with the whole telemedicine thing. It's sort of, you sort of break things down and make it easy, as easy for your mentees as you can.

And I say, look, If you want to get to where I am, focus on doing a couple of things. Get good grades. Get good board scores and get good letters when you do your rotations and your sub I's, where you spend a month rotating as a fourth year med student, because those three things will get you in the residency program you want, because if you have bad board scores, You're probably not going to do well in neurosurgery match.

If you have bad grades, probably not going to do well in neurosurgery match. And worst of all, if you have bad letters, you're not going to get matched in neurosurgery. And so, don't worry about any of the other stuff you and I talked about today. All that stuff can happen later. Focus on those three things.

Okay? And to get good letters, You have to be able to work with people. Like when you work on a rotation, they're going to notice if you're a med student, you're kind of acting snotty to nurses and support staff. Nobody wants to work with somebody who's like that, right? Because if you're snotty to nurses, then as you rise up through the ranks, you're going to be snotty to the residents.

You're probably gonna do that to patients and just not going to be a good person to work with. So you got to be somebody that people want to work with because when they're choosing you as a resident, they're choosing you, not only they have to work side by side with you for the next seven years. But you're going to be the face, the forward facing care for their patients.

Like, when my patient's in the hospital and there's an issue, they don't see me first, they see the residents in the middle of the night. And who do I want talking to my patients, who are incredibly important? I want residents that are good people, right? And so, on your sub eyes, you need to make sure that everyone who's looking at you, and everyone's looking at you, everyone needs to see a good person.

[00:50:22] Dr. Sam Rhee: cares about

[00:50:23] Dr. Christopher Winfree: Cares about patients. Cares about working hard. Cares about not being a complete weirdo around the other people. And so, this is what I tell med students. You want to be a neurosurgeon? Do these three things. Start with that. Once you're a neurosurgery resident, then you can start to make some decisions about career trajectories.

Do you want to subspecialize? Do you want to do fellowships? Do you want to do research? You know, what do you want to do with your life? Um, but none of that matters if you don't get the first three. Okay? So, I try to break it down and make it super simple. From

[00:50:56] Dr. Sam Rhee: How competitive is the neurosurgery match now compared to when you applied back in the day?

[00:51:03] Dr. Christopher Winfree: a numbers standpoint, I think it's about the same. I think there are just as many neurosurgery applicants and slots available. So I don't know that that's changed. What has changed is the astonishing quality of the medical student applicants. When you and I were going through med school, okay, when I did presentations I don't know about you, but I had transparencies and a slide projector, okay?

I didn't know what PowerPoint was. I didn't know what the internet was. Like, it was the stone ages. Like, we were doing these crazy, like, I would type on a Microsoft Word thing and then have to get special printing paper to print out. I mean, it was ridiculous. And, you know, I had a couple abstracts and a couple of papers when I applied for neurosurgery residency, and I was like, whoa, this guy's great. And now we're interviewing applicants that have, you know, 20, 30, 50 papers, as many as a dozen of which are first author papers. And some of these people, you see their applications, they've got board scores, they're 99th percentile. Like, I was maybe 90th percentile. You know, I was good, but I wasn't.

99th percentile, and they've got papers in Nature Medicine, uh, JAM, you're like, how, like, how do you even do that? Like, like, these people are so astonishingly polished and qualified that it's mind blowing. And had I applied with my application this year, my application back in 1994, whatever it was, 95, I, I, maybe I'd match.

I mean, I'm not matching at Columbia. I might, you know, match, you know, overseas or something. I mean, I don't know. It would be, it would be a horror show. So you're asking me if it's more competitive. Yeah, it's more competitive because the applicants as a whole are so much stronger. I mean, it's amazing we ever made it to where we got, but I guess everyone was sort of mediocre back then.

So,

[00:53:14] Dr. Sam Rhee: I agree. I agree. We look at the, uh, at how things have progressed in terms of their accomplishments, and it is just mind blowing how, how amazing the young, uh, the young surgeons or surgeons to be are at this point. So yeah, absolutely.

[00:53:28] Dr. Christopher Winfree: well, at least they are on paper. don't think, I don't think their work ethic or their personality is necessarily any better, but their applications So I just want to, again, I'm not, I'm not bad mouthing the current generation,

[00:53:48] Dr. Sam Rhee: Mm.

[00:53:48] Dr. Christopher Winfree: I will say as somebody who is evaluating, These people, the current generation, you have this, it's a, it's a spectrum of your bell curve of abilities, but their applications are no doubt stronger.

I don't know that as individuals, they're any stronger. In fact, I think Generation X had a single minded, nose of the grindstone work ethic. That no subsequent generation has had since. Now that doesn't mean other subsequent generations don't have other qualities that are equally valuable. Collaborative, teamwork based, more, you know, interactive.

Whereas GenX is like, I'm gonna get this job done. I'm gonna do it by myself. Yeah, I'm not saying that's, you know, You know, perfect or anything. But in certain fields like neurosurgery, that tends to be the, the, the personality trait that gets you through residency's ability to do that. Someone who insists on collaboration, all this other stuff that may not get you through the horrors of residency.

You need to be able to, you know, get in there and suffer for seven years and make it through intact on the other side. And so I think Gen X had a unique ability to do that.

[00:54:54] Dr. Sam Rhee: I would, obviously, I am part of that gen we're part of that generation, so I would agree with you in the sense that, like, there, we face adversity and failure, and had to pound through that regardless. Some of these guys that are so young and so accomplished, I really want to see how they do in terms of resiliency after encountering situations where, you know, You aren't doing your best where the situation is impossible, where you failed multiple times and how you bounce back from that.

Um, but I guess that's why they have you as a mentor, because you're the one who's going to say, listen, this is what you're supposed to do when these situations happen. And you got, you know, that's where the, uh, the Gen X teaching in terms of dealing with adversity, dealing with the grindy, cause those are boy, especially Columbia Neurosurgery.

That residency was one of the worst. I'd ever seen in terms of training. There's

[00:55:53] Dr. Christopher Winfree: It wasn't the worst. I mean, there are plenty out there that are, but, but it was definitely, it was hard, but I think today, you know, some of the current generation issues are, are one of the anxiety. There's a lot of anxiety now that I don't, we didn't really have so much of that, uh, when, when we were coming up and, and it, it can't blame the generation for that.

It's, it's probably something external that's happening to them, whether it's social media. You know, I'm not an expert in this, but something has happened to the current generation where people are dealing with levels of anxiety they didn't have before. Maybe it's partially a pandemic, although I think it predated that.

Um, it's almost a disease that we didn't have to confront so much, uh, that the current generation is. And it's really crippling for a lot of people, and I don't have the right answer for that. What I will say is I spent a lot of my life, you know, Essentially training for controlling fear and controlling my response to danger.

And it all started when I was a little kid surfing and, you know, getting tumbled around underwater and, and drown proofing and, and learning not to panic, even though I was disoriented underwater, zero visibility. You have to be able to find the surface and not panic and then, and then from there, uh, scuba diving and then cave diving and being stuck and pinned under water and in situations where if you panic, you're dead.

You just cannot, you just don't have that option. You have to just be able to control your response to danger in a way that, that gets you out of that danger in a way where you're, you're, you're thinking right. You're, Heart rate's controlled, breathing's controlled, and you, you actively are preventing your own death.

And that translates to neurosurgery, where you have to do that in the operating room. When things go down, um, you've got to be able to take a step back and say, I'm not going to lose my cool. Everything's going to be fine. We're going to get through this. And, and I think that ability, which again, I've worked on for decades, helps prevent anxiety.

But there are certain things that, you know, maybe it's a medical thing and, you know, people get anxious and it's not something you can just will yourself out of. So, so I don't know. I don't have the right, I don't have the answer for everyone. But,

[00:58:01] Dr. Sam Rhee: exposure is one thing. I will tell you this. I knew I wasn't, I didn't know what I was going to do, but I definitely knew I wasn't going to be a neurosurgeon. The first time I showed up at a Saturday conference and I saw those guys beat the crap out of medical students up on the, on the board and, uh, Pimping the hell out of people.

I was like, oh, yep. Nope. Like, yep. I don't love this like that. So for

[00:58:22] Dr. Christopher Winfree: right. Well, there's less, Well, there's still questioning. It's, it's more education. Like, uh, like, for example, I give a talk at 645 in the morning every Thursday to my residents. I've, I've gotten away from pimping, but what I'll do is we'll give the lecture and at the end of it, I have a series of questions where instead of, you know, I'll What did I say?

But I was like, how would you explain to a patient the concept of how an antidepressant works? Or, you know, because, you know, antidepressants are important for treating chronic pain, which, you know, a lot of patients run it like, how do you explain this surgical procedure to a patient? So it's not just, you know, having them repeat stupid stuff.

But it's, these are skills you're going to need as a doctor, so how are you going to explain this to a patient in a way a patient can understand? And so, it's more these integrative type things where I don't just point to a thing and say, What's this anatomic structure on a film? But, how are you going to consent a patient for this surgical procedure?

Which is an integrative sort of thing where they have to process a lot of information and then communicate that to a patient. And it, I think, pimping is, has sort of, hopefully for most, Most teachers, most educators has moved into a, into a, an area where you're actually helping the person be a better doctor.

Right? Because it's not about asking for stupid facts. Can you show me your learning how to be a doctor? That's what i've tried to integrate into my teaching and it's a work in progress I mean, i'm not like i'm the world's best teacher, but i'm trying and i'm really trying to to make Um these things better and have it not just be what we went through But have it be something that's actually useful and it ultimately is going to help their patients in the future Because remember as medical educators It's not just about us and teaching the residents or med students, it's about training the next generation of people who are going to actually take care of patients.

So, again, keeping your mind, your focus on the big picture and doing what you can to enhance that process and not just do it for yourself.

[01:00:21] Dr. Sam Rhee: Well, it sounds like the future of Columbia's training is, uh, in good hands. I really appreciate, uh, you sharing that. And being on this interview, I really learned a lot. Even though I know you, like, it's amazing to know so much more about, uh, You're thinking the depth of, uh, your experience over these years.

Uh, I really hope that those who listen really appreciate, I mean, you know, I think every surgeon's amazing. I think you're amazing. But when I listen and hear what you've gone through, the way you think about approaching things to what you've learned, like that just blows me away. I love that. And, uh, I just want to thank you, Chris.

It's been what, 20 some, almost 30 years. And, uh, I still feel sometimes like a medical student. Uh,

[01:01:10] Dr. Christopher Winfree: 33 years.

[01:01:11] Dr. Sam Rhee: yeah, that's a crazy. And, uh, you look about the same. Maybe a couple lines are a little deeper, but that's, that's about it.

[01:01:20] Dr. Christopher Winfree: You can't see. I've got a ton of gray hair. I've earned every single one of

[01:01:23] Dr. Sam Rhee: Not as

[01:01:24] Dr. Christopher Winfree: know you've earned yours too. I know you got them. I got them. They're here. They're, and I, I, I have, like, I cherish every single one, whether it's whatever cases I've done or stresses I've had, or near-death experiences or family and friends, whatever.

It's just part of, part of, you know, part of getting older. It beats the alternative, right?

[01:01:46] Dr. Sam Rhee: That is a thousand percent right. Beats the alternative. Thank you so much, Chris. I really

[01:01:50] Dr. Christopher Winfree: thanks for doing this. It was a real pleasure speaking with you. I'm glad we got to catch up.

[01:01:54] Dr. Sam Rhee: I love it. Thank you.