Rick Thirlby - Retired Physician
Leader to Learn From: November 2022
November 9, 2022
In July 2020, Dr. Richard Thirlby began his retirement after serving as a general surgeon for 35 years. As the Program Director of Virginia Mason Medical Center’s Surgery Training Program for 23 years (now Virginia Mason Franciscan Health), Dr. Thirlby developed a tremendous passion for developing surgical residents as leaders in healthcare.
When working with his teams, Dr. Thirlby believed in “early attempts at establishing independent responsibility and confidence in all members of the team.” Both his teammates and patients appreciated Rick for his kind heart, work ethic, sense of humor, and passion for teaching. “My greatest superpower as a leader was my ability to have fun no matter what the circumstances,” Rick shared.
As The Thirlby Company celebrates the one-year anniversary of The Monthly Digest, we are honored to recognize Dr. Richard Thirlby (our company founder’s father) as our November 2022 Leader to Learn From. Read on for some wisdom and inspiration from the operating room…
OUR INTERVIEW WITH RICK
As a general surgeon, what was the hardest part about your job?
I was not always good at delivering “bad news” to patients and family members. For example, when talking to a patient upon whom I had performed an operation that identified an aggressive tumor with a poor prognosis, it was difficult delivering bad news the next morning. It is too easy to say, “everything went well,” and avoid giving bad news so soon after surgery.
Even more difficult is the discussion with a patient and their family when they want “everything done” - even though the best care is palliative care or hospice. Too often, surgeons are talked into performing operations that will not prolong duration of life and or quality of life. Most medical centers have ethics committees that help with these tough issues, but the best scenario is for these discussions to be accomplished ASAP with the consulting surgeon and medical specialist in attendance.
As someone who worked in healthcare for your entire career, what is something that most patients would be surprised to learn?
The first would be the ability of practitioners to incorporate new knowledge into their daily care. Classic studies indicate that, on average, it takes more than 10 years for new Level 1 study conclusions to be incorporated into practice.
As a corollary of this surprising or disappointing ability, only about 15 to 20 percent of medical care is supported by Level 1 data or randomized trials. In other words, only about 20 percent of every day patient care processes have been proven to be best care. Most of what physicians do is guided by dogma or the experience and wisdom of their mentors during training. The point is - it’s entirely appropriate for doctors or patients to question specific elements of care.
Second, there is a problem with recent policy that requires health care providers to incorporate assessment of patient satisfaction into their care. Patient satisfaction surveys do not always correlate with the quality of the healthcare provider. Frequently, patients want treatment or procedures that are not recommended by current research. As a result, a doctor could get a poor review even though they are practicing evidence-based care.
What was the most valuable lesson you’ve learned from your patients?
In 2006, I had the honor of giving the Presidential Address of the Western Surgical Association. My title was Top 10 Reasons why General Surgery is a Great Career. The number two reason was that “patients will change your life.” During that speech, I shared about one of my patients, J.S., who had developed radiation-induced pelvis cancer, which required major surgery. Despite everything he went through, he never expressed any blame on the medical community. He never seemed the least bit scared, bitter, or sad. He never intimated that he had been dealt an unfair circumstance; he only asked what we, and he, needed to do to get on with treatment and healing. And J.S. did not change after his operation.
On his second postoperative evening, his care team decided that he needed to mobilize to a bedside chair the next day. When I sized up the situation and told J.S. to “hold on” so we could lift him to the chair, he stopped his agonizing transfer, somehow managed to smile at me, and said: “Don’t worry Doc, I don’t need any help.” With tears in my eyes, I thanked him for changing my life. That moment is etched in my brain. I shall never forget it.
Many times, I treated patients with a disabling or lethal disease. Despite pain, despite the prospect of mortality or severe disability, despite potential financial ruin, these patients routinely smiled. When it is all said and done, we are privileged to see a strength of mind, body and spirit that trivializes our daily worries. When our patients thank us for all our work on their behalf, our response should be: “No, thank you. You did all the work. I did the easy part. Thanks for the privilege of getting to know you.”
When you think about the topic of leadership in the context of healthcare, what do you feel is the most important skill one must develop to be successful leading a team?
Successful team leadership in health care, both in the operating room and in the clinic, starts with early attempts at establishing independent responsibility and confidence in all members of the team. The leader must successfully define the limits, skill set and appropriate responsibility for each team member. Each team member should be given roles that initially test their confidence level, and as much independence as is appropriate will facilitate growth of confidence that eventually enhances task achievement.
Dr. Richard Thirlby completing his last day in the operating room in July of 2018 at Virginia Mason Medical Center (Seattle, WA).
Switching gears a bit - how would you define confidence?
I think confidence is on a continuum with arrogance. Confidence has a positive association with success and ability to achieve goals - but sometimes, a person’s confidence is not warranted based on their actual behavior or performance. Confidence that is inappropriate degenerates to arrogance or hubris (pride). Hubris is said to be the root of failure in all Greek and Shakespearean Tragedies.
What have you learned about vulnerability, in the context of leadership?
As a surgeon, I was captain of the ship for all my patients. This is in the outpatient setting, 24 hours per day, and in the operating room. While many of my adverse events could have been attributed to care provided by my trainees, I always insisted that I was ultimately responsible. This mandated that I would have conversations with the trainee with sincere reassurance that it was my responsibility. This routine consistently results in better team work.
How would you define your mission or purpose in life?
My mission or purpose in life was twofold: work and home. At work, my mission was training over 100 surgical residents while providing optimal surgical care to thousands of patients. At home, my mission was to provide the necessary foundation for my wife, Pat, and my kids, Margie and Dave. The goal of this foundation was to maximize the likelihood of lifelong happiness and success.
What is your greatest superpower as a leader?
My greatest superpower as a leader was my ability to have fun no matter what the circumstances. Handling the stress of pre- and post-operative care and very difficult operations was routinely made achievable with the daily incorporation of humor into nearly every encounter.
At home, my wife, daughter, and son have a terrific sense of humor. I think that I had something to do with this fact, and would contend that their sense of humor is crucial to their ongoing success and happiness.
What is something that might surprise people about you?
If I could have lunch at the local tavern with anyone living or dead, I would choose the cast of Seinfeld - Jerry, Elaine, Kramer and George. This show is comedic genius. Watching the show is therapeutic and is a tension reliever. Others might pick more serious folks, living or dead, such as Barack Obama or Winston Churchill. But I view the value of downtime to be relaxation - not always inspiration or introspection.
What advice would you have for someone who is struggling or feeling stuck right now in their life or career?
This is a tough one. The characteristics of different generations is a real thing that would make a simple answer to the above question impossible. For example, Baby Boomers have historically been dedicated to “the mothership.” Many spend 40 years with the same job. Millennials, on the other hand, have an average of seven jobs by the age of 30.
Having said that, I think the current workforce would be better off if they were more loyal to the mothership. Too often, Millennials (and other generations) switch jobs without enough introspection. Thus, my advice to the person who is stuck might be to not quit yet. Look at your role at work, and identify a role or task that would require independent responsibility and present that role or task to the boss as a new part of the job.
What is one piece of advice you would give to your younger self?
Take longer vacations! I never took a vacation longer than one week for about 40 years. It may take up to three weeks for someone to unwind.
Anything else you’d like to share with our readers?
If you are thinking about retirement or switching jobs, and are worried about the consequences of leaving your team, consider the sage advice: put your index finger into a bowl of water, then quickly remove it and observe the momentary defect in the water, which almost instantly resumes its previous state. The point being, your team and employer will survive without you, and it’s up to you to make sure there’s enough water in the bowl before you leave.
About Rick Thirlby
Rick Thirlby was born in Traverse City, Michigan. After obtaining his undergraduate degree at Dartmouth College and his M.D. at the University of Michigan, Rick completed his surgical residency at Parkland Hospital (Dallas). Dr. Thirlby practiced general surgery at the Virginia Mason Medical Center for over 30 years, and served as the Program Director of their Surgery Training Program for 23 years. His areas of expertise included surgery for morbid obesity, inflammatory bowel disease, gastrointestinal cancer, and post-gastrectomy syndromes. He published more than 100 papers and book chapters addressing topics such as gastric surgery, morbid obesity, ileal-pouch surgery, health-related quality of life, and gastrointestinal cancer.
Dr. Thirlby is an active member of numerous professional associations, including the American Surgical Association and Western Surgical Association. He is past president of the Washington State Chapter of the American College of Surgeons, the Western Surgical Association and the Seattle Surgical Society. He is a senior Director of the American Board of Surgery and was on the ACGME Residency Review Committee (RRC) for Surgery. He is currently the Medical Director of the Surgical Clinical Outcomes Assessment Program (SCOAP), a Washington state-wide program focused on creating a learning healthcare system to improve the quality and safety of surgical care.
As a newer retiree, Rick splits his time in between Seattle and central Washington, and enjoys staying active and spending time with his wife of 46 years, Pat. Rick’s key hobbies include skiing, hiking, riding his Peloton bike, and cheering on the Seattle Seahawks.
About This Feature
Leaders to Learn From is a standing feature in The Thirlby Company’s monthly newsletter that recognizes leaders in our community who embody our company’s core values. You can learn about our other honorees here, or subscribe to our newsletter to receive this feature and more inspiring content in the future.
