Hans Lederhuber | University of Tübingen

Hans Lederhuber is a General Surgeon and one of the National Leads of COVIDSurg in Germany. He was involved in the COVIDSurg Cohort, COVIDSurg-Cancer and GlobalSurg / COVIDSurg Week studies.

During the pandemic, Hans Lederhuber moved from Germany to the United Kingdom and continued his work in the international COVIDSurg network from Exeter as one of the National Leads for Germany. In a very personal interview, the surgical expert shares the experiences and insights he has gained in the course of his career.

Interview by Sarah Polzer

Dr. Lederhuber, you are a national lead of COVIDSurg Germany – what role does Germany play in the research network and – what are the focus areas here?
Germany plays an important part in the COVIDSurg collaborative as it is one of the largest countries by population in the EU and has a health care system, which is quite different to many other European countries. Hence, it is important to mirror this in a worldwide trial. But beyond that, I would not say that Germany plays or should play any role different from the rest of the countries participating in COVIDSurg.

Was there a key moment that made you want to become a part of COVIDSurg?
Yes and no. I simply engaged in a discussion on Twitter with Aneel Bhangu from the Global Health Research Unit on Global Surgery at the University of Birmingham (and others) in early March 2020. We agreed that we needed some sort of consensus paper on surgery during the pandemic. COVIDSurg was not really born yet, the pandemic was just gaining pace and discussions on Twitter were boiling hot, about how the surgical profession should react. These tweets brought me together with Aneel and with what would later become COVIDSurg.

In your opinion, what is the philosophy of COVIDSurg and how do you identify with it?
I don’t know whether I’d call it a philosophy. I’d rather think of it as a modern, inclusive, forward thinking and solution-oriented research approach, which is very much based on the principle that everyone can contribute and that every contribution is highly valuable.

How are you personally dealing with the pandemic? Were there any formative moments during this time that changed your thinking?
I guess, I deal with the pandemic as everybody else working in healthcare. Continuing doing my job, having better days and worse days. Feeling a little bit tired after so many months, wondering whether I would want to continue if the pandemic would become the new normal. Finding loads of joy in my family. There were no formative moments. But I moved country at the height of the pandemic, so I’d say this reassured me that I can follow the current rules without having to put my life to a complete halt.

What lessons can be learned from the pandemic? Are there perhaps positive aspects?
We can learn very much from the pandemic. We’ve seen how fragile many services are and that many routines do not work well during a pandemic. As an example, clinical trials during the pandemic needed fast assessment by institutional review boards – no guidelines existed for this scenario. We have learned that we have to collaborate internationally if we want to survive. We cannot do it all alone on national level. COVIDSurg is leading the way here. In the end, it might turn out that the pandemic is rather a cataclysmic event, leading to even deeper gaps for provision of health care between privileged and less privileged groups. Or, and that is my hope, that we change course and actively re-define how an equal and generally accessible healthcare system should look like.

What are you currently researching and what was the decisive point in dedicating yourself to this topic?
My current main area of research is – apart from COVIDSurg –circling around abdominal wall hernias. It is an area of high complexity; the variety of diseases affects to a certain extent a very large part of the population sooner or later in life; and there are massive evidence gaps in this area.

Was there an experience in your career so far that has stuck in your mind in a special way?
The first patient who died under my care. He was a palliative cancer patient and I had a quite tight relationship to him, as I had been taking care of him for quite a while. I could be part of his life for the very last leg of his journey and I’m still thankful for this experience. Personally, I’ve never understood framings such as that healthcare professionals must try to separate professional life from private life and somehow ‘mentally shield’ after going home from the job. I’ve never done that and I would not want it.

While we are talking about emotional experience: How should a surgeon deal with a failed operation?
I do not think there is a one-fits-all coping strategy. Coping is partially based on personal history and hence every individual is different. But if trying to break it down, I’d say: go home, embrace family, friends or what else is good in your life and allow grief and self-doubt for some while (if you don’t doubt or grief, maybe think about a change of profession). But then speak with colleagues who mean well, a mentor. Someone who is not just confirming what you want to hear but at the same time will give you reassurance that it will be alright, that literally every doctor has been through this. And of course, speak with your patient. Be honest. Be constructive. If the patient is angry, just swallow it. I have seen deep patient-doctor relationships emerge from honest, heartfelt conversations after complications.

During your training you were not only in Germany - what stations were on your way?
I studied medicine and worked as a paramedic in Munich and Vienna, worked in basic research in Vienna, moved to Sweden and did my internship and surgical residency there. I then moved to Germany and worked as an associate specialist doctor. Recently, I have moved to Exeter in the United Kingdom to work as a fellow with Professor Neil Smart.

You have chosen a medical profession. What inspired you to do so?
I was certain quite early in school that I wanted to become a medical doctor. And I cannot actually remember a trigger event or process. My best friend and I pursued our plan as long as I can remember, when thinking about choice of profession. He became a paediatrician, I became a surgeon. I imagined becoming a surgeon early on, but negative experience with bullying surgeons made me re-think, whether I really wanted to expose myself to that. A very stimulating experience in paediatrics made me pursue this speciality for quite a while –- until I finally realized that surgery was still what I wanted to do. In a modern, equal, open-minded environment with flat hierarchies, it ideally provides just the perfect blend of manual work, team approach and intellectual challenges.