====== Honesty ======

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Honesty is a facet of moral character that connotes positive and virtuous attributes such as [[integrity]], [[truthfulness]], [[straightforwardness]], including straightforwardness of conduct, along with the absence of [[lying]], [[cheat]]ing, [[theft]], etc. Honesty also involves being [[trustworthy]], [[loyal]], [[fair]], and [[sincere]].
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[[Neurosurgeon]]s may have multiple [[role]]s including [[clinician]], [[educator]], [[researcher]], and [[administrator]]. [[Leader]]s in neurosurgery have the added responsibilities of setting a [[vision]], communicating the vision, implementing a [[plan]] to achieve it, and gaining [[commitment]] from the [[team]] and other [[stakeholder]]s. For success in the current era of U.S. health care, neurosurgical [[leader]]s must deliver despite challenges such as reduced [[resource]]s, increased protocolized [[care]], [[automation]], and [[depersonalization]]. 
Neal and Lyons described five empowering strategies that can help [[leader]]s perform best. The steps include deepening self-awareness, leading with [[honesty]], developing [[emotional intelligence]], improving [[coaching]] [[skill]]s, and becoming a better [[influencer]]. [[Leader]]s that take these steps to invest in their leadership skills will reap broad [[benefit]]s
((Neal MT, Lyons MK. Empowering qualities and skills for leaders in neurosurgery. Surg Neurol Int. 2021 Jan 5;12:9. doi: 10.25259/SNI_899_2020. PMID: 33500824; PMCID: PMC7827298.))
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In his 2003 Presidential Address to the American Association of Neurological Surgeons, Dr. Heros discusses his personal additions to the six basic competencies for which all neurosurgical residents must be tested. The basic competencies are as follows: 1) [[patient]] [[care]]; 2) medical [[knowledge]]; 3) practice-based [[learning]] and improvement; 4) interpersonal and communication skills; 5) [[professionalism]]; and 6) [[systems-based practice]]. To these, Dr. Heros proposes to add six supplemental competencies: 1) intellectual honesty, which involves frank [[discussion]]s about patient [[complication]]s and admissions of the physician's frailties; 2) scholarship--the art and science of medicine, which recognizes the value of evidence-based medicine but does not discount knowledge derived from experience; 3) practicing in a hyperlegalistic society, which involves tailoring [[informed consent]] to fit individual patients' circumstances; 4) time- and cost-efficient practices, in which the physician strives to conserve time and resources by forgoing testing that is not strictly necessary, doing only what is needed to return patients to [[wellness]]; 5) approach to patients, which entails acknowledging and respecting the [[dignity]] of all patients; and 6) pride in being a neurosurgeon, which carries a sense of elitism without [[arrogance]]
((Heros RC. Neurosurgical education: the "other" competencies. The 2003
presidential address. J Neurosurg. 2003 Oct;99(4):623-9. PubMed PMID: 14567595.
)).
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Medical [[student]]s in [[Canada]] must make career choices by their final year of [[medical school]]. Selection of students for a [[career]] in neurosurgery has traditionally been based on [[mark]]s, [[reference letters]] and [[personal interview]]s. Studies have shown that marks alone are not accurate predictors of success in medical practice; [[personal skills]] and attributes which can best be assessed by [[reference letters]] and [[interview]]s may be more important. A study was an attempt to assess the importance of, and ability to teach, personal skills and [[attitude]]s necessary for successful completion of a neurosurgical training program.

A [[questionnaire]] was sent to 185 active members of the [[Canadian Neurosurgical Society]], asking them to give a numerical rating of the importance of 22 personal skills and attributes, and their ability to teach those skills and attributes. They were asked to list any additional skills or attributes considered important, and rate their ability to teach them.

Sixty-six (36%) questionnaires were returned. Honesty, motivation, willingness to learn, ability to problem solve, and ability to handle stress were the five most important characteristics identified. Neurosurgeons thought they could teach problem solving, willingness to consult informed sources, critical thinking, manual dexterity, and communication skills, but honesty, motivation, willingness to learn and ability to handle stress were difficult or impossible to teach.

[[Honesty]], [[motivation]], [[willingness to learn]], [[problem solving]] and [[Stress management]] are important for success in a neurosurgical career. This information should be transmitted to medical students at "Career Day" venues. Structuring letters of reference and interviews to assess personal skills and attributes will be important, as those that can't be taught should be present before the start of training
((Myles ST, McAleer S. Selection of neurosurgical trainees. Can J Neurol Sci.
2003 Feb;30(1):26-30. PubMed PMID: 12619780.
)).
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Complications in spine surgery: honesty is the best policy
((Benzel E, Ghogawala Z, Heary RF. Complications in spine surgery: honesty is
the best policy. World Neurosurg. 2010 Aug-Sep;74(2-3):273-4. doi:
10.1016/j.wneu.2010.06.007. PubMed PMID: 21492558.
)).
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Trust, malpractice, and honesty in medicine: should doctors say
they are sorry?
((Ausman JI. Trust, malpractice, and honesty in medicine: should doctors say
they are sorry? Surg Neurol. 2006 Jul;66(1):105-6. PubMed PMID: 16793463.)).
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Galen's methodological approach to medicine anticipated modern rules. His experiments on the spinal cord contributed greatly to our knowledge of this structure by reporting the variegated pattern of neurological impairment after sectioning at different levels. His approach to injuries of the spinal roots and peripheral nerves documents both diagnostic skill and intellectual honesty
((Viale GL. The spinal cord and its roots according to Galen. Neurosurgery. 2004
Jun;54(6):1490-5; discussion 1495-6. PubMed PMID: 15157307.)).
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Honesty, motivation, willingness to learn, ability to problem solve and handle stress are important for success in a neurosurgical career. This information should be transmitted to medical students at "Career Day" venues. Structuring letters of reference and interviews to assess personal skills and attributes will be important, as those that can't be taught should be present before the start of training
((Myles ST, McAleer S. Selection of neurosurgical trainees. Can J Neurol Sci.
2003 Feb;30(1):26-30. PubMed PMID: 12619780.
)).
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The Baron Dominique-Jean Larrey, one of the greatest names in military surgery, participated as Chief Surgeon in all the Napoleonic campaigns. He developed the concept of early evacuation from the battlefield, and of immediate treatment of the wounded, even under fire. He implemented improved surgical techniques and improved wound care that were followed by surgeons all over Europe. His devotion to wounded soldiers crossed national boundaries and became a way of life. Here is an account of Larrey's involvement in the aftermath of the Battles of Lutzen and Bautzen (May-June 1813), when many soldiers were accused of self-mutilation and were about to be executed. He dared to oppose, singlehanded, the Emperor, the highest military authorities and their concurring physicians and surgeons, armed only by his undisputed honesty, professional authority and exceptional reputation won over years of devotion to wounded soldiers. Larrey saved the lives of many soldiers and set an example of unbent ethical integrity
((Feinsod M. [The surgeon and the Emperor--a humanitarian on the battlefield].
Harefuah. 1998 Nov 1;135(9):340-3, 408. Hebrew. PubMed PMID: 10911440.
)).
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The notes in the cupboard: the question of intellectual honesty in neurosurgery
((Maurice-Williams RS. The notes in the cupboard: the question of intellectual 
honesty in neurosurgery. Br J Neurosurg. 1997 Aug;11(4):277-9. PubMed PMID:
9337923.)).

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The historical background of neurological surgery for pain demonstrates a remarkable honesty in outcome assessment. Because of apparent concentration on technological break-throughs, the contemporary focus is less directed to socially important issues. Because of the importance of outcome management in the current political environment, it is important to return to basic principles. A more socially and economically responsible approach is desperately needed in the neurosurgical community at this time. Standardization of outcome reporting and issues of societal impact must be included to justify the real value of new technology
((Seres JL. The neurosurgical management of pain: a critical review. Clin J
Pain. 1993 Dec;9(4):284-90. Review. PubMed PMID: 8118094.
))

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Last revision 17 November 2019.

===== References =====