“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

Friday, January 11, 2008

Did you see my xray?

“Whoever undertakes to set himself up as a judge of Truth and Knowledge is shipwrecked by the laughter of the gods.”
~Albert Einstein

The reason I went into medical school was because I wanted to go into orthopaedic surgery. With an undergraduate degree in engineering, orthopaedics was a natural progression. One of the major draws to orthopaedics is the surgical side. A common orthopaedic joke is, "bone broke; me fix." We do multiple complex procedures to help individuals stand straight, walk better, and live without pain. We have instrumentation that costs more than most people's car. We gaze at our xrays as if it was a work of art. We show them to patients and other surgeons as if saying "look what I can do."

We are very xray driven. We like to see fractures AFT with plates and screws, or a rod placed perfectly. Residents get caught up in this superficial, self-aggrandizing look at patients. We see xrays not faces. We remember fracture patterns not names. We hear drills and not voices. But, these are people, human beings with families and friends.

I do a number of larger cases on children with multiple medical issues. Because of the chronic nature of their diseases, I become almost like a primary care doctor. I see them multiple times during the year. I know many of the family's stories and the triumphs and trials of their lives. I treat the patient like family. I would not recommend a surgery that I do not feel is needed and I involve the family in making the decisions.

For most of my complex surgeries, we have a preoperative conference. I recommend that everyone involved in the child's life come to the visit. I ask them to right their questions down prior to the visit so that they don't forget any. We go through the risks and benefits. I give them numbers on some of the risks. Regardless of what we do, there is always a risk of a major complication that can result from unforeseeable events.

When I was a resident, we would salivate over big cases. Beg to do major surgeries to xrays, because we knew that we could "make it look better." We knew exactly what instrumentation would make this perfect. It was always the wise, grey-haired attendings that would make you rethink your decisions and look at the potential harmful risks to the "patient". Because regardless of what we do, there are always risks. As much as we talk about the xrays and our surgical prowess, they don't necessarily matter. In the end, what really matters is that you did what was right for the patient based on what was needed and not based on making a pretty xray.

“We learn more by looking for the answer to a question and not finding it than we do from learning the answer itself.”
~Lloyd Alexander

1 comment:

make mine trauma said...

So true! There is always a gathering of ortho docs in the lounge huddled around the downloaded xrays of some patient or another that had come through the ER the previous night.
It's almost an unspoken game of "Can You Top This?"