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Jay Lieberman,
DPM, FACFAS
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(ANECTDOTAL) Ode to my Mentors
At this point in my career (thirty years), I am not changing too much. Yeah, I go to at least one really good seminar each year and attend my fair share of cadaver skills courses. Nevertheless, the way I treat patients does not change very much. I have taken all the treatment alternatives, distilled them down and found the method that works best. Sure, evidence based medicine is great, but “anecdotal” information is really what we use. Am I the only one who has noticed how commonly this word is used in lecture presentations? It seems as though the lecturer is saying, “Let me give you something you can really use.” Interestingly, it turns out that the treatment alternatives that I have come to trust are quite similar to the methods that my mentors use. Even today, I turn to them to know what I should really believe.
My first mentor was Myron Boxer. Dr. Boxer taught my podiatric medicine course at NYCPM. He taught me the importance of professionalism. He stood like a doctor and carried himself like a doctor because he “was” a doctor. He drove a really nice car, so I knew that if I worked hard, I could have the goodies too. Two years later “Mike” (only his friends got to call him Mike) became my residency director. I was young, dumb and aggressive. He taught me to hold back on the reigns a bit and be sure that whatever I attempted would never harm the patient. He taught me to be sure it would work. In Journal Club Meetings, I would yak about a new procedure I was anxious to try. Dr. Boxer would reinforce the fact that we should never do anything that would not definitely work and work well. At times, we would butt heads. In the end, we did it his way. Most of his former residents knew that he shortens the legs on the visitor’s chairs in his consultation room. The doctor must always sit higher than the patient.
Like me, Steven Spinner was also a bit of a Boxer clone. He wore top quality suits while treating patients and always had a hot car. Success was written all over Steve Spinner. There was no facade here. The guy is brilliant and is the finest surgeon that I have ever encountered. He has been a residency director longer than I can remember. He is also the finest educator I have ever met. Spinner made me a surgeon. He also made it clear that I knew “squat.” Experience makes a great surgeon and until you have some, you know nothing. His work was always clean and uncomplicated. If he understood it, you understood it. He bailed me out as a resident when I inappropriately scrubbed a case with an unaffiliated surgeon at an unaffiliated hospital. I was suspended for two weeks. I spent it with him in his office. I learned as much there as I did in the hospital.
In the 60’s and 70’, we relied heavily on Walter Cronkite to bring us the real news. There was something about Cronkite that said, “I would never lie to you.” We would tune in at 6:30 every night to get a summary of what was going on in the world from a man we trusted.
There are people in our profession just like that. Let’s face facts, if Warren Joseph says this is a good antibiotic, we use it. If he doesn’t say it’s a good antibiotic, I’m simply not going to rely on it. Forget all the pharmaceutical studies, I will let Warren Joseph tell me if it works or not. He has never failed me yet.
Back in the day, based upon the studies that I read, I believed unquestionably that Trental was the definitive cure for intermittent claudication. I still remember the very impressive booth that they had at The American Podiatric Medical Association seminar. I came away from the experience thinking that, not only should I use Trental, but also I should call my broker immediately and invest in this stuff. After a while, we came to learn that it didn’t quite meet up with all the hype. Boxer and Spinner probably would have said to me “Let’s wait and see.”
When a new osteotomy with incredible statistical studies to prove its worth was described in JAMA or ACFAS, Boxer and Spinner would say, “Let’s wait and see.” We always used mentors like Spinner, Boxer and others like Harold Vogler, Jack Schuberth, Dalton McGlamry and more recently, Thomas Chang to get the anecdotal information and perspective we so desperately need.
For years, we admired the heroic efforts of skilled surgeons who reported the successful results of advanced clubfoot surgery procedures. However, today, through the work of Dr. Ponseti, we have learned that The Ponseti Method is a safe, efficient treatment for the correction of clubfoot that radically decreases the need for extensive corrective surgery. Ponseti and his colleagues have shown that virtually all children, even those with the most complex club foot deformities, respond to pediatric casting, if done correctly.
What will history say about all the limb salvage work we are doing? Nothing makes a podiatric surgeon prouder than being able to save a persons leg. The question is, are the benefits truly there and does the work hold up in the short term and the long term ? When I was a recent graduate, a lot of work was being done on limb reattachment surgery. Almost weekly, you would read about a sixteen to twenty hour surgery performed to reattach a severed limb. Nightly news would report the “coloration of the arm has improved significantly”. One week later, movement in the fingers was reported. Though this work was incredible, the limbs were often found to be useless. Some of these patients ultimately underwent elective amputation.
During a recent trip to New York, I encountered endless advertisements for the new panacea in bunion surgery. A strong non-absorbable suture, percutaneously placed between the first and second rays is used to close down the IM angle and repair the bunion. Are these claims over exaggerated? My personal feeling is that these sutures will prove to be no more than an excellent way of augmenting already excellent procedures for bunion correction.
I’ll check with my mentors first.
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