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Maxims offer orthopedic wisdom and share fundamental principles of patient care
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Maxims are succinct, make relevant points and are full of wisdom. When we entered medicine, the first maxim we heard was, “Primum non nocere,” which translates to, “Firstly, cause no harm.” It applies to the care of patients.
Different versions of these expressions of fundamental principles apply to all professions as well as life in general. However, some are specific to orthopedics. At times, they can be used as euphemisms during residency as a less offensive expression may often prompt someone to think differently or alter behavior. All orthopedic surgeons remember some frequently repeated orthopedic maxims shared during their training. We even find ourselves repeating these adages to our junior staff during their training. Oftentimes, we first hear our most memorable maxims from our most helpful mentors.
I thought it would be worthwhile to review some of my favorite quotes and explore the wisdom they share for orthopedists.
Importance of patience
Several of my favorite maxims were about being patient, and that it is important to shape your practice and reputation over time. An attending once told me to give it 10 years to get it the way you want. I saw a few young, impatient orthopedic surgeons who wanted to become rich and famous quickly, which ultimately brought negative outcomes. Early during my residency, this concept was well-expressed in a simple phrase, “Repetition, repetition, repetition–reputation.” This adage embodies the notion that you will earn your reputation; however, it takes not only time but also doing things well over and over again. Orthopedic surgeons have to allow their reputations to grow with time and continued good results.
Douglas W. Jackson
Another mentor once told me, “Your reputation was to be earned and only you could give it away.” Younger and even some older orthopedic surgeons can get wrapped up in self-aggrandizing promotions and marketing all too easily. One must be cautious because although this practice is often legal, colleagues may regard this as offensive.
The same wise mentor also told me that, “It is always easier to get more patients, but it is much harder to regain the respect of your peers.” Orthopedists should not believe that just because they are a part of a new study or procedure, they are the only ones who can do it. Most orthopedists can learn new procedures and be involved in studies if they choose.
Preparation is key
“Be prepared, know your limits and pace yourself” is something I have said time and time again over the years to my fellows. This principle applied to not to only the strenuous physical activities we did together, but more importantly, to patient care. Being prepared means you have studied the patient’s specific problem and have prepared with adequate practice and learning. It also means coming to the operating room rested, focused and not feeling rushed.
It is important to know your limits and capabilities. One should not try things beyond his or her level of expertise and training. If that is the case, then send the patient to an orthopedic surgeon who can deal with it. Then, if you wish, take the time to study, practice and get better.
I always believed it is important to pace yourself as your career is an endurance event. Stress, chemicals, financial difficulties and disruptive personal relationships take time to deal with and are best avoided. If they occur, then they should not be neglected. We have an obligation to our patients to be prepared and perform at the top of our game.
Make a patient better
Good advice about how to avoid complications is that, “The enemy of good is better.” I often heard this maxim during stressful surgeries where I had struggled and wondered if I should try one last time to make it better.
“A chance to cut is a chance to cure” is a maxim common to surgery. One aspect of surgery we try to avoid is making the patient worse as a result of an intervention. One variation that Jack C. Hughston, MD, often said was “There is no condition that cannot be made worse by surgery.” Kenneth E. DeHaven, MD, shared with me that his mentor, C. McCollister Evarts, MD, often said, “Meticulous attention to detail is the key to success.”
Lanny L. Johnson, MD, also once told me that Fred C. Reynolds, MD, taught his residents that, “I do not care what you did or what went wrong, just tell me the truth.” Not always easy, but the truth will set you free. In surgery it is usually best to use the general premise of working from “known to unknown.” This also entails preparation as well as a strong knowledge of anatomy to avoid vascular and nerve complications.
Postoperative infections
A memorable maxim I heard early in my career was during a county hospital rotation. I was confronted and lamented over my first postoperative infection. The attending told me this was a part of orthopedics and went on to say that is why “salmon” is the official color of orthopedics. He said this is the color you obtain when you “mix blood, pus and tears.”
Avoiding postoperative infections is a major concern. Orthopedic surgeons work to minimize postoperative infections. I have often thought of his words during the years when a deep infection developed, and that attending’s words came back to me. Postoperative infections cause the equivalent of tears in the emotional stress shared among patients, families and surgeons.
Education and supervision
Early in my training, I used a frequently heard phrase, “See one, do one, teach one.” However, as I went further in my training and career, I believed this was far too cavalier of a saying. While there are simpler procedures that one resident can teach another, difficult and technical procedures require experienced and qualified mentors.
Teaching and learning orthopedic surgery and patient care require a faculty of experts and mentors. Training in an under-supervised residency, where primarily one resident trains another for most of their surgical experiences does not help our profession. Accreditation has been helpful in raising the bar on appropriate learning environments. However, it remains challenging for busy service-oriented rotations not to fall short on teaching and supervision.
Many maxims in orthopedics are used more frequently in some residency programs than other programs. At times, maxims can seem provincial. But to me, these words of wisdom were always the most memorable when I heard them during my most stressful learning experiences. Their meanings continue to make more sense with every passing year.
For more information:
- Douglas W. Jackson, MD, is the Chief Medical Editor of Orthopedics Today. He can be reached at Orthopedics Today, 6900 Grove Rd., Thorofare, NJ 08086; email: orthopedics@healio.com.