Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Commitment, Integrity, and Humility


Humility is what allows us to approach clinical challenges. Thus we should behave with humility to all of those around us: patients, families, and co-workers.

The clinical mission and values that I believe in are:

1.) Complete commitment to patient care.

2.) Clinical Excellence.

3.) Integrity.

4.) Humility.

These have inspired me through my entire learning years and professional life, and form the base of my objectives as a physician and as a pediatric cardiac surgeon.


Complete commitment to patient care

Although I have strived to achieve significant results as a clinical/collaborative researcher, I am a clinical surgeon. I found my passion for what I do in the operating room as a medical student, and that passion has remained there and in the perioperative care of our patients. The field of congenital cardiac surgery is without any doubt one of the most technically challenging clinical arenas in our profession. Outcomes are not only a direct result of the accuracy of complex operative intervention, but also of the constant involvement in patient care, with critical and relentless attention devoted to every detail.


Commitment to patient care cannot be anything else than complete. I do not just have a beeper, but a cell phone that can be accessed by colleagues, nurses, residents and families at any time. My commitment does not stop in the operating room or shortly thereafter—operating on children gives us the unique perspective of following them as they grow and mature into young men and women—a privilege and a unique opportunity for all of us.



Clinical excellence

Clinical excellence has many components. Technical dexterity is learnt, in our field, through rigorous training that on average lasts just over one decade. But the ability to mend a newborn’s heart with congenital heart disease is not just limited to the intraoperative phase. It is made of judgment that is acquired during the years, after a protracted learning curve that extends for some time after completion of training. Judgment is what makes us choose the correct pathway before an operation, and what helps achieve recovery that culminates in the hospital discharge of a healthy, corrected child. Clinical excellence is developed during years, weekends, and nights in which we don’t look at the clock but take care of clinical problems and patients.




This should of course be a prerequisite for almost any human activity. The qualities of not having personal or financial interest, the respect of the other human being, the understanding of the value of life, honesty, and respect have been ascribed to physicians for centuries.




In our field, we face death and complications on a daily basis because of the nature of what we do. It is easy to feel galvanized by a sense of empowerment when a neonate survives an eight-hour operation or when a transplanted heart starts beating again into another child’s chest. But it is at least as easy to plunge into despair when things don’t go well, when that mission, that quest for “complete” patient care is shattered by a patient’s death or by a catastrophic complication.


Humility is what I believe allows us to approach these challenges, realizing that there is nothing more humbling than the mission that we face every day. While we should feel humbled, we should also behave with humility with those around us: patients, families, and co-workers. The arrogance and the sense of omnipotence that too often tempt the life of surgeons should be banned from the operating room and from clinical care.