Tuesday, October 16, 2018

Discovering the shoulder

The Discovery was a 38-foot “fly-boat” captained by John Ratcliffe that left England in 1606 carrying colonists to establish the colony of Jamestown. Captained by John Smith, she next explored the Chesapeake Bay region. Then, under the command of Samuel Argall, she set out for Bermuda but wound up being blown off course to Newfoundland. She next took part in the search for the Northwest Passage. During the 1610-1611 expeditions in the Canadian Arctic, her crew mutinied and set her captain, Henry Hudson, adrift in a small boat. He was not seen again.

In a sense, we are on board the Discovery. Our search for better ways to serve our patients leads us to establish new principles and practices, but we are sometimes blown off course, and occasionally we are set adrift. It may seem safer to stay home, doing things the way we were taught in residency and fellowship; Robert Fulghum warned: “be aware of wonder.” Helen Keller countered: “Security is mostly a superstition. It does not exist in nature, nor do the children of men as a whole experience it. Avoiding danger is no safer in the long run than outright exposure. Life is either a daring adventure, or nothing.”

In our personal voyage on the Discovery, the author points out that we must be certain that we follow a true compass that keeps our course headed toward the most cost-effective care for the patient-travelers who entrust to us their safe arrival at their desired destination. There are many conflicting magnetic fields, such as our own fiscal or reputational self-interest, that can cause our compass to tempt a suboptimal course. To be sure we stay on the right track, we must (as E.A. Codman admonished)  “follow every patient [we treat], long enough to determine whether or not the treatment has been successful, and then to inquire ‘if not, why not?’ with a view to preventing similar failures in [the] future.” Was the failure because the patient was a poor candidate for the procedure, because we did not obtain enough complex imaging before surgery, because the implants were not “fourth generation,” because the operation was not done well, or because the rehabilitation was not optimized?

There is much to be learned from studying our own failures and those of others. While our voyage is a “daring adventure,” we should do all we can to avoid having it be risky business for our patients. But patients are not our only co-voyagers. The next generations of shoulder and elbow surgeons are on board as well. We must teach them what we think we know but also point out that half of what we teach them will be proved incorrect; it is their challenge to figure out which half. We need to invite them to speak their truth to our power—to tell us old emperors when we have no clothes.

We have a new set of shoulder youtubes about the shoulder, check them out at this link.

Be sure to visit "Ream and Run - the state of the art"  regarding this radically conservative approach to shoulder arthritis at this link and this link

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You may be interested in some of our most visited web pages   arthritis, total shoulder, ream and runreverse total shoulderCTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'