It would appear quite apparent that you are intent on transforming a discussion into an argument, and I would not be surprised if that is not your first such venture.
By your own previous statement,
"All I know is from my experiences with these doctors."
it would be well for you to acknowledge, mostly to yourself, that the only credentials which you possess in the area in which you now offer highly opinionated commentary is resultant from your very limited personal experience and from that which you have gleaned from these "Johnny-One-Note" doctors, most of whom do not appreciate that everything . . even good things, have both their place and their limits.
If you will recall the initial question to which I responded was an inquiry as to how many bunion corrections should be done at one time, and I replied, "Depends on the nature of the deformity and what procedures were appropriate." No where in the ensuing discussions did I say that minimal incision surgery was without merit in some cases. What I have firmly and repeatedly stated was my objections to contentions such as yours that MIS is the one and ONLY way to go.
The fact is that not only have I performed MIS from even before micro-power equipment was available in podiatry, but I have taught these procedures. Important in my teaching is also instructing when NOT to employ these techniques. Your confusion of these procedures with closed endoscopic procedures performed by other disciplines is that fatally flawed, in that the MIS procedures performed in podiatry, save for one or two, are BLIND. The vast majority of these procedures do not employ endoscopes or other methods of adequately visualizing the surgical site. Therefore, collateral damage to tissues is virtually assured and accuracy of "corrections" can only be assessed by visualizing the overlying skin. I have seen the radiographs of many of these patients who come to me for revisions, all too often, where the outside might look reasonably okay, but the inside looks like a fragmentation grenade went off.
The quality of a surgeon lies not only in his hand-eye coordination and technical skill, but even more significant is his capacity to evaluate, discriminate, diagnosis and make appropriate choices. Anyone good with his hands can be taught to do surgery, but thinking is a horse of a different color. The skilled surgeon knows not only when to do something, but even more important he knows when NOT to do it.
The best advantages of a hospital setting is that one's work is scrutinized by others and that the hospital and the department set standards of practice as well as credentialing mechanisms for staff members. A surgeon must prove to his peers who are knowledgeable in such matters that he has the skill to perform a particular procedure. Every surgical staff members is not cleared to perform every procedure. When a member of my staff wishes to expand the procedures for which he is credentialed, either I or my designee, who is qualified to perform the procedure, scrubs in with him/her for several cases before I clear the doctor. Those performing MIS surgery or other office-based surgeries have no such oversight, and lack of oversight lead to poor, sloppy and inappropriate work. In the office, there is virtually no ongoing quality assurance. Perodic departmental audits in the hospital assure that proper criteria, as established by standards of practice and departmental policy, had been met prior to the performance of any technique or procedure. Doctors not meeting those criteria are required to make their case before committee for deveating from those standards, and are judged accordingly. Case presentation meeting are held reguarly in the hospital so that others might learn from their peers. To assert, as you have implied, that hospitals are only, or even mainly, for the ego of the doctors is simply ignorance of the of the reality.
Even though you admittedly have no real expertise in the area about which you pontificate, you have resolutely opined that not only is MIS ALWAYS a good choice, but that it should be the ONLY choice. And YOU have the audacity to state that I am a danger to my patients. I can just say, "Thank God that it is ME and not YOU who has those patients."
Finally, it would be poor service to leave this discussion, as you have suggested, totally to the patients. Patients have no means of determining that which is good and not so good medical practice. You have proven this with your uninformed comments. Patient evaluate doctors almost entirely by their bedside manner, by the appearance of their caring and by the efficiency and appearance of their offices. They are simply unequipped to determine their doctor's technical skill other than whether or not they resolved their own particular problem. Though certainly patients have the inalienable right to make their own decisions regarding their own care as well as the inalienable right to be wrong, individual anecdotal results, whether good or poor are not the scientific arbiter you would have them be.
Self-serving opinions, Harry, are easy to come by. Real earned knowledge is NOT. Best stick to that which you know rather than playing doctor. |
