Dear CSS Members and Colleagues:
Few surgeons have been as impactful as Dr. Zuckerman when it comes to critical analysis of shoulder care and teaching. Here are a few thoughts on his view of Innovation in Shoulder Surgery.
“In medicine we are constantly striving to do things better”
Codman was first and foremost a proponent about measuring to improve. In the words of Bob Kaplan, a distinguished professor at Harvard Business School, “If you can’t measure it, you manage it, and if you can’t manage it, you can’t improve it.” Joe Zuckerman is all about thoughtful measurement, management and improvement. A message we should all hear!
“Getting to this end point included some missteps along the way, with important effect on our patients.”
Innovation is not always clean and pretty and certainly not without failures and harm. Dr. Zuckerman uses the example of Pain pumps and thermal capsulorrhaphy, but there are many more. I submit that with careful measurement of impact of such technology we would have avoided not only patient harm but medicolegal issues which ensued after introduction of these ill-fated treatment methods.
“The success of surgical procedures we considered standard today were developed over time in which “trial and error” was the common theme….In this context, recognizing that the common thread through-out these refinements is the patients we treat is most important.”
These statements are very true; however, we can find many examples where the “common thread” was not that the patients we were the most important factor, unfortunately. Conflict of Interest may be reported but not so for conflict of ego. That said, we now face an unprecedented opportunity in orthopedics for the impact of new technologies including artificial intelligence, virtual reality and augmented reality. These offer enormous potential to “DO GOOD” while innovating at the same time. The method of such a blend is engineered error avoidance during surgery and a digital conscience with guidance of AI.
“…it is important to appreciate the cost of our innovations….”
“…the well-known learning curve…”
Dr. Zuckerman makes some very important points about how we learn on our patients and how we should try to balance this curve with responsibility. He offers and example of what he learned from Lafosse about subscapularis sparing arthroplasty surgery and then how he applied this to his own patients. The message here is that we need to learn from each other to shorten our learning curves on our patients. In keeping with my theme of new technology helping our patients, the opportunity to do virtual surgery on patients prior to doing it in the real world may be shown to improve value for our patients by allowing us “trial without error” in the future.
Another example he offers is the introduction of Reverse prosthesis by Grammont and the learning curve we all experienced with this new technology. Again, those of us who took time to learn from each other not only improved value for our patients but allowed us to contribute innovations which improved outcomes and reduced complications.
“Each one of us is responsible for providing the best patient care we can and “to do no harm.”
We all probably strongly agree with Joe; however, how many of us measure in order to improve. My message to all of us is if you don’t measure your outcomes, start now. If you don’t analyze those outcomes start now. If you don’t improve based on what you measure, start now!
“JP” Warner MD