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June 18, 2025 20 mins

What happens when medical legacy intersects with personal passion? In this captivating conversation, host Jason Edwards sits down with general surgeon Dr. Christopher Cronin, who shares the remarkable story of his grandfather, AJ Cronin—a physician who transformed an illness-induced retreat into a groundbreaking writing career.

The discussion reveals how AJ Cronin's seminal work "The Citadel" critically examined the British health system in 1937, addressing corruption, unethical practices, and healthcare inequality decades ahead of its time. This literary perspective from a practicing physician ultimately helped shape the National Health Service established a decade later. Dr. Cronin's reflections on this family legacy provide a unique window into how literature can drive healthcare reform and professional ethics.

But this episode goes beyond family history to explore the formative experiences that shape surgical careers. Dr. Cronin shares his evolution from aspiring orthopedic surgeon to general surgeon specializing in thyroid procedures—a journey influenced not by his famous grandfather but by the transformative power of mentorship during his training. His compelling account of working in a challenging DC hospital under an inspirational chief resident illuminates how profound these relationships can be in medical training.

The conversation takes a fascinating comparative turn as Dr. Cronin details his year training in Australia, highlighting the stark differences in surgical education systems worldwide. His insights on surgical hierarchy, the art of teaching technical skills, and the critical importance of repetition in surgical training reveal the complex balance between supervision and independence that creates competent surgeons. As duty hour restrictions change how surgeons are trained, these reflections become even more valuable.

Listen as these two physicians discuss the delicate art of mentorship, the trust that develops between surgical partners, and how the best teaching surgeons know when to step in and when to let trainees work through challenges. Whether you're in healthcare or simply curious about how great surgeons are made, this episode offers memorable insights into the human side of surgical training. Ready to hear more? Contact Dr. Cronin's practice at 314-434-1211.

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Episode Transcript

Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Hi, this is Jason Edwards and welcome to Doc
Discussions.
I'm here with Dr ChristopherCronin, a general surgeon.
Chris, how are you doing today?
I'm doing well.
So a funny thing happened theother day.
I was reading a book that wasput together by Reader's Digest
called Getting the Most Out ofLife, and it was published in
1948.
And I opened the book and thevery first story is by a guy

(00:21):
named AJ Cronin, somebody youknow well.

Speaker 2 (00:25):
Well, I can't say I knew him real well, because I
really only met him four or fivetimes because he lived in
Switzerland and he passed away,I think, when I was a senior in
high school.
But yeah, he was my grandfather.
He was an author, also aphysician.

Speaker 1 (00:39):
Yeah, yeah.
So the story talked about himyou know brief synopsis getting
sick and then he had to kind ofit was a stress-induced ulcer
and he had to go up out to thecountryside and when he was
there he decided to write a bookand it ended up being a raging
success.
And then he wrote many, manybooks and I think 19 of them got
turned into movies and so heknew people in Hollywood and the

(01:01):
whole thing.

Speaker 2 (01:02):
Yeah, he was a pretty famous guy.
So he knew people in Hollywoodand the whole thing.
Yeah, he was a pretty famousguy.
So basically the way it allstarted was he was a physician,
grew up very poor, got ascholarship and was able.
He chose I was either going tothe ministry or medicine.
So he said lesser of two evils.
So he picked medicine and ifyou read the Citadel it's almost

(01:23):
it's a little bit anembellished life story.
Yeah, so what happened was hewas a successful doctor, kind of
specialized in pulmonary typestuff, and then he got this
ulcer and I guess back then youtook three months off on a milk
diet that was what wasrecommended.
So he went to some farm andI've read like a similar

(01:46):
anecdote about where he hadwritten half the book and he
just thought it was terrible andhe just threw it in the trash
can and he took a walk and thenhe runs into this guy who's like
clearing a field trying to makeit into pasture land.
It was like a bog or something.
And he kind of knew the guy andthey start chatting.
He told him you know, I justthrew away the book, was

(02:07):
terrible.
And he's like look, I've beenworking on.
My grandfather worked on thisfield.
My father I'm working on, I'mnot giving up and he kind of
thought about that and said andhe pulled it out of the trash
can and he worked it and workedit and then he sent it to a
publisher and I guess he kind offorgot about it.
And then he sent it to apublisher and I guess he kind of
forgot about it, and then theyliked it and it was very
successful, sold millions ofcopies.

(02:29):
And so then he said forgetmedicine.
And he wrote a few more booksand then he published the
Citadel, I think four or fiveyears later, and that was a huge
success.

Speaker 1 (02:39):
Yeah, it reminds me of.
There's a book by a guy namedSteven Pressfield who wrote
Bagger Vance, called the War ofArt.
I think it's a play on the Artof War by Sun Tzu, but the book
just talks about it's.
When you create art, it'syou're putting yourself out
there and whether it's music orliterature, you know you're

(02:59):
putting yourself on the line forpeople to criticize you and
it's kind of a man.
You know Teddy Roosevelt man inthe arena thing.
You know it's line for peopleto criticize you and it's kind
of a man.
You know a Teddy Roosevelt manin the arena thing.
You know it's easy for peopleto sit in the stands and
criticize something, but it'svery hard to create work and it
takes courage.

Speaker 2 (03:13):
Absolutely Well.
You know, the Citadel was verycritical of the British health
system.

Speaker 1 (03:18):
Yeah.

Speaker 2 (03:19):
So if you, let's say, you go on Amazon and you read
the little paragraph about whatthe Citadel is, they always, you
know, say, well, it probablyhelped bring about the National
Health Service.
Yeah, and I'd heard that, butit seems to be more kind of
established.
Yeah, that's what I've read tooand that came about.
So the Citadel came out in 1937.

(03:39):
I think the National HealthService came out in 47.
And it addressed a lot ofthings.
You of things that he was kindof brought to light in the
Citadel the lack of training andthen continuing medical
education.
He was very critical.
Some of the doctors outpracticing weren't really
changing what they were doing.

(04:00):
They were doing the stuff thatthey had been doing 30 years
earlier, even though thetreatments had kind of changed.
Yeah, they were doing stuff thatthey had been doing 30 years
earlier, even though thetreatments had kind of changed,
yeah.
So, getting back to what youwere saying, it's difficult to
create something and then you'rebeing critical of a lot of your
peers, so he took a lot of firefor that.

Speaker 1 (04:14):
Yeah, so you know the book itself.
There are several themes.
It's the corruption andunethical practices within the
medical profession.
You know, do you do it to makefunny or do you do it to make a
difference in people's life, orboth the conflict between
personal ambition and moralintegrity.
He kind of touched on thesocial class and economic status

(04:35):
of health care and access tohealth care, because he worked
in a very poor mining town andthese.
You know he was very avant-garde, ahead of his time in a lot of
these things and I'd read thesame thing that this was kind of
an impetus to ultimately pushthe NHS over the line which

(04:56):
England is very, very proud of.
I remember in the 2012 LondonOlympics, in the opening
ceremonies they even had like anhomage to the NHS, oh really,
and so I know they're proud ofit.
But in his other books too, youknow, he kind of delves into
these deep life questionsmeaning of life type of thing

(05:20):
and obviously hugely successful,and these are things I think,
as doctors, we think about too.
You can't help but treatpatients and you see good
outcomes and bad outcomes anddifficult situations, and it
can't help but make you thinkabout these deeper meanings to
life, and I'm sure that's wherehe got this from.

Speaker 2 (05:39):
Yeah, well, you know you do the best you can and even
when you do that, everythingseems to go right.
And then one complication itcan really make you rethink
about what you're doing.
Yeah, and that, you know, onetheme in the Citadel was, you
know, he was working with thissurgeon.
He really respected the guy andhe was doing an anesthetic.

(06:00):
That was they didn't haveanesthesiologists.
You just kind of do a littlebit of ether and uh.
So then he finally saw the guywork and he realized how
incompetent this guy was andthat's sort of is sort of the
big dramatic change he had inthe book he's he.
He realized, you know, he kindof had the, the morals that he
had started out with when hestarted, you know, was going to
medical school and things hewanted to do.

(06:21):
Then he realized, sort of withthat one seminal event, that he
had changed and he needed to goback to, you know, his morals
and his ideals, you know when hestarted, yeah, so yeah.
And I think medicine will dothat to you.
You know, because you knowthings happen and you take it
personally and you got torethink about what you're doing.

Speaker 1 (06:43):
Yeah, for sure.
Did him being a physician pushyou into becoming a physician or
not really?

Speaker 2 (06:50):
Not really.
I didn't really know him wellenough.
He would come over now andagain.
Like I said, he lived inSwitzerland and visit and then
we visited him a few times onvacation.
Yeah, so he didn't really havean impact like that.
I guess my mom kind ofrespected him a lot and maybe if
anyone pushed me into that itwas her.

(07:11):
I mean, the short of it was Igot to college I realized I'm
really not good at a lot ofthings.
It's like I'm pretty good atscience and so I'd started
taking some science.
You know the preliminary anddid well and liked it, and so
that's the other thing mostpeople don't realize.
You know you go into medicalschool.

(07:35):
You really don't know what Imean.
Most people don't really knowwhat they want to do, don't
really know much about medicine.
I mean some guys you know dadsare doctors, so they know more,
but for the most part you reallydon't know what you're going to
end up doing and a lot of it'sjust the mentors that you meet.
You know the chief residentthat you respect or you know you
have one attending that kind ofyou know you like or takes
interest in you.
And that can swing you into whatyou want to do.

Speaker 1 (07:53):
Yeah, I agree, and in fact I worry about somebody who
comes in as a first yearmedical student and says they
want to do this professionbecause they don't know the ins
and outs of it.
You know, they're kind ofbiased in a way that they
shouldn't be, and so was thatthe experience with you.
You were in medical school andyou did the surgery rotation.

Speaker 2 (08:10):
Yeah, absolutely A hundred percent.
I was ortho all the way, I justseemed like a cool thing to do
and kind of like the jockey typedoctor.
And so I remember I did arotation with a guy when I was a
first year.
Didn't really think the guy hewas saying the same thing every
time you know, and say you know,we can either grease it or you

(08:30):
know, or send you physicaltherapy.
That was the same for anyonewith a bad knee.
I was like this is boring.
So anyway, fast forward.
We had these acting internships.
I don't know if you did that AIs, yeah, ais.
You did six weeks in medicineand surgery that you had to do
and I had done my preliminary inorthopedics.
Didn't love it.
The guy I worked with, theresident, was kind of a jerk and

(08:52):
didn't really seem to care thatI wanted to do orthopedics and
so I did my surgical actinginternship and I had a guy named
Steve Evans who was justoutstanding.
It was a DC general which wasas tough of a city hospital I
think it's since closed but itwas bare bones.
We were really needed.

Speaker 1 (09:09):
And you took the indigent population.

Speaker 2 (09:16):
It was primarily indigent a lot of trauma and
very few services.

Speaker 1 (09:18):
So the medical students.
We were drawing blood.

Speaker 2 (09:19):
We were putting IV, we were doing a lot of stuff.
Which is great as a student,absolutely.

Speaker 1 (09:24):
Yeah.

Speaker 2 (09:25):
And the patients were appreciative too.
Yeah, because we're taking careof them and the residents
really worked with us.
And I remember this guy came inlike 30 nights in a row.
He had a trauma like everynight and you'd never know it.
He was always like teaching andso like teaching and and so, uh

(09:46):
, anyway, I was like I reallyrespected this guy and that's
when I was like I want to bethis guy.
Yeah, and it's interestingbecause he ended up going on.
He went to gw, he finished histraining, went to gw, was there
for five years and, um, theybrought him back to georgetown
and within like 10 years he waschairman, yeah, and now he's
head of the med star, which islike the whole medical system.
I think he may have justretired.
How about that?
Yeah, I had some patient whowas a lawyer and he looked me up

(10:10):
and said, oh, you went tomedical school at Georgetown.
You know Steve Evans.
I was like kind of weird.
He was my chief resident.
How would you know him?
He's like well, I'm a lawyer, Iwork with him at MedStar, he's.
So I guess the guy I picked waspretty good, because he became
very successful.

Speaker 1 (10:24):
You know, talking about him coming in 30 nights in
a row.
I very much remember my surgeryrotation in medical school and
then I did my first year oftraining in general surgery.
It was part of the program andit's an attitude.
It's an attitude and a standardthat comes with general surgery
and it's like don't complainabout it, just soldier on.

(10:45):
You might not feel great, youmight be tired, but it doesn't
matter.
The more you talk about youknow, you don't talk about it at
all, you just keep going.
And I feel the same way.
My chiefs I loved them andrespected them.
I would do anything for them.
You know just and it wasn'tthat they necessarily did
anything for me, I justrespected the hell out of the

(11:06):
standard that they had.

Speaker 2 (11:08):
Absolutely yeah, and you know, you always remember
those guys.
I remember you know, when I wasan intern, you know the five
chief residents we had.
You know some of them Irespected more than others.
But there was, you know, theyhad the long coats.
It's a little different insurgery coats.
It's a little different insurgery At WashU.
We had to wear white pants.
So we had basically a uniformand then the short coat until

(11:29):
you became a chief resident.
So, by the time you're a fourthyear, you were considered a
chief on some services, so theylet you have the long.
But it sort of was demeaningbecause all the medical
residents had long coats.
There's sort of a status thing.
But it made sense.
Someone explained it to me oncethat hey, if there's five of us
coming up here, they know theguy with the long coat is the

(11:50):
guy in charge, so they can justcome up to me if there's a
problem.

Speaker 1 (11:53):
Yeah, and there's a very clear hierarchy, absolutely
, it's not only an age-basedhierarchy, but a
competence-based hierarchy,which is very necessary in
difficult situations.

Speaker 2 (12:05):
Yeah, I think it works really well.
You know, I did a year oftraining in Australia.
So my fourth year a chairmancalled me up, or I guess it was
the end of my third year.
I was a PGY-5 because I did twoyears of lab time so I did some
research but they had a spot inAustralia and so he's like look
, you got like 48 hours and letme know you can go over there

(12:27):
for a year.
So I said what the heck?
I'm going to do it, and whichis a lot, because, like you said
, there's a hierarchy.
I'd been there.
People kind of know your levelof competence.
So if I'm calling and attendingat 2 in the morning, look, this
guy needs to go to the OR.
They know me, they'll respectwhat I have to say and you know,
you kind of build up yourcredibility.
So it was difficult going overthere because they didn't know

(12:48):
who I was.
But you know that worked out.
But it's a totally differentsystem because they have what
are called registrars and itdoesn't really matter.
You know, it's a four-yeartraining program.
They rotate every six months ona different service so you
could be on start on the battlebillary service as your first
rotation.
You're obviously not going todo nearly as much, but you're
kind of considered the same.

Speaker 1 (13:10):
Okay.

Speaker 2 (13:10):
It's it's so I.
I much preferred our systembecause there is a hierarchy and
it's just.
You get better training thatway, yeah.

Speaker 1 (13:19):
My wife did a a rotation in Africa with other
international students and it'sfrom her perspective.
The training was much better inthe United States.
I don't know, you know, thatwas just her experience as a
single person, but she said shesaid that it was more rigorous,
which is good, you know.

Speaker 2 (13:38):
Yeah, no, I.
I for sure you know we had a.
I remember we had a surgeryresident come over from Ireland.

Speaker 1 (13:56):
He had already completed his training.

Speaker 2 (13:56):
He was fully trained, yeah, and he was maybe like
pgy3 level, yeah, and out offive.
So out of five, which is, yeah,not super functional but you
could like yeah kind of amid-level resident you know,
generally a chief resident atleast back when I was training
can operate independently.
Yes, they don't really let youdo that anymore, but they, you
know, you, you sort of havereached that level of competency
.

Speaker 1 (14:11):
Yeah, and I think this whether it's sports or
surgery, reps matter, yourrepetitions matter and the more
training you do, the more timesyou do anything, the better
you're going to be at it,whether it's hitting golf balls
like your son, who's anexcellent golfer in college,
second in state, is that right?
Second in state.
So whether it's hitting golfballs or doing surgery, reps

(14:33):
matter.
And this is a thing that's comeup with the duty hours
restrictions.
You know it used to be kind oftake the bridle off of it.
There's 167 hours or 168 hoursin a week.
You know you work 100 hours andsleep, you know, and eat the
rest.
They're very strict about that.
They throttled it down to 80.

Speaker 2 (14:49):
It's down to 80.
And you know you could be doinga case and if you're going to
violate it, I mean you have toget someone to come in and
relieve you.
Basically, which?

Speaker 1 (14:58):
was unheard of.
So you get less reps, whichmeans more people are going into
fellowships, which isadditional training after the
residency.
Now did you do a fellowship forneck surgeries?
Because, unlike most generalsurgeons, you do abdominal
surgeries but you also do someneck surgeries too.

Speaker 2 (15:13):
Yeah.
So when I went over there Ispent so they rotate every six
months.
I had no idea what they're like.
Well, there's a, the chairman.
There was a thyroid expert, sothat's Dr Wells.
He was an endocrine surgeon,mainly did thyroid.
So he knew this guy justthrough international meetings.
Lee Delbridge was his name.
Great guy, I mean great surgeon.

(15:35):
So I really learned a lot fromhim, but that's all he did.
He did thyroids andparathyroids.
We did like one or twoinsulinomas and then a couple
adrenals and I was betterbecause I had learned from Dr
Brunt.
He was doing laparoscopic andthese guys were way behind us.
But that's a whole other story.

Speaker 1 (15:54):
So you were great in the abdomen, but you learned
from him yeah.

Speaker 2 (15:57):
So at Wash?
U because of Wells, you didn'tdo anything until you were a
chief resident.
So he would have a second year.
You'd hold retractors, thechief would scrub with them and
he'll let the chief do the case.
So it's like a thyroid at WashU.
Maybe not at another place wasbecause you know Dr Wells, the
chairman you know, chiefresident every time.

(16:18):
So, and that was your time withDr Wells, you had, like you know
, usually it was about eightweeks and you were sort of the
administrative chief at the sametime.
Yeah, so, yeah, we, I, we didsix months so and this guy was
super busy.
We get every thyroid in NewSouth Wales practically, so
we're doing maybe like 10 a week.
Yeah, we do six in a daysometimes.
Yeah, and then I had my ownclinic.

(16:39):
He would like just send people,you know.
Getting back to the nationalhealth service, it's a little
bit different in Australia butsimilar.
They had, you know, sort of 01and 04.
So 01 were the private patients, 04 were public, so he would
send those to me which I thoughtwas kind of weird, but that's
just the way they did it.

(17:00):
So I learned a lot about doingthyroid surgery.
I think I did over 130.
In fact, when I applied to getmy boards they flagged me.
They're like there's no way youcould have done this many of my
thyroids and parathyroids.
They sent it back to me there'sa typo here and I said I had to
have Wells call them and tellthem no, I had done that many.

(17:20):
And then actually the secondsix months was even more.
I worked with these two guys inprivate practice and this one
guy was probably one of the bestsurgeons I ever worked with.
This guy could do anything DidERCPs, did laparoscopic, we did
whipples, we did everything.

Speaker 1 (17:34):
And he was a really patient, good guy.

Speaker 2 (17:37):
So I was really lucky that the time I spent over
there because we had, I think,two or three other residents
follow me and some of didn'thave like nearly the experience
that I had yeah, yeah, for sure,and, and, and.

Speaker 1 (17:51):
You know we all owe a lot to our mentors.
You know people we love andrespect.
Um, you know, for teaching us,you know how to be good doctors
absolutely.

Speaker 2 (18:01):
It takes a lot of patience to take, you know, to
allow someone do something.
You're watching them, I mean,you're still kind of guiding
them through the case andeverything.
But not everyone can do that.
It's difficult sometimes.
You know someone's struggling,you've got to like let them kind
of struggle a little bit, butnot too much.

Speaker 1 (18:18):
Yeah, you've got to figure it out.
When I graduated there was apoem written about the SR-71
Blackbird, which is the fastestairplane.
The SR-71 Blackbird, which isthe fastest airplane and kind of
the basis of the Palm, is as amentor, even when you want to
jump in and help, sometimesyou've got to let people kind of
work their way through itCorrect, and that's hard,
especially as a new attending,to do.

Speaker 2 (18:41):
I think Well, it builds confidence.
If you've got to help themevery time, they're going to
lose confidence.
You've got to be able to kindof do it.
So and we've got a new justright out of training, a new
associate, and so you know,there's some, we do some hard
cases out here and sometimesshe's wow, this is difficult and
we got to go in there and yougot to sort of help but you

(19:02):
don't want to do too much.

Speaker 1 (19:03):
Yeah, and you guys work your, your team works
together.
You just got out of a surgerywith one of your partners and
it's sometimes it's helpful tohave another set of hands in
there.

Speaker 2 (19:12):
Yeah, I mean having two experience.
I mean I think that it you knowif me and one of my senior
partners doing a case together,it's better than certainly like
down at Barnes when you've got afellow, you've got two really
experienced guys.
Been working together for 20years.
Yeah.

Speaker 1 (19:30):
It makes a difference , makes a big difference.

Speaker 2 (19:32):
We can move a little bit quicker and we just you kind
of know each other.
Yeah, there's always thatfamiliarity.
So when you're rotating throughconstantly all the time, it
sort of takes a little time totrust somebody.
Yeah, and by the time, once youbuild that trust, then they
move on.

Speaker 1 (19:45):
And it's there with your partners and the techs who
help you during the surgery, andthe nurses and the
anesthesiologist, and that's thenice thing about St Luke's
being kind of a smaller hospital.
Yeah Well, chris, thank you forsharing your story with us.
You're a general surgeon.
The phone number to your clinicis 304-434-1211.
And so if anybody's looking fora great general surgeon, give

(20:09):
Chris a call.
Thanks for coming on, hey,thank you for having me.

Speaker 2 (20:11):
I really enjoyed it, thanks.
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