Developing A Perspective When Judging The Outcomes Of Other Surgeons

Perspective is an interesting topic. I believe perspective, particularly professional perspective, comes with experience. Perspective in medicine is often a tricky subject, especially when it comes to passing judgment on a colleague’s patient care. John Kwon, MD, and Christopher Miller, MD, recently examined this thorny topic in Foot and Ankle International in an article titled, “Orthopedics in Glass Houses.”¹

The op-ed article begins with a resident’s assessment of an ankle fracture that had open reduction with internal fixation. The resident’s evaluation of the case segued into an evaluation of the surgeon’s skill and competence based on a set of X-rays. The outcome was poor by any account. The resident’s ivory tower (university setting) armchair quarterback evaluation spurred the authors to write the article, which examines the three components of understanding and evaluating that are necessary for an adequate case review: resources, context and experience.¹

Context is a tricky concept as it applies to surgical outcomes. Adverse conditions at the time of surgery can be contributory to poor outcomes. Numerous adverse conditions can tilt the pendulum of success toward failure. Kwon and Miller echoed this, saying, “Your colleague is probably more skilled than you think. Try and understand the reasons for a poor radiographic outcome in the context of a good surgeon trying to do the right thing. We would all hope that others afford us the same courtesy when examining our failed surgeries.”¹

Albert Einstein said, “The only source of knowledge is experience.”² I know for certain I am a better surgeon with my 27 years of experience than when I finished my residency program. The article’s authors captured this notion with such clarity, stating, “Consider the variables of surgeon experience in the context of difficulty of surgery when assessing the work of your colleague. As learning is a lifelong journey, we suspect that for many procedures, all surgeons continue along this theoretical learning curve without perhaps ever performing the ‘perfect’ surgery. Reflect on your experience and understand where your colleague may be along his/her journey.”¹

This topic is not about standard of care and self-regulating our peers who fall below accepted practice guidelines. It is our moral and professional obligation to protect patients from gross incompetence and negligence. In their article, Kwon and Miller emphasized a culture change in the training of future surgeons that avoids rash judgments and hasty conclusions, and encourages a stronger understanding and humility when it comes to the key factors behind good and bad outcomes. As Kwon and Miller noted, “… No surgeon who takes on challenging cases will ‘win’ them all. It is the authors’ earnest hope that we can all acknowledge our own successes and failures and remember that we truly do live in glass houses. Let us throw no casual stones.”¹

Perspective is important. The authors began their article with a quote from Wayne Dyer that sums things up nicely, “When you judge others, you do not define them, you define yourself.”¹ Remember these words of wisdom the next time you are about to pass judgment based on some X-rays.

References

1. Kwon JY, Miller C. Orthopedics in glass houses. Foot Ankle Int. 2017; 38(4):465–66.
2. Brainy Quote. Available at https://www.brainyquote.com/quotes/keywords/source.html .