Physician at Work: Being a surgeon is about solving problems
Daniel Boffa says his success in thoracic surgery is in the details
Before he went to medical school, Daniel Boffa, MD, was a carpenter, developing skills that would later serve him well as a thoracic surgeon.
“Surgery is all about problem solving,” he said. “It’s taking anatomy that has been distorted by tumor, infection or trauma, cutting away the dysfunctional parts and coming up with a way to restore things to as close to normal as possible. Just as it’s not only how well you swing a hammer, it’s not only how pretty your sutures look—it’s how well all the pieces come together that counts. In this way a patient’s health is like a finished structure—some seem to need little maintenance, others seem to be fixer-uppers.”
As a Yale Medical Group surgeon working at Smilow Cancer Hospital at Yale-New Haven, Dr. Boffa specializes in both minimally invasive and traditional surgeries for thoracic cancers, especially esophageal cancer.
Good outcomes depend on the details
If he sounds like a perfectionist, he is. He believes that successful outcomes are entirely dependent on the little things. “I would much rather be considered an average surgeon with great outcomes than the converse,” Dr. Boffa said.
The result has been outcomes his team is quite proud of, such as an operative mortality rate for esophagectomy—a surgery to remove a portion of the esophagus—of only 2.6 percent compared to the 10 percent national average; and operative mortality for lung cancer surgery of 1 percent compared to a 5 percent national average.
“It is the unrecognized, undercompensated, underappreciated extra efforts of my team that make the difference,” he said. “Our office staff will pore over charts, ordering tests, checking medications until 8 at night. Our operating room team creates notes for my cases after hours, stays late for difficult cases, and comes in to help prepare the room, even when not on call. Our unit and floor nurses adopt difficult, labor-intensive care plans, and push patients through their recovery, often making key clinical judgments because of their investment in our service.”
Full-service thoracic surgeon
About 70 percent of lung and esophageal cancers can be managed with minimally invasive surgery. The goal is the same as is it with traditional surgery: completely remove the tumor and regional lymph nodes. Dr. Boffa specializes in both techniques.
“Minimally invasive surgery fits many patient scenarios, but I try to be a full-service thoracic surgeon, and I try to match the best approach to fit the specific disease and the specific patient,” he said. For example, he recently operated on a patient with a lung cancer that was growing into the main right-sided airway, pulmonary artery and superior vena cava (the large vein that drains the head and arms). In that case, he used the traditional approach and was able to remove the cancer and part of the vessels, reconstructing the vena cava with a GORE-TEX® tube. “I essentially took the whole lung apart and sewed it back together,” he said.
“You can’t take shortcuts just to keep the incision small. If you only performed minimally invasive surgery, that patient would have been inoperable, which is what many of our patients are told by outside institutions before coming to see us.”
Name: Daniel Boffa, MD
Title: Assistant professor of surgery (section of thoracic surgery)
Area of expertise: Thoracic surgery; thoracic oncology
Place of birth: Cleveland, Ohio
College: John Carroll University
Med School: University of Chicago Pritzker School of Medicine
Training: Residency in general surgery at New York Presbyterian Hospital-Weill Cornell Medical Center; fellowship in thoracic surgery at Cleveland Clinic
Family: Wife, Jill Boffa; sons, Luke, 4; Matthew 17 months
What do you like most about your practice? I have really been able to connect with the patients that come to me. I see a wide variety of tough problems and feel extremely confident in our team’s ability to get patients through their illness and back to their lives.
Personal interests or pastimes? I still do carpentry. I recently built a 400-square foot deck on my house.
Last book read: Decks 1-2-3, a Home Depot guide. I had built several decks prior to my recent addition, but have to admit, I picked up several handy tricks in this book.
What would you do to improve our clinical environment if you had a magic wand? Empower every person to improve their work situation. I would bet that just about every person is frustrated by something fixable in their work routine. I would further wager that if these smaller things were addressed, it would actually save money, improve efficiency and in many cases enhance the patient experience I have always felt that many of the answers to the big problems can be distilled out of the frustrations of people working through the smaller problems. I think too many great things happen from the unrecognized efforts of people that are under the radar. It takes a very skilled and committed person to achieve greatness in clinical outcomes, so I would revamp the evaluation of those who are in the trenches.