Frans Johansson presents the Medici Effect as the key to creating innovative ideas that can change the world. The Medici Effect needs curiosity and diversity so that revolutionary ideas can arise. The Medici Effect and its intersection of ideas were responsible for the Renaissance. The Medici Family brought together this principle, hence its name. The intersection of ideas “is the combination of ideas from different fields into a unique combination”. It means that people with different knowledge and skills work together to create innovative and revolutionary ideas to solve the same issue. According to the author, this is the only way. A solution arises from a totally different area, the reason why knowing different things (diversity) is crucial to innovate. Once again: diversity is the key.
Can we apply the Medici Effect to surgery? General Surgery is moving towards sectorization in small areas. The so-called functional units are growing throughout worldwide surgery departments. Surgeons are only performing a small group of procedures and treating a small group of diseases. General Surgeons are becoming colorectal surgeons, hepatobiliary surgeons, abdominal wall surgeons, endocrine surgeons, and so on. The "true" General Surgeon is today a minority. Surgeons are only studying and updating themselves in just a small area of general surgery. This is being noted in the scientific meetings, where a small group of surgeons repeats themselves in the lectures, and the same group of surgeons attends all the meetings on that topic. The most negative thing is that those experts in just one area do not know nor care about other different topics of general surgery. Some would say: I know nothing about that topic. And they do not even care. No innovation will arise from this model. Innovation needs creativity and creativity needs diversity. Diversity of ideas is crucial for a society to evolve and move forward. What can we do to change this?
Frans Johansson in his book “The Medici Effect” states that people must move away from dogmas and established ideas. Always keeping the legis artis in mind, we must think “out of the box” and pose no limits to our knowledge. Most of all, do not let anyone tell you what you should or should not do or know. According to the author, “while education and expertise are essential, youthfulness of mind allows you to have ideas that experts no longer pick up through habit. So, educate yourself in different fields and don’t hesitate to clear a new subject on your own”. This “youthfulness of mind” is being eliminated from surgery by creating small, closed, elitists groups of experts who follow the same line of thinking, and believe they are the “masters of the universe” because they know almost everything from that topic while knowing nothing more.
The Medici Effect means diversifying your activities. The author tells us that one company makes the workers rotate through all areas “so that all topics are studied by everyone”. Expertise in a field is important, “but expertise must not become a straitjacket”. You must educate yourself in different areas of surgery, even if you have an area of interest. Like Prof Martin Walz once said: “A surgeon can have a hobby, but he must know how to do everything.” In surgery, this is being eliminated. Nowadays the main idea is: one surgeon, one surgical area. There is no diversity in this model.
The Medici Effect also means talking, working, and getting together with different people with different ideas and skills. Surgeons are creating closed groups that only talk about one area of surgery. The problem is that those groups are composed of surgeons who get together for years and now follow the same line of thinking. In that setting “they reduce the flow of ideas, because whoever looks like them thinks along the same lines”. Outside surgeons do not attend these groups because they do also have a specific area of interest and/or do not care about another. This model can bring new ideas to the game, but no revolutionary or innovative ideas will come. Outside surgeons and their ideas are not welcome in these groups. As Frans Johansson states, “following an innovative idea can indeed become a fight against the established order. The leading players in the fields you touch have the obsession of an innovation that comes from outside”.
The Medici Effect and the intersection of ideas are crucial for innovation. Although surgeons can have a field of expertise, they must know how to perform different procedures in every different area of surgery. This diversity of ideas, knowledge, and skills will make the surgeon think differently and will make them overtake barriers to ideas that experts in one specific area cannot overtake due to habit. Diversity will feed creativity and innovation. Always remember that what you learn in one procedure may be useful in a totally different one. You can be an expert in one specific area, but you must keep learning and performing different tasks. The solution can be where you less expect, but your mind must be free of dogmas so that innovation can lighten your life. In surgery, this is no different.
Open your mind, question established dogmas, think differently, learn the most you can from different fields, train hard, increase your skills, learn and respect the legis artis but “don't be afraid to plunge into the unknown, even without experience".
“Keep your feet on the ground and keep reaching for the stars.” Casey Kasem
Reference:
The Medici Effect by Frans Johansson. 2004.
Costa Almeida CE, editor. Posterior Retroperitoneoscopic Adrenalectomy. Indications, Technical Steps and Outcomes. Switzerland: Springer; 2023.
Dr. Carlos Eduardo Costa Almeida
General Surgeon
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