Routine vs. Variety in Practice

Jarrod Shapiro, DPM
Practice Perfect Editor
Assistant Professor,
Dept. of Podiatric Medicine,
Surgery & Biomechanics
College of Podiatric Medicine
Western University of
Health Sciences,
St, Pomona, CA

This is the most interesting blog issue you’ll ever read – just kidding. Few things can close the eyes and the mind like routine. Even the word sounds boring. Rooo teeeen

It sounds like a cow chewing grass on a lazy summer afternoon. But seriously, routine as a concept is actually quite important to podiatric physicians and surgeons . This is not something we commonly think about during our day to day activities, but humans are creatures of habit. In medical practice, routine has a power that often improves our performance. Of course, the opposite may be said for those procedures that fall out of the norm.

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Routine in Practice

Consider routine from a practice management standpoint. Most physicians running a private practice spend considerable time creating protocols for their office staff. Whether it’s rooming a patient, instrument set up for a nail procedure, or the postoperative patient visit, having a routine for the staff automates regular procedures and takes work away from the physician. It also helps to prevent important steps from being forgotten when the office is running at peak capacity.

One of my colleagues said it best: the only thing the doctor should be doing are those things no one else in the office can do. This isn’t to say the doctor should sit high on his pedestal, not deigning to come down to do a hard day’s work. But it does make sense, from an efficiency standpoint, to do those tasks for which we’re trained. There’s a power in the routine.

Routine in the Operating Room

In the operating room, routine is absolutely necessary. Almost every step of a surgical procedure, from the preoperative evaluation to anesthesia induction, to gowning and gloving, has a routine. The same set of procedures is performed in every operative suite in the country, and for good reason Without our routines, the repetition can become mind numbing and important steps are forgotten. Any one of us can walk into any operating room and function without difficulty. This is due to the standardization of these procedures – a routine.

The same is true for surgical procedures themselves. Ask yourself, which are the procedures you have the easiest time performing? I’ll bet your answer will be those you do most often. I once watched my first boss perform an Austin bunionectomy the same way he’d been doing it for almost 30 years. He completed the procedure rapidly and almost automatically – and successfully. I found the same to be true for me. Those procedures I do most often end up having an essentially standard method with less apparent thought. On the other hand, when I do a large reconstructive procedure that I might not perform routinely, it takes much more brain power to reach the same result. Clearly, this is the same argument for large volumes of cases during residency and fellowship training. By performing a large number of cases, they become routine and standard.

The Other Side of the Coin - Variety

Of course, there’s the flip side to the routine argument. First, during training if you make the same mistake 300 times is this good education? I doubt it. This is why the other component to surgical training – variety – is so important. Variety adds the unexpected and forces us to learn when to break the routine and when to innovate.

The same is true for those of us in practice. Excessively relying on routine is dangerous and may stifle creativity and thought. Take driving as an example. It’s quite common to hear people talk about how they were driving along and “spaced out’, stopped paying attention for some period of time, and came back to themselves not realizing how far they’d gone. Think about the last time you took an important call on your cell phone while driving to work. Was my old boss driving on autopilot all those years? Did performing his Austins the same way mean he had an excellent result 100% of the time? No, although he did have good results overall. The danger of routine is falling into the complacency trap, becoming so comfortable that we stop analyzing and improving our methods.

This is why balance and judgment is so pivotal in professional practice. The key to success with routine is to understand its place. Routine works best in those situations that require simple repetitive actions, while rare or high level cognitive actions necessitate thoughtful consideration. Routine also needs periodic evaluation and adjustment as conditions change. Combining the two – routine and variety – we will maximize both our human tendency of habit as well as our minds’ ability to innovate. In the future, consider where routine fits in your daily life while maintaining the balance to innovate. Best wishes.

Keep writing in with your thoughts and comments. Better yet, post them in our eTalk forum. Best wishes.

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Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]