The 5 A's

  • Thomas S. Roukis
    Editor-in-Chief, Foot & Ankle Surgery: Techniques, Reports & Cases (FASTRAC)
    Past President (2014-2015), American College of Foot & Ankle Surgeons
    Clinical Professor, University of Florida College of Medicine-Jacksonville, Department of Orthopaedic Surgery & Rehabilitation, Division of Foot & Ankle Surgery
    Search for articles by this author
Open AccessPublished:January 06, 2022DOI:
      Twenty-years ago, I remember begging an ear-nose-threat surgeon to perform a radial forearm free tissue transfer for coverage of an exposed ankle joint when I was right out of fellowship. He was a professor at a major medical center in the upper Midwest and had written myriad textbook chapters on the use of this particular flap to cover intra-oral cavity soft-tissue defects. He was openly pleased that I knew who he was based on his textbook chapters I was familiar with (only because the foot and ankle soft-tissue coverage sections required skimming through these other chapters). Regardless, he helped me and the patient's leg was ultimately saved and functional. During subsequent interactions, he told me I was on track to become a quality healthcare provider because I had the “3 A's.” I smiled and nodded while I tried to search my brain for what he meant-what was the appropriate acronym? He could tell I was not processing what he meant and so he spelled it out for me as follows
      First, you need to be AVAILABLE. This means you answer your pages, phone calls and emails timely and offer to help rather than set up “hoops” for providers or patients to jump through. Second, you have to be AFFABLE. You need to be likable and nice to all persons encountered throughout the patients cares. Third, you need to be ABLE. You must have a quality surgical skill set
      Over the past two decades I have had the opportunity to interact with myriad students, residents, fellows and colleagues with whom I shared the “3 A's”. I've always found it interesting to see the realization on their faces that being ABLE was actually the least important part of being a great healthcare provider. In fact, over the engaging discussions that followed I have found it necessary to add two more “A's” to the original list. Addition one, you need to be ACCOUNTABLE. You have to complete your dictations, consults, patient paperwork requests, workers’ compensation ratings, etc. without requiring administrative intervention or repeated patient requests. Addition two, you need to be ARTICULATE. You have to communicate clearly, succinctly, completely and timely with colleagues, support staff and especially with the patients’ and their families
      We all strive to be the best foot and ankle surgeons we can be. It is unfortunate that the vast majority of our educational time is spent learning new or evolving surgical techniques since, as stated, the least important of the “5 A's” is being ABLE. The problem for us as individuals is that the first four involve personality traits that are difficult to teach to adult learners. If you are missing one of these professionalism-based attributes associated with the first four of the “5 A's”, then you should reflect on them, ask for guidance from trusted colleagues and develop a personal improvement plan to remedy the deficiency(s)
      So, now what? Well, although the focus of Foot & Ankle Surgery: Techniques, Reports & Cases (FASTRAC) is on the ABLE portion of the “5 A's”, I am encouraging interested readers to write a commentary article involving their own experiences with being AVAILABLE, AFFABLE, ACCOUNTABLE and ARTICULATE as a foot & ankle surgeon. Through sharing your comments, you can help all interested FASTRAC readers grow as a person and ultimately help our patients receive better care.
      Be well