From: “drpugs”   Sent: Sunday, June 10, 2007 2:53 AM

Subject: THE FIRST HUNDRED

Hi All,

Just catching up after not having time since the end of may. I noted
many posts on the number of cases (a new surgeon)  needed to become proficient. Some
mentioned it being bogus to learn on patients and other similar
comments.

I ask everyone to consider that everyone needs to start somewhere
and all surgeons (even Gross, DeSmet and McMinn) had to do their
first resurf and their next 99 prior to reaching 100.

This issue is one that is difficult for me because I set very high
standards for myself and always want to do the best thing for my
patients. That is why I became interested in the resurf concept. As
I went through my first 50 cases I was always questioning my
experience and analyzing the results to be sure I was doing the best
surgery I could. On the one hand you know you don’t have the
experience that some others do. On the other hand there is no way to
get it without doing the cases. It is a very difficult issue for a
surgeon.

I resolved it by training as follows.
1)observing surgery with three different resurf surgeons. (Gross,
McMinn and Stachniw)prior to doing my first case.
2)Taking the formal BHR training course.
3)Carefully selecting my early cases to be straight forward.
4)Carefully reviewing each case looking for ways to improve.

While I realize the importance of experience as I hope most of my
fellow surgeons do we all must start somewhere. There is really no
way to resolve that issue.

As for an individual deciding where to have the procedure done there
is no easy answer. I would make sure first that you are comfortable
with the surgeon and your experience on your visit. Ask questions
and be comfortable with the answers. If you don’t have a good
feeling look elsewhere.

If you personally set a minimum number of cases for your surgeon
that’s fine. But please don’t insult the surgeons starting out by
claiming them to be bogus. Most are like me when I started. Worried
to death about doing a perfect performance every time while starting
a new and difficult procedure. Doing their best each and every time
and beating themselves up for every mistake no matter how minor. Ask
my wife and she will tell you how much it bothers me every time
something doesn’t go perfect in surgery, even if it is something
that won’t affect the results. I take the responsibility and trust
that patients give me very seriously and I feel the majority of the
orthopods do.

I hope that will give you all some insight into the moral dilema
that faces a surgeon starting with a new procedure. If some of us
don’t learn and gain experience in resurfs then the procedure won’t
be widely available and many resurf candidates will lose their heads
needlessly due to lack of qualified surgeons.

Remember we all had to crawl before we learned to walk and then
stumbled unsteadily before we learned to walk well. Thanks for reading this ramble.

Scott Rubinstein M.D.

Illinois Bone and Joint Institute, Chicago, Illinois

www.hiportho.com
<http://www.hiportho.com>