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07/27/2021 | Unmasking the Surgeon

Stefaan Bergé

Stefaan Bergé infront of his house

1. You are Belgian, living in Germany and working in the Netherlands. How did it come to this? Do you live “The Convinced European”?

After my studies in dentistry and later medicine in Belgium back in the 80’s, there were two main factors that brought me to Germany. The first one is, that German-speaking countries are the cradle of OMF surgery from my point of view. The second reason why I was drawn to Germany is my love for classical music, that I already had as a child.

When it comes to my workplace, I did not decide for the Netherlands, but rather for a clinic that has an outstanding reputation and is one of the big European centers for OMF surgery - Nijmegen. Thinking of my great predecessors there, like Merz, Freihofer and Stoelinga and what they achieved in the past, I was not hesitating a minute, when I received the call to go there.

2. Do you get along with all these national mentalities and where are the main differences from your perspective?

There are a lot of existing clichés when it comes to different countries, but I think they are by far overrated. I prefer to look at the positive aspects rather than the possibly national stigmas or problems. For me, there are intriguing things in all of these countries. Living in Germany means to me to have a lot of green spaces, a high level cultural agenda and very caring neighbors. Living here almost feels a bit like a long holiday. When you look at the Netherlands, you have a more vibrant and busy professional life with a very high university standard. When you combine these aspects with a bit of a Belgian-Burgundian lifestyle, one cannot complain. 

3. What would you say is the principal aspect of your personality? 

In my yearly feedback rounds with my team, I often hear that I am able to transfer my passion for OMF surgery and research or teaching projects to others. This aspect is also really important to me personally, since my projects are often of a visionary and future-driven nature. I prefer to dream about what will be in 2030 rather than to make plans for tomorrow. Choosing this way of working, I try to have a significant impact on our future healthcare. For those long-term projects, it is important to break them down into smaller steps to win others for your ideas, to find allies – and this strategy seems to work.

4. When and how did you decide to become an OMF surgeon?

Right after I graduated from school, I started my studies in dentistry. Everything went smoothly and I was about to finish my studies by the age of 23. Back then, I could not imagine to work as a dentist for the next 45 years. In the same period of time, I met Prof. Eric Fossion, which was a really good fortune for me. With his incredible charisma, great sense of humour and impressive skills within the OMF speciality, he really was an idol for me. These two factors brought me to OMF surgery.

5. What is it that fascinates you about your surgical discipline the most? 

For me it is the great diversity in patients, the team collaboration and the quest for perfection. We really see patients of all different ages, starting from babies up to the cancer patients in their terminal status. Apart from this, I appreciate the cross-discipline cooperation with students, assistants, scientific collaborators and surgeons to only name a few. Another important point is the high precision we work with. For example, when closing a cleft lip, 0.5 mm mean a lot. In our discipline you really have the chance to work closely to the limit of perfection – and that is what I love.
 

Stefaan Bergé in his music room

6. Which profession would you have chosen, if you had not become an OMF surgeon? 

Besides OMF surgery, I have a great passion for classical music that already started early in my childhood. That is why, in a second live, I would choose for a career as a conductor of an orchestra.

7. If you had the opportunity to look over the shoulder of a colleague, who would it be and why?

I thought a long time about this question. Although there are some senior surgeons, that I really admire, I would always choose to look over the shoulder of a young talented colleague, who is willing to learn and to do the next step. That is also an important part of my general attitude, where I ask myself what I can do to support younger colleagues in their individual development. 
When it comes to senior colleagues, I really admire Prof. Klaus Wolff from Munich, Prof. Gosla Reddy from Hyderabad, Prof. Fossion from Leuven and Prof. Niederhagen from Bonn and I would love standing at the OR table with them (again) - not for their outstanding surgical skills, that they certainly have, but because one can learn a lot from them in terms of social skills, philosophy and friendship. That is what it is all about in the end.

8. What was the most eye-opening event in your career and what did you learn from it?

A very special moment appeared at the end of my residency in Saarbrücken, Germany, together with Prof. Dumbach and Dr. Rodemer. We received a complex panfacial trauma but unfortunately, Prof. Dumbach was not around and Dr. Rodemer was already busy within an oncological case. I was alone and there was no supervision or assistance in order to instruct me. Dr. Rodemer then said to me: “You can do this; you are capable of this.” Following his words, I started the operation being certain, that I would not be able to finish it successfully. In the middle of the surgery, I noticed that I could do it in a very proper way. This moment when I realized that I could do it and that I was indeed a real OMF surgeon meant mental liberation to me. 
Another game changing moment in my early career, I think it was 1988, took place in a second hand book shop, when I found a book on cleft lip and palate. I was completely fascinated by this book and kept on reading it again and again. That was the beginning of my love for cleft surgery, and it influenced my future perspective tremendously. 

9. Do you think that young surgeons are too much protected nowadays? Should they be more exposed to the challenges of the specialty?

That depends on the country you look at. In the Netherlands, we have fixed, nationally organized training plans and learning aims of what you are supposed to learn at which moment in your training. The residents are nicely guided through theirtraining and have seven different tough examinations. In Germany, you do not have this nationally guided system, there is a wide variety on training programs. On one hand: when you are talented, strong and ambitious and you take the initiative, you can do a lot more during your residency in Germany compared to the Netherlands. On the other hand, a lot of young colleagues go overboard when there is not enough guidance ormentoring. Today, we work with so called entrusted professional activities (EPA’s) in the Netherlands. An EPA is a key task of a discipline (i.e. specialty or subspecialty) that a resident can be trusted to perform in a given healthcare context, once sufficient competence has been demonstrated. This way of working creates a safe balance between protection and exposure. One should google it!

10. You have shown your visionary streak by founding one of the first OMF 3D labs in Europe. What was your motivation for doing so?

I am a strong believer of the holy anatomical trinity in OMF, i.e. the unbreakable interaction between facial soft tissues, hard bony tissues and dental tissues. For all three of them, there are great imaging techniques available, but at the beginning of this century, the challenge was to bring them all together in one digital data set. The 3D lab focused on that in the early days, and I think we achieved some important results. 

Another answer to this question goes back to the period of time that I studied medicine. There was a moment where I was really struggling to choose between radiology and OMFS. So, what I mean is that imaging techniques have always been fascinating to me. During my time in Bonn, I had the chance to experiment with early innovative 3Dimaging techniques like stereophotogrammetry and holograms, thanks to the close cooperation between the University and the Cesar Research Institute. As I then moved to Nijmegen in 2005, I was already obsessed with those techniques and wanted to go on with the research in Nijmegen as well. After tough negotiations, the University Hospital in Nijmegen allowed me to organize the first Cone Beam CT and the first stereophotogrammetry camera in the Netherlands at the moment that I started as Head of the Department. This investment back in 2005 was of course a luxury base for the establishment of our 3D lab.

In addition to this technical things, I was extremely lucky with my first fellow co-workers, especially Thomas Maal, who was only 23 years old and still an engineer-student when he started in our department. Today he is still very young, but he is nevertheless the first medical 3D professor in the Netherlands and has over 200 publications. 

11. How will the surgical future look like in a growing digital and big data environment? 

I am fully convinced, that artificial intelligence (AI) will take over a large part of our responsibilities. We currently have several PhD theses running on the topic “AI in OMFS”. We believe, that a lot of the decision-making will be covered by AI - whether it will be on removal of wisdom teeth or on orthognathic rehabilitation, implantology or oncology. 

Besides AI, augmented reality will also play an important role. We already do nice things in craniofacial surgery, implantology, orthognathic surgery or TMJ surgery - robotic navigation and data acquisition will as well play a much more prominent role in the next decade. 

We also believe in dynamic medical networks. The idea, that a clinic will offer a certain service and the patient will come and visit the hospital is disappearing. The clinic needs to establish a network in which the patient will receive the optimal care, depending on his/her individual pathology. The patient will travel less and the institutions will orientate themselves more towards the patient. 
Also prevention will change things. I cannot imagine that our numbers in oral cancer will remain that high by the end of this century. And a final point: genetics will have an incredible impact in the near future. When it comes to cleft lip and palate patients, I am not that certain that we will see cleft babies in 2070, which is only 50 years from now. 

12. Do you have a ritual before performing surgery or a lucky charm?

Maybe one thing, that I would not necessarily call a ritual, but rather a way of working: I tend to operate barefoot without my clogs. I learned that in Nigeria, where it is very hot in the operating theater. Some doctors there take off their shoes and place their bare feet in a bucket with cold water which cools their body temperature down considerably. Of course, the European doctors followed this example and it turned out that it felt nice to operate without clogs. It also forces you to operate in a perfect clean way without a bloody mess under the table. 

13. Which kind of music supports your work in the OR? 

I am a fanatic opponent of music in the OR. We know, that pop music is negative for your concentration and bad for the general mood. In my opinion it should be forbidden in the OR. 

The sound I most enjoy in the OR is silence. We currently have a project to build up the perfect silent operating theater. If there is one thing that I would like to bring to a big success in the next ten years, it is this project. Hundreds and thousands of surgeons are being mistreated by anesthesia and other noisy equipment. We hear the heartbeat and saturation levels of our patients all day long. We constantly hear loud, (almost always) false alerts coming from the anesthesia unit mixed with incoming phone calls and chattering staff and nurses. If you analyze a recording of 30 minutes of an average operation procedure, you will find routinely used instruments generating sound levels of more than  130 dB. That is insane.

So we are trying to build up an OR environment which brings silence back to us. Anesthetist, nurse or surgeon: everybody is wearing a knob in the ear and only hears what he or she is supposed to hear. Everything is on a professional level: I raise a question, you answer – just like in a cockpit of an airplane. I do not need gossip talks about private holidays or an analysis of a soccer game in the OR. I know that I am quite an exception regarding this topic, but sometimes we practice and try to be silent whenever possible and by the end of the day everybody is amazed by the beauty of silence and the level of concentration that was achieved.

14. What is something only few people know about you?

It is maybe a well-kept secret, but for things I really do care, I can have a huge amount of patience. Usually I have the reputation to be impatient and pushy, if things are not moving. For example, when I am doing grocery shopping and have to wait three minutes in line, I nearly go crazy. However, when it comes to a complex operation, accompanying a young surgeon to one of his/her first operations or building harpsichords at home, the contrary holds true … 
 

Stefaan Bergé infront of a harpsichord

15. What do you enjoy most in your free-time? 

I most enjoy building harpsichords at home and take it as a moment of silence, meditation and rest in order to concentrate myself. Apart from building them, I also love playing music instruments. I try to play a bit every day and compose some music, mostly during the weekend.

Another hobby I really love is playing snooker billiard. When I come home from work, this is generally spoken the first thing I do with one of the kids. I have one daughter, the oldest one, and five sons, and all the boys are addicted snooker players – so finding someone to play with is not that hard. Sometimes when I come home, one of the kids wants me to play snooker as soon as possible. That means that they urgently need some private quality time for a good talk. Snooker makes difficult conversations easy, especially for the kids. 

16. Which deceased person would you have liked to meet and why?

My top two would be Georg Friedrich Händel and Giacomo Rossini. Two composers who were real popstars at their time. Both had an extremely fascinating life. Händel was the first rockstar ever. He never married but had several affairs and an incredible passion for beauty, art, music, opera, festivals, culinary experiments and drinks. If you listen to his glamorous, sparkling, ingenious music, you will understand that immediately. He must have been an extremely funny and sunny character as well. As a matter of fact, I am pleased to share my date of birth with this unique personality.   

When it comes to Rossini, who is at least as genius as Händel, he might even be funnier and more charming. Another specific thing about Händel and Rossini is that you only have to hear their music just for a second to recognize it. This strong branding is only given to a very few composers. They are grand masters in perfection, performing on the highest level ever possible, but still very social people, genius to the bone. I really believe one could learn a lot from them. Although I cannot talk with them anymore, I still can hear them through their legacy.

17. If you were able to tell three things to your younger-self, what would you tell him?

There is one thing I know for sure: if I had the chance to start again, I would be a much more professional student. My student years of dentistry in Leuven were just one big party. I do not regret this, because it also offered me a lot in terms of developing leadership or social skills, but looking back, it was definitely over the top. Today, I see how my children organize their lives at the university in a much better way. The four oldest kids are studying now and besides that, they still develop their music and sport talents on a very high level. That is something I really admire, that I would copy from my kids, if I had another chance.

The second point is maybe an open door: From 18 to 28, I practiced a lot of sports. In recent years that declined, which is a pity. I would do that differently now. I admire people who still have a very good fitness level at the age of 55 or 60 - but I am lacking a lot of discipline there.

18. If you could witness any event past, present or future, what would it be?

I would like to be present at my own funeral, which ideally-speaking should happen at a very high age, satisfied with a fulfilled life surrounded by all my children who are grateful and happy on that day. If I had the chance to sign for that, I would do that straight away. The reason, why I chose this event is simply because I would then know, that my children are doing fine. That is by far more important than anything else in the world.

19. If a plane flew you to any destination you like right in this moment, where would you go and what would you do there?

I strongly believe we are already flying far too much. So I would prefer to stay here with my family and my team and I would build upon the here and now as good as possible.

And if it was by bicycle?

That is a good one! I hope, one day, I will be in the physical condition to complete a Tour de France stage in the Alpes or in the Pyrenees. Beating one of this legendary cols of the Tour de France like Alpe d’Huez, Galibier or Mont Ventoux. I could not be more satisfied....

20. What are the top three things on your bucket list?

A very ambitious dream would be to play a century snooker break. That means a hundred points in one game in a row. The maximum a player can achieve is 147, but that is impossible for non-professionals.  But a century break, if I keep practicing for another ten years, who knows? Not very realistic to be honest. I am only telling you this, because it gives me a good reason to practice more, which for me is very social, interactive and relaxing.

Maybe due to the Corona pandemic, short ski trips with my kids would be high on my list as well. We used to do that several times in the past and it was always a highlight throughout the year. You cannot do that often enough. 

My third point would be playing the “Concerto for four harpsichords and orchestra” from Johann Sebastian Bach. I am now about to build my fourth harpsichord. I would love to finish that and then play the concerto. That is a project from which I am not sure, if it is realistic but I think I will try hard for that. 

21. How did classical music come into your life?

My father used to be a conductor of a church choir in Antwerp and I myself was already member of the children choir of the Royal Opera House in Antwerp at a very young age. That dominated most of my youth up to the age of 15. Two to three times every week, me with my brothers and sisters, we found ourselves in the opera, either practicing or performing. Apart from that, I went to music school at a very young age and learned how to play violin and harpsichord. Since playing alone spoils all the fun, we have always played in a group of four, five or more musicians, which was very fascinating tome. I really became addicted to music by practicing it.

Bergé orchestra

22. Your family are all music lovers resulting in the Bergé string ensemble mainly formed by your kids. Please describe how you made that happen. 

All the credits for that go to my wife. She is in medicine as well, but additionally studied violin and has also a great talent and passion for music. She started teaching every single child at the age of three. If you start music at three, you can already play very well at the age of seven and then it is already fun. If you only start at seven or eight you will soon turn into puberty, where playing an instrument becomes uncool – and this is usually the end of the story. If you have already played the “Four Seasons” from Vivaldi with orchestra at the age of ten, you only want to do one thing – play that again! And the kids have success, they support each other and they thoroughly enjoy that. 

I firmly believe that (almost) all kids on earth have fun and talent for music, if only they are brought in the right environment and are trained adequately. As a society, we should pay far more attention to this. Music can build up bridges and create peace. Two children who play in an orchestra can have different opinions, but they will always find a more harmonic way to deal with different ideas compared to kids in a boxing school. Music is a very good school for social behavior and functioning in groups.

23. How was it possible to keep up the motivation for all of your family members for such a unique project? 

You have to give them the lead, at least a shared decision making process, for instance by playing their favorite pop music as well. I really do not care what we play as long as we just keep on playing together every now and then. It is about the playing, not that much about the music. Thatis what counts. Recently, my youngest son, a thoroughbred musician, came home and said: “I looked through the notes of “Love of my life” and “Bohemian Rhapsody” from Queen (two songs that we have on the family repertoire) and I think, it would be better to play it on a bass guitar instead of on my cello.” I replied that he does not know how to play the bass guitar yet, even has no bass guitar at all. He insisted firmly, so we organized a bass guitar. I am absolutely positive that he will exercise as hell and will perform both songs by the end of the year, so fulfilling his own music project. It is all about fun and motivating people.

24. Where does your love for harpsichords come from and how did you become a harpsichord builder yourself? 

I had a harpsichord teacher when I was 14 or 15 years old, who built his own harpsichord. It was back then that I knew that one day, I would do the same. I collected all kinds of books and plans over the years. The bottleneck, apart from having the knowledge, is that you also need a special well-tempered large room for such a project, which is why I could only start at the age of 40, when we moved into a bigger house. One can find all the components for the instruments on the internet or in a special bazar in Paris.

One day, I would love to construct a harpsichord only with components which everyone can buy in a hardware store - but I believe I can only do this once I am retired. Actually, I would like to go on and build six harpsichords: one for every child.

25. Building an acoustic natural instrument needs a lot of patience, passion and love for detail. Do these characteristics also describe the person Stefaan Bergé?

I would say yes, but again I would prefer other people to judge on this. Love for detail is certainly true and I already mentioned that. Sometimes it can really become neurotic and painful. Last year we were renovating a barn here, by transforming it into a small pub, a project that I did with all the kids. Sometimes they really got mad at me saying: “Daddy it is fine now, it is good enough, basta!” But I tried again and answered: “Let’s sand-polish the whole wall just one more time and repaint it, then it will be perfect and then it will be fine!” Finally, I had to give way. 

That also holds true for cleft surgery, which in my personal opinion is the most demanding field in our specialty. I used to do a lot of oncological procedures in the first ten years of my career, but in the end it remains kind of a destroying surgery, at least to me. In cleft surgery, you have quite the opposite. It can be a very mandatory but very much constructive surgery, even though you cannot always lead it to absolute perfection. More than in other surgical procedures, I have the feeling that in cleft surgery (as in buildingharpsichords) the strive for perfection really lies in your hands and I enjoy that feeling.

26. How do you manage your work-life-balance to have enough time for your family and your work?

If people are talking about bringing their life into balance, that means that they do not have it in a right balance right now. This way of thinking is from a different time, when you had to work hard ten to twelve hours in a factory and needed to recharge your batteries afterwards. Today, our professional and private lives are completely tangled. We need to stop to tell each other, that we need a work-life-balance. We need to arrange our private and professional affairs in such a way that we have a good life. Let me give you an example: If my son has a test tomorrow at 11:00 a.m., I will certainly write him a WhatsApp at 10:45 a.m. wishing him good luck. If I have a patient in severe circumstances and I want to know how the patient is doing, I do not care at all if I am not on duty or holiday on that particular day - I will call or I will be called to remain well informed. 

You need to make the best out of the time you have. If you live that way and if you try to introduce your fellow workers into that philosophy, you will gather a large group of happy people around you. 

28. Can you give any tips to young colleagues for their career path which could be helpful? 

Try to mobilize the strength in you not to follow the path of least resistance. Follow your own path and your heart. Try to find out what makes you happy and do not accept a professional position simply because it is vacant. I explore that in many application talks. I always ask the people: “Why do you want to work here; you have never ever been here before? Probably all doctors over here are arrogant bunglers?” There must be a reason, a specific drive, a project, a believing, a philosophy. Applying just to get a job is a bad start for a fortunate professional career- in my eyes. 

A good career will partly be formed by luck: You need to encounter the right people to hear the right talks and so on - that is the luck factor, but the steady factor is yourself. You are the blacksmith of your own career and sometimes the iron needs some days longer to be heated until you can work on it. So take your time and be elective before you take a decision. I think that is very important.

Another advice, that I also often tell my fellow workers (and you realize you are getting old once you start talking this way): “Listen to the seniors when they tell you that something they did was a mistake in retrospective and do not try to verify it on your own. I am telling this to you since I made the same mistake 15 years ago.” I do know that surgeons below the age of 40 to 45 need to operate their own list of complications as well, but it would be nice, if we could find a way to prevent that. 

29. What helps you to relax after a long or exhausting working day? 

Although my life is in balance (I presume), I also experience tiring days. That is usually the case when I have a lot of meetings and talks. That leads to headaches and does not make me happy. That happens to everybody in responsible positions and is related to the job - so I am fine with that. Here again, you are the designer of your own fortune. You also have the possibility to say “no” and give up some of your part-time activities. My career is “over”, I have no ambitions for higher or other positions and I am completely happy with what I have achieved. That also offers me freedom for myself. It is good when you notice that you reached a position, where the people that surround you are glad, that you are in that position. If you have achieved this feeling, you should remain in that position and not do another step.

 

30. What were the reasons for you to join SORG?

In my case, I was just dropped in. When I moved to Nijmegen, my predecessor there was Prof. Stoelinga, who was a very prominent SORG member. One morning he just mentioned that from now on I would be a SORG member, too. That is the reason why I entered, but by far more important is the question why I have remained within SORG until today. For me the best about SORG is the teaching aspect as well as creating a network with fine, talented and ambitious colleagues all over the world.

31. What was your favourite experience with SORG so far?

That definitely was the international band we created at ICOMS in Hong Kong on behalf of SORG. The band comprised OMF surgeons from all over the world playing musical instruments or singing together during an evening event of the world congress ICOMS 2017. That is my SORG experience number one. That was really outstanding and I am still thankful for that. Especially Oliver Scheunemann, SORG Secretary General, and myself were taking the lead and could show to the world, that OMF can be far more than just operating. There are beautiful humans behind the professionals. It is fantastic that we could work this out so close to perfection. 

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