Did I Really do That?
When you’re finished changing, you’re finished!
Thalidomide for morning sickness, babies sleeping on their stomachs, cranial radiation for tinea capitis and prolonged bed rest for back pain are all medical interventions that had their day before fading away when better ways were found. Some things stick, while others do not stand the test of time – this is true across all domains, not just medical innovations. Science, technology and civilization are evolving at a meteoric pace; as a result, change and evolution is inevitable. It is no surprise that looking back just a few years brings on embarrassed gasps and sputtering – Did I really do that?
Blunders and Worse
Reviewing some of the dogma from my residency makes me shake my head – why did we think these were the right approaches to a whole host of neurosurgical diseases? Clearly, neurosurgery (medicine) is not alone in such retrospective head-scratching. Science is rife with such blunders. Most, though not all, scientific and medical mishaps are done with good intentions and are firmly rooted in the prevailing knowledge and culture of the day. A short, but startling list includes:
- Blood letting
- Interventions based on the “four humors”
- Sperm production by the spinal cord
- Fusions for back pain.
Then, there is the intervention too far ahead of its time – a viable or possibly optimal treatment abandoned, because the technology was not ready, studies were performed badly or public resistance. On occasion, the reputation of the innovator can deter promising interventions. Such was the case with Irving Cooper, who fell prey to almost all of these forces. His flamboyant media and profit-focused personality resulted in strong neurosurgical efforts to debunk his work. Today, functional surgeons have returned to some of his nearly lost ideas and are applying radically improved devices to explore their promising potential.
The Value of a Change Mentality
One hallmark of a good physician is remaining vigilant when it comes to the rapidly changing landscape of patient treatment. The drive to stay current is the only way to insure a physician provides optimal, quality care to patients. This can be a daunting task for at least two reasons. First, there is an incredible volume of material to absorb and understand. Secondly, it is far easier to persist with what one has “always done,” rather than take on the challenge of disruption. Most humans are inherently wired to resist change, whether personally or professionally. The first step to successfully staying up-to-date is recognizing and acknowledging that change is essential to life. Further, it is the key to greatness:
“A good hockey player plays where the puck is. A great hockey player skates to where the puck is going to be.”
The tenets of embracing change should be conveyed throughout the educational process, particularly during resident training and early practice. Critical rules of engagement are that change is:
- Part of life
- A proactive process
- Part of being a physician
- Essential to best practices
It requires an open mind and an avoidance of clichés. The proactive component requires critical appraisal of one’s own strengths and weaknesses as well as engagement with others in the improvement process. Tony Hileman offered a poignant description of how this process unfolds, especially for science and medicine:
“… created and recreated in a delightful and dizzy upward spiral – we have to work at it. There comes a point in this cycle … where we realize that what we held as rational has become rationalization … we once again uncover in our thinking a mythology masquerading as rationality.”
Look around right now and then imagine how things would be radically different if:
- We still thought the world was flat.
- Penicillin had not been discovered.
- There were no MRI, CT or PET scanners.
- Opioids were still copiously prescribed as the primary treatment of all pain and thus readily available for abuse.
- Smart phones and computers had not evolved for everyday use.
These represent a miniscule drop-in-the-bucket of scientific and medical changes that have positively affected our lives. Fostering a change mentality in ourselves, colleagues and those we train will help insure even more remarkable progress!
What Doesn’t Work
Neurosurgery, though still a relatively young specialty (100 years), has had its share of blunders, reversals and “before its time” moments. When first conceived, the focus of the current issue was intended to be “summer breezy,” poking gentle fun at all the things our specialty once loudly proclaimed (or suppressed) that have been soundly reversed over time. However, the authors submitted intensely thoughtful and thought-provoking pieces that draw a highly nuanced and complex picture. Perhaps more than anything, they reveal how little we know or truly understand about so many of the diseases and conditions that plague our patients. What does echo is the desire for progress and the recognition that it can only soar on the wings of change.
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