Beyond the Scalpel with Dr. Liane Feldman

In this episode of Doctors Unscripted, host Dr. Nadia Giannetti sits down with Dr. Liane Feldman, Edward W. Archibald Professor and Chair of the Department of Surgery at McGill University and Surgeon-in-Chief at the McGill University Health Centre.

Dr. Feldman is an internationally recognized leader in minimally invasive gastrointestinal surgery and enhanced recovery after surgery. Her patient-centered research focuses on improving surgical recovery, optimizing perioperative care processes, and using technology to enhance operative performance. She founded a multidisciplinary enhanced recovery program at the MUHC that was recognized by Accreditation Canada as a leading practice. She currently serves as President of the Society of American Gastrointestinal and Endoscopic Surgeons and has held leadership roles across major surgical organizations in Canada and the United States.

In this candid conversation, Dr. Feldman reflects on how she chose surgery as her specialty, what draws physicians to the intensity and precision of the operating room, and the mindset required to thrive in a demanding surgical career. She also shares how she prioritizes her own well-being, maintains balance, and sustains longevity in a high-performance field.

If you are a medical student considering surgery, a clinician navigating leadership, or simply curious about what drives those at the top of their field, this episode offers insight into the discipline, humanity, and resilience behind surgical excellence.

To learn more about how the MUHC Foundation supports life-changing research and patient care at the MUHC, visit:  muhcfoundation.com

Transcript

SPEAKER_00 0:07

Hi everyone and welcome to Doctors Unscripted. I'm Dr. Nadia Giannetti, your host. Our guest today is Dr. Leanne Feldman. She is the Edward W. Archibald Professor and Chair of the Department of Surgery at McGill University, as well as the surgeon-in-chief at the MUHC. Dr. Feldman's focus is minimally invasive gastrointestinal surgery. Her patient-centered research program focuses on improving quality and outcomes of abdominal surgery. She has established a multidisciplinary group implementing evidence-based, enhanced recovery, perioperative care plans at the MUHC. She has served in international leadership roles, including the Society of American Gastrointestinal and Endoscopic Surgeons, where she has served as president. She has received more than 4.5 million in research support and has authored over 375 articles and book chapter and is co-editor of three books. Recently, Dr. Feldman received the Medal of Honor of the National Assembly of Quebec. Lianne, welcome. Thank you for being here today. Thank you. I'm going to start right away with the congratulations on your recent medal from the National Assembly.

SPEAKER_01 1:24

And I would say congratulations to you because we both were recognized with that nice ceremony. It was a lovely evening.

SPEAKER_00 1:33

Thank you. Thank you, Lianne. It was a lovely evening, and um I loved hearing everything that you had to say. Congratulations on that. I'm gonna jump right into it. You are the chief, uh physician and surgeon in chief, sorry, at the MUHC and chair of surgery at McGill, the first female in that role. How important is that to you?

SPEAKER_01 1:59

Um, I can't say that, you know, coming along through medical school and residency and deciding to do, you know, and and go into academic surgery, that it was front of mind to me. Um, however, when I was appointed in the role, the I received a lot of emails and notes from uh women and young women, girls. Uh, and so it was it became a lot clearer to me that that that that that that is important and that that kind of representation does have an impact and and is important. Certainly the field of surgery has changed.

SPEAKER_00 2:36

I should remember when I was a resident, you could count the females attendings probably on one finger and the female residents on another finger. Uh has that changed? And uh, if so, why has that changed?

SPEAKER_01 2:52

Yeah. Well, it has changed, as you probably noticed. You probably can use both fingers. No. Um I think it just reflects so, and I I think it reflects just who's in medicine. Um and um but we do see differences depending on subspecialty. So in general surgery, there are a lot of women now. Uh, but in cardiac surgery, for example, there's still uh a low proportion um of women. And then also if it depends how what the denominator is. So if you look at who's entering versus overall in the profession, which w represents what you were saying, the last 20, 30 years. Yeah. Are things changing? Definitely, definitely they're changing. Even in in cardiac surgery, vascular urology, things that had a lower proportion of women. I think it's more reflective of who's in medicine. However, I would say that we know that uh as we progress in terms of, let's say, academic rank, there are still very few uh full professors. There are, there are still relatively few chairs. Um, so that is still um, and that's probably not just a pipeline issue. That's probably not just it's not just an inflow part of the leaky pipeline question.

SPEAKER_00 4:09

It's part I like that expression, part of the leaky pipeline. Has it changed? I tell me a little bit about your trajectory. You did, you went to medical school at McGill. Where was your undergrad?

SPEAKER_01 4:20

Yeah, so I did my undergrad duet in cognitive science at Brown University in Providence, Rhode Island, um, which I it was I really loved those those years. Uh, they really expanded my horizons. I traveled a lot. Um and um I got interested in in research doing uh cognitive psychology basically. And when I started at McGill, I always wanted to be a doctor. Um sort of my dream. Um and when I started at McGill, I wanted to be a neurologist because of my background in cognitive psychology.

SPEAKER_00 4:55

Is that right?

SPEAKER_01 4:56

So what changed your mind along the way? It's quite different. Okay. Um and then uh I thought it was interesting, but I didn't see myself uh doing that kind of practice.

SPEAKER_00 5:13

And then who would have been, I'm trying to think, who would have been your surgical mentor? Yeah.

SPEAKER_01 5:18

Um well I and I I didn't think about, I didn't really seriously think about surgery until I did I did my surgery clerkship very late in my clerkship, my rotation, my second to last rotation. And um, that was where I met Jerry Freed, um Lloyd Rosenberg. Fabulous, yeah. Very established and well at that time they they were young. Oh, I guess I think of them as true. That's right, that's right. So they they they were they were relatively early in careers. They're very dynamic. Yes, you know, great teachers. Um it was exciting to be both did went on to do great things, right?

SPEAKER_00 6:01

And mentor. And Lori did too. I did research with Lori. And you're following actually very closely in their footsteps in your leadership.

SPEAKER_01 6:08

In uh Jerry specifically, because um we've worked together very, very closely. He's been a mentor for me throughout my life.

SPEAKER_00 6:16

And they were always your your because at the time you would have had predominantly many colleagues were always supportive of you.

SPEAKER_01 6:23

Well, like you said, we did have women, uh, you know, getting back to representation. Uh I had um two of my there were very few, but there were some. Um so Caroline Vasileski at the Jewish Jews Trudel at the general. So call both of them were colorectal stuff. Dr. Milne. Dr. Milne at the VIC. Um, but Carol Ann and Judith, I actually were pregnant during my reaction.

SPEAKER_00 6:46

Oh, I see.

SPEAKER_01 6:47

Um and and so that that became something, and I have a memory of Judith rounding in the old IC with the general, you know, 37 weeks pregnant, uh operating, being on call. So that that kind of that gets back to this representation question that makes that possible as you see it, and you don't necessarily consciously think about it, but it becomes part of your sort of day-to-day understanding of how the world works.

SPEAKER_00 7:11

Are you witnessing? Did you find that you're witnessing an evolution in the sort of lifestyle acceptance, particularly in surgery, compared to when you were resident versus residents today? Has that changed a lot in terms of, you know, the expectation of work hours, overnight call? Uh, you know, you had to be pretty dedicated to be a general surgery resident in the day.

SPEAKER_01 7:37

You definitely had to have a good idea of what you were getting into. Yeah. Um I think um I I I don't, I'm not necessarily nostalgic. Um there were good, there was good and bad. Yeah, I think our training was was very good. But I will say that um we're graduating very good surgeons. Yes. Um, there's a lot more subspecialization, so people probably get a little more deeply into the things they're interested in. Um and um, you know, everybody learns to operate. Yeah. And and and I think it's a different approach. Um, but I think it's a team, you know, if we look at it more, it was more individualistic and it's a more team approach and that has its own, that has to be managed in a certain way. But at the end of the day, I think we're turning out good, really good surgeons.

SPEAKER_00 8:26

And if uh for a trainee listening who's considering surgery, uh would you say that the, you know, the training uh period is is manageable um or still very still very difficult? Do people have to be difficult? It's still very difficult. You have to be prepared for because it's five years.

SPEAKER_01 8:45

Yeah, you have to understand that I think if you're any craft that you're dedicated to, um I'm sure it's the same for you.

SPEAKER_00 8:53

I mean, I don't think it's quite okay.

SPEAKER_01 8:55

But Manu, when you're when you're doing a procedural specialty, yeah, you there it's a there is a craft component, and there's nothing that can be replacing that, just time uh in that apprenticeship role, where at first you're really not good at it and and you get you have to trust the process and you get you get better at it. Um and I don't think there's anything you can do as much simulation, yeah, you know, and that that's important for sort of getting pre-trained before you're in the field, so to speak, but but there's nothing that replaces just the time that it takes. And and and you know, cases don't only happen from nine to five. And you know, there's absolutely I think I think you you have to understand that you are going to probably it's a big commitment. You're gonna sacrifice certain things, and it's very these are hard-earned skills, but the reward is to be able to apply those skills, um, you know, to really be able to uh combine your knowledge and then those skills that you've worked so hard to get, and the knowledge and the judgment to really act decisively in people's lives and patients' lives to give them a durable solution for their problem, or even sometimes, you know, save their lives in in that moment. So that's where the reward comes and it's not free. And you find that that reward is still there for you. Still there. Yeah. I mean, it's it's still, I find operating still very stressful, to be honest. I don't think that's ever gone away from me. Um, it's a huge responsibility. It there's a huge amount of trust that somebody puts in you, and that's not, I mean, that is a that's a huge privilege, even routine procedures. There's no such thing as a patient. There's no minor surgery. That's right. Um, and I think that's a huge thing to cherish in a way. Um, but it it is a big responsibility, but it is a huge, there is um, there's so much satisfaction um in in it because there's a an art in art to it and a craft to it, and teaching other people to do it or continuing, and you continue to refine it. Uh, you're always tinkering with it, you're always trying to just perfect it. Um that's you know, a lifelong pursuit, and that's very satisfying. I would say even even now, you know, year decades into it, um, I still kind of like sometimes I'll come in to do a case in the middle of the night, which I don't love doing at this stage, but sometimes, you know, you still don't call and you do. And then I'm driving home and I kind of I'm like, wow, I can't believe I know how to do that.

SPEAKER_00 11:34

That's fantastic. I can tell. I mean, the listener can't see you, but I can see your face that you're still very clear you're still passionate about it, just looking at you.

SPEAKER_01 11:42

And people are so grateful. Yeah. You know, they're grateful when it goes better than they thought it was. Oh, I didn't have so much pain. Or, you know, uh, people I talked to had so much pain. I didn't, and I did, you know, so people are very grateful. You get to be involved in some people, some of their most vulnerable periods of their life and try to reassure them. And and, you know, so there are I know it's very rewarding, I think.

SPEAKER_00 12:06

It is stressful. I remember you actually operated on my son, you his appendicitis many years ago. I think he was 16. And it is stressful as a parent or as an individual to see your loved one sort of go beyond those doors in this sort of zone where you don't really know what's happening and you have no access to that zone and you're waiting for someone to come out. So it is a huge responsibility, I think, in a different way than sort of the medical specialties are. Um, thank you for that, by the way, because great job. We are very happy. Um but I what would you say to someone? Because now I guess the medical and surgical worlds are merging a little bit in that the medical people are doing, you know, more procedures. And, you know, one of the people I interviewed is Yanni Chen, who's a medical person but is doing almost pseudo-surgical type procedures, and surgeons, including people like you, are doing kind of less invasive. So there's a kind of coming together a little bit. There's a little bit more of a gray zone there, whereas when we were training, it was very, very separate, right? So you were either a surgeon or medical or surgery, and we were really worlds apart. Yeah. Um, so what would you say to someone who is training today who likes to do procedures but is thinking, maybe I don't want to be a surgeon. I'm going to go down the medical, you know, cardiology versus cardiac surgery or gastro, you know, gastroenterology versus general surgery. What would you say to them?

SPEAKER_01 13:36

I I think um like you said, there are many we have converging training paths. Um and that's okay. I think um surgery in general, the evolution of surgery or procedure surgery is is to be less and less invasive. That's that's the evolution that we see. Uh so if you are starting to be a GI surgeon now, you you need to understand how to do inter, you know, more interventional endoscopy. And the same in cardiac surgery, vascular surgery has changed completely with vascular surgery. Um, so I think probably I'd start with the disease you're interested in. Okay. Because I think um, or or or the the the the group that you're interested in being in, the colleagues and the and and and kind of more the culture and the the the disease and and go from there because the treatments are are evolving all the time. Um so I think that would probably be you have to kind of like the bread and butter of whatever specialty. It's a very good point. Yeah. And um, and and I'm doing procedures now that I didn't train in doing. So it's it's a lot of, and I I I think everybody is. Yeah. So it's more of getting the training that will give you the backbone to be able to evolve with the specialty.

SPEAKER_00 14:53

Fair enough. Fair enough.

SPEAKER_01 14:55

I like that.

SPEAKER_00 15:05

This podcast is being brought to you by the MUHC Foundation. The MUHD Foundation funds cutting edge research at both the MUHC and its research institute and supports excellence in patient care for millions of Quebecers. You can follow them on social media or take a look at their website at www.muhcou-n-d-a-t-i-o-n.com, muhcfoundation.com. Coming back to you. So after you're Montrealer, you went to Brown, you came back to McGill Medical School, you did your surgery training here, and did you go elsewhere afterwards? Right. Well, I I wanted to.

SPEAKER_01 15:50

Okay. So as I said, uh Jerry was a great mentor, and he was really one of our pioneers in in laparoscopic or minimally invasive GI surgery. And um he um in those days it wasn't so formal with fellowships. And I was going to, it was it was pretty much arranged for me to go and do my fellowship um in uh in Seattle with with another leading person there. And then what happened was I got pregnant.

SPEAKER_00 16:18

Okay. So you would have been our f last year of surgery when I when you got pregnant.

SPEAKER_01 16:27

Yeah. Um I had the my first child, uh, I was chief resident. You were my last year. So we were kind of setting up a fellowship at the end of the fourth year. Okay. And um, and then that then I wasn't going to be going away. And so I ended up doing um, Jerry ended up training me clinically, and I did some research training as well. Research. Okay, so you were able, and were you able to take a little bit of time off? How how was that? Yeah. I mean, as a as probably as a trainee, it's a lot more specific. It's a little bit easier. Yeah, I think so. I didn't understand that at the time. I remember Judas Trudeau is actually my uh who I mentioned, uh colorectal surgeon, who I, you know, was also a mother, and and I she was my um program director. And when I was pregnant and I went to tell her, I was really feeling bad about it because I said, Oh, it's gonna ruin your schedule. She's like, Don't worry about it. Okay. And and, you know, I was very worried about it at the time, but in retrospect, having had a child as a chief resident and as a fellow, and then in early on in my practice, I would say it was a lot easier to manage as as a trainee.

SPEAKER_00 17:35

Then when you had started because you that's right, because you have, I know you have three children. Your husband is not a physician, so that gives you a little break from medicine when you get home, I imagine.

unknown 17:47

Yeah.

SPEAKER_00 17:48

Is that a good thing? Or it's hard to know because the only husband you've ever had.

SPEAKER_01 17:51

Yeah. I mean, he's very actually um ironically, very squeamish about medical. Okay. So we really don't talk about medical things. Um, yeah, I think it's a good balance. It's a good and I'm not, I don't, we don't talk about what he does either. Okay.

SPEAKER_00 18:05

He's a lawyer, so you don't really want to hear about that. He's a like business lawyer, so it's uh really about deals and stuff. So your other so your your third child you had while you were staff, because that's a little bit how early were you in your career?

SPEAKER_01 18:21

Two, three years.

SPEAKER_00 18:22

Okay, so that's hard, right?

SPEAKER_01 18:24

When you're yeah, that that was that was harder just because you're relying on your on your colleagues. Yeah, but they were very understanding. I was always in a super supportive. I mean, I'm very grateful. I've I've always worked with really great people, great team, always there to help. You can always get people to help. It's it's it was really a good group uh here.

SPEAKER_00 18:43

Um and that's even that's going back a few years. Yeah. Yeah. So, you know, if they were supportive then, I'm sure that even now when you have trainees or junior attendings that are coming to pregnant, it's normal that they would take a leave.

SPEAKER_01 18:58

Absolutely.

SPEAKER_00 18:58

So to someone who's training today and is contemplating a career as a surgeon, and even in an academic environment, you can have your career and you can have your family. You must. Yeah. I like that. Why would you say you must?

SPEAKER_01 19:13

Well, I mean, you you must if that's what you want. Okay. I mean, I think where the disconnect is, is that that's it's chaos. Okay, okay, right? I mean, you know. No, absolutely. Um it's chaos for several years, a few years. You need a lot of people involved in raising a family.

SPEAKER_00 19:32

Did you have a nanny?

SPEAKER_01 19:33

A nanny, yes. Um my parents were here, my husband's parents were here, they were super involved. Uh, kids were, you know, thankfully they they were healthy. Yeah.

SPEAKER_00 19:46

Um you know, so no, it takes a village. It's not easy. It's not easy to have, you know, two careers.

SPEAKER_01 19:53

Anybody though? It's not unique to medicine. And I see because of my husband in the more in the corporate world, I mean, it's not easy there either. It's not easy there. I think um I I I think this is I think what younger people do better than we did is that this is not a woman's issue. Very good point. Um, I think it's it's the men want to be involved in their kids' lives. The men want to go to the soccer games. And we it's not right that we have, you know, certain accommodations for women that it's harder to sometimes culturally to come forward to and those those accommodations end up not helping women necessarily because now you're giving unequal accommodations to one gender and not the other. So I think I think younger people are better at it. I think they're taking time, paternity leave.

SPEAKER_00 20:45

And they're not afraid to ask for it. I think for us it was a little bit harder to say I want time off, or I need, you know, I want to go to my kids' recital or something. I think it's easier now. People just do it. They basically say they're they don't ask, right? They say I'm that's right.

SPEAKER_01 21:00

I think we learn, I think, yeah, I think they're that that's better. And um, it also gets back to the idea that it's less individualistic and more of a team.

SPEAKER_00 21:08

Yeah.

SPEAKER_01 21:09

And, you know, I saw many of my mentors rounding on their patients every weekend. Um, and we don't do that anymore. We we basically, you know, you want to text to see what's going on, but we we can um trust our colleagues to take care of the patients. Um our patients. That's right. And I I think that's that that that's part of the shift.

SPEAKER_00 21:32

And um that's a natural evolution. We have that too. You know, you have your time on when it's quite intense, but you also have your time off, which I think has evolved and has gotten better and better. So I think there's an expectation there. Tell me a little bit about um, you know, you're doing early, a lot of your patients are sort of you're trying to do as much as possible sort of short stays, right? Early rehab. There's a special program that you've developed here. You're running. Tell me a little bit about that. Is that sort of something that you think there's going to be more and more of this kind of idea of short hospital stays post-surgery?

SPEAKER_01 22:09

Yes, because the idea is that the better, uh, the more the sur the less invasive the surgery and plus advances in uh anesthesia, analgesia, nutrition, uh, physical activity, uh, avoiding opioids. Um, these help people recover faster and therefore don't require as much time in hospital. So when we were training, you'll remember on your surgery rotation, if you did a bowel resection or colon resection, patients would normally stay about a week in hospital and even come in the night before. And um, you know, our colorectal group have really they're excellent surgeons, they've refined their techniques, working with anesthesia and for all of those different elements that I've mentioned. They've even done uh a few hundred procedures as same-day discharge, but really, really pushing it. Um, and safe and and you know, evaluating that and doing that safely. Um, so if and what that does is so you know, the premise is not that we're kicking people out of hospital sooner. They're not, they're not, they don't have increased readmissions, they're not having more complications. Um, it's that we're working on how to improve recovery from surgery and therefore not requiring as much inpatient support. And of course, at the systems level, that does free up beds for other patients who need it, uh need to be in hospital. And um, and so that's helped the hospital and all of the system work better. Um, I would say that there's interest, um, you know, and we're not the only people who've developed these, obviously. So, and this has been going on for now decades. Um, I think we were sort of early adopters, so we we have a little bit further down the line, but of course, uh there's uh now a provincial program that's implementing these concepts in every in every etablissement, um, and using some of the concepts and some of actually the people that um we worked with over decades uh who are now um at um Santé Québec implementing this throughout the province.

SPEAKER_00 24:14

Speaking of Santé Québec, tell me a little bit about your administrative role. Something that are you uh equally passionate about your administrative role, less your you know, clinical role or research role. I mean, it's not really a fair question, but you know, you fall into these administrative roles. We don't, you know, we we don't train for that, obviously.

SPEAKER_01 24:35

There's no formal dream to say I'm gonna be in surgery or in cardiology because I dream of being a division director. No, yeah. Or a or a department. How do you find that? Is that I think the the opportunity is that it's it's an opportunity to take uh maybe projects that you've done at a smaller scale and see if you can if you can apply them and scale them and and and have a bigger impact. I I think that's that's what where the satisfaction comes from.

SPEAKER_00 25:00

Yeah. And sitting at the table where pr you have a voice, right? I find that sometimes you can sometimes you're hitting your head against a wall, but sometimes you know your voice is heard and things do move forward. So so you you make time for that, you enjoy that? Yeah, I mean, I do make a lot of time for it now.

SPEAKER_01 25:18

Um I would say it's uh I'm not really running a research program. That's what I've replaced it doing this role. It does take time. I think um I th I think we have to, you know, we we're in this privileged position, whether it feels like that or or not. Uh if we're not gonna do it, it who's gonna do that. That's right. Um, and we benefited, I think, also from the people who built our ancestors who built these institutions um that are not perfect. But um, I think we've had good ancestors um who built something and and we are, I do feel, you know, some responsibility for doing my part in maintaining them or improving them or moving them for continuing to move it forward.

SPEAKER_00 26:08

Yeah, I I agree with that. I like that very much. A couple more questions. What would you tell your younger self?

SPEAKER_01 26:16

Um I I I don't know what I would tell my younger self because I don't think my younger self would listen to me. My older self. Fair enough. My younger self was not like a big listener of advice. Um but I I think in the end, um, you know, things you can't plan everything, you can't control everything, and and and things things work out. Um and to sort of, you know, to to if if I if I could be a little more patient, that would have probably been been useful, but I'm not I'm still not very patient.

SPEAKER_00 26:47

So I don't know. I think things somehow work out, right? I mean you look around, most of our colleagues are happy. Things work out somehow, right? Yeah, exactly. So most people have opportunities and they have a chance to do what they really want to do for the most part, right? It's still a very nice career. Oh no, no doubt. Yeah, being uh being in medicine is has its challenges, but it's still a wonderful career, right? Absolutely. What do you do to take care of yourself?

SPEAKER_01 27:11

Well, um I like to to cook and eat. Um, and that's something um our family likes to do together. I have a great group of girlfriends that have um we've been together for a long time and make me laugh and are huge, great supports. Um, you know, so spending time with the family. Um I've I've I do exercise quite a bit. Um what do you do for exercise? You go to the gym? Uh no, I don't, I don't, well, not right now. I'm very uh probably bike the most. Um so road biking and my husband and I do that together. Uh ski. I I started doing backcountry skiing during the pandemic, so it looked more across country.

SPEAKER_00 27:53

Um yeah. So it's a good time in your life though, now I guess, right? Where the kids are a little bit older and you probably have cool times. Yeah.

SPEAKER_01 28:00

They're grown up. And um yeah, and and and you know, there were times, and I'm sure it's the same for you, where there are times in in our lives where where where you can't do this stuff. And like for example, I missed, I didn't ski for 10 years when kids, you know, you all you always have a little one.

unknown 28:16

Right.

SPEAKER_01 28:17

Um, but now uh skiing every weekend, really loving it. Um never thought I would get to be a better skier or improve, but you do, you still do improve.

SPEAKER_00 28:26

So um, yeah, and that's fun. Sounds wonderful. Congratulations on all because you know, uh your CV is very impressively, and we didn't get through most of it. We didn't get through, you know, we got through only a small part of it, obviously. But uh congratulations on everything you've accomplished and thank you for sharing this with us. I greatly appreciate it. Thank you, Nadia. Thanks. That's fun. Have a great day, and I wish all our listeners a great day. Thank you for joining us today. If you like what you've heard, please subscribe so you never miss an episode. We also would appreciate it if you could take a moment to rate the show or leave a review. Thanks so much for listening.