“Look at every path closely and deliberately, then ask ourselves this crucial question: Does this path have a heart? If it does, then the path is good. If it doesn't, it is of no use.” ~Carlos Castaneda

Monday, August 6, 2007

It is an emotional issue ...

“Feelings are not supposed to be logical. Dangerous is the man
who has rationalized his emotions.”
~David Borenstein

Every few months, the residents change services. Regardless of the sub-specialty or residency program, it is required that they get exposure to the different sub-specialty areas and/or patient types in order to have "general" understanding of their specialty of choice. My specialty is orthopaedics. To comply with the requirements of the RRC, residents must rotate on different services and/or physicians. It is this change of service that confuses many of the younger residents and even the more experienced resident. You may say, "Why?" Evey time the residents encounter a new physician, they must learn a whole new set of quirks. It is because we all have our own "Emotional Issues."

Now, my definition of Emotional Issue has nothing to do with the DSM-IV (or V or whatever number they are on now) diagnostic criteria. My definition pertains to a particular thing that you do that has no proven scientific benefit; but by doing it, it provides you a sense that everything will be better if it is done. Now, I am not talking about OCD. I am speaking of the little things that people do because of anecdotal experience but have no literature support.

Here are some examples:
  • When I would press fit an acetabular component under reamed by 1 or 2, I would put in at least one screw. My rep said I didn't need it, but it made me sleep better. So, we termed it the "sleep better screw." (for all of you with dirty minds, that would be an orthopaedic device)
  • When I use allograft bone, I put gentamicin in it. Why? I have no studies to support it, but it causes no harm and it makes me feel better.
  • How about antibiotics in irrigation? I am sure we can find articles for both sides.
  • Webril under the tourniquet or not?
  • To ioban or not?
  • Pre clean with alcohol or preop hibiclens shower?
I am sure there are a thousand more that we can list. These are what I term Emotional Issues (EI). Things we do because maybe we had a "bad experience" when we didn't do it or because it helps us sleep better. Every surgeon has them. Sometimes it is seems like OCD. This is what causes residents such anguish when they switch services. What they may do for one surgeon may be a no no for another surgeon and visa versa. It must seem like a moving target.

In the end, we all have these hangups. For me, I realize these EI's are the equivalent of an emotional security blanket. But, they help me sleep better.

“There are moments in life, when the heart is so full of emotion
That if by chance it be shaken, or into its depths like a pebble
Drops some careless word, it overflows, and its secret,
Spilt on the ground like water, can never be gathered together”

~Henry Wadsworth Longfellow

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