Via Basel: Insights from 50 Years…
Via Basel: Insights from 50 Years of Orthopedic Practice
Recently I was approached by a young family member in his final year of college to give an informal lecture to a club in his university dedicated to students aspiring to be physicians. Telling them about my journey and experience as a physician/orthopedic surgeon can inform them and help to decide if they want to continue to pursue a similar career and vocation. That prompted me to reflect on my 50+ years of training in, and practicing Orthopedics, as well as teaching it. I soon realized that certain repetitive themes, lessons, quirks, insights, or whatever they are called were in plain sight. These insights are not unique to me or even my profession but I believe are embedded in human experience, universal, and in some ways timeless, too. Allow me please to share a few with you, dear reader.
My patients were my best teachers. To study the tools of the trade, any trade, gathering information from various sources, teachers, and professors is only the beginning of mastering your profession, to be followed by practicing it under mentor supervision. I was honored and humbled when my patients gave me permission to treat them medically or surgically. Learning from the subjects themselves, patients in my case, plants for a biologist, animals for a zoologist, is more comprehensive, effective, and practical. It is also more accurate because of the diversity and complexity in living beings. But this learning requires constant attention and patience, both of which are uncommon attributes these days. Listening well, and being open minded is the key to correct diagnosis and treatment. Tests and imaging are great but also need personalized interpretation and context, just as medical or surgical intervention requires compassion and emotional support as well.
Life is hard. Upon evaluation and diagnosis of common ailments, arthritis, tendinitis, etc., my recommendation inevitably includes lifestyle advice, activity, diet in addition to definitive treatments. “But doc, it’s hard” or some version of that, is a common response and it baffles me. Not sure how the concept of minimal effort and easy solutions to our life problems became so pervasive. Maybe our expectations are out of line with reality, and the comforts we have in contrast to our ancestors have made us complacent. The first sentence in his seminal, groundbreaking book in psychology and personal growth, M. Scott Peck writes, “Life is difficult.” First published in 1978, a best seller for over a decade, it remains as relevant as ever. If you haven’t read it, read it, and if you have years ago, then re-read it.
All phenomena have a beginning. Once I tell my patients what I believe is the cause of their problem, such as degenerative disc disease in the spine or rotator cuff tears in the shoulder, some exclaim astonishingly, “But doc, I never had this before.” Tempted to respond sarcastically, “Well, you do now,” I don’t, but then elaborate that some chronic pathologies have been there all along, but were not symptomatic for a variety of reasons and sometimes no reason at all. Our minds are not good at accepting novelty, especially with negative connotations. However, we totally embrace unexpected good news and believe in our core that we are worthy of it, a hypocrisy of sorts.
Priorities, priorities, and you are not #1. On my late son’s desk under the glass top is his handwritten sentence, no author named: “To know the order of precedence is the beginning of wisdom.” I have wondered over the years over its exact interpretation and meaning. In the real world we act out what priorities our minds dictate to us. Some value, ethical principle, moral guide, or interest has to rise to the top followed by others. Unconsciously we act according to the values on top of this list. Most of us do this by default, without a clear reflective attitude, and get in trouble. In the Hippocratic oath physicians take, the patient’s health and well-being is our first priority, with doing no harm a close second. Constantly reminding myself of that, and not efficiency, financial, or ego incentives, has been a guiding principle in my career. It is not easy or comfortable, and modern medicine technology’s effect on patient/physician interaction has not helped either. In technical or legal jargon it’s called “conflict of interest.” Any action, test, procedure in medicine should be performed according to these stated priorities with patients well-being number one. Our profession has suffered from not always adhering to the priorities of the Hippocratic oath. This conscious and deliberate effort to repeatedly remind ourselves of these priorities of helping patients, customers, consumers is relevant in any profession. It also helps in our daily decisions when we have multiple and competing choices. For this to happen we have to Pause, Reflect, and Remember. Again another reason to cultivate mindfulness. I should stop now before getting too preachy.
Basel Al-Aswad, father of EIL founder Christopher Al-Aswad, is a yogi trapped in an Orthopedic Surgeon’s body. His loves in life include reading, writing, hiking, enjoying nature, meditation, and spending time with his large Iraqi family, and now, semi-retired, he is exploring new avenues in medicine, education, public speaking, teaching, and social engagement.
Proverbs 9:10 (a list for comparison)