Are We Overly Cautious When It Comes To Trying The New Surgical ‘Stuff’?

Ron Raducanu DPM FACFAS

During residency, I was exposed to a lot of newer techniques and technology. Well, they were new back then. It was an exciting time. Not only was I learning the art of foot and ankle surgery, some of my attendings were really on the cutting edge and did not shy away from trying the latest techniques and the newest “toys” so to speak.

Two recent Podiatry Today blogs got me thinking about this. The first was Dr. Barrett’s blog about “gadgets” (see http://bit.ly/bD0cKp). The other was Dr. Jacobs’ blog about fixation for the Lapidus procedure and how this was a basis for litigation (see http://bit.ly/cVjfpY).

As I was learning to use all these new and neat “toys,” some concern came up within the residency with respect to encouraging us to seek out these new toys and use them on our own patients. The concern, of course, is that of not wanting to be “that guy/gal” who does all the new procedures and uses all the new toys.

As a practitioner, I hear this a lot, mostly for medico-legal reasons. Apparently, you do not want to be the first in your neighborhood to try the “new stuff.” The fear is, that since it may not be the standard of care yet, you may get burned if you are the first to introduce these techniques/products.

So who is going to try this stuff when there is so much concern about not being “that guy”? Why shouldn‘t you be “the guy“? I wrote this blog while sitting on an airplane on my way to lecture at a conference. The conference organizers very graciously asked me to come to their conference and lecture about some of this new stuff. The technique is actually not very new. I have been doing it for a while. Apparently though, since I was one of “those guys,” now some of my colleagues are ready to see what the fuss is about.

The next natural line of questioning revolves around progression and advancement of technology. Unfortunately, we cannot invest a significant amount of time doing lab research since we have to make a living. So how does one progress a skill set and knowledge base if not for the “new stuff”?

Some of the company reps of some of the products I use call me an “early adopter.” (I’m not paid by any of them to say this by the way.) They say they welcome that I am apt to try the new stuff and give feedback. Recently, I started using a new intramedullary fixation device/technique for forefoot Charcot and Lapidus repairs. Why? I was not happy with the “old stuff.”

Did the old stuff work? Of course, it did. That is why it has been around so long. Did the new stuff work? Sure, it did. Yes, there is a learning curve and usually the new stuff needs some tweaking before it is becomes accepted enough to become the old stuff, but isn’t that the point? I would say the new stuff works better. This is why I used it and will continue to use it.

Interestingly, those same reps who say I am an early adopter also call me “old school.” This is because of the way I analyze my cases, go over everything with a fine tooth comb before committing to using any of their products, and still use some of the tried and true techniques that I learned in residency that I have adapted to the new stuff.

I am certainly not professing to be an innovator. I am also very far from being a hot shot. I am just trying to take what I learned in residency, along with my confidence in the OR, and push myself forward. The true visionaries are the ones who develop these new technologies and the real hotshots are the ones whose minds thought them up in the first place.

I would really like to hear from the community how they perceive this aspect of our art. Should we just let the big names try the new stuff and then let them decide what goes on and what we pass on? Alternatively, do you feel that it is within all of us to use new technology together to advance our technique? Do not forget that even as recently as the generation before mine, ankle surgery done by podiatrists was the new stuff.

Comments

Would you have been an early adopter with thalidomide or with silicone first MPJ implants? I do not want an early adopter as my own surgeon.

Respectfully,
Dwight L. Bates, DPM, DABPS

Dr. Bates,

I think you got the wrong impression. I don't jump into it without thorough research on the design of the products and the potential impact it will have on my patient population.

People are still using silicone 1st MPJ implants. I was just at a conference talking to some of my generation of practitioners and they are still using the silastic implants.

As for thalidomide, it was used for years before the deformities associated with its use were identified and the product was pulled.

When I was a student, Trovan was the rage and it helped a lot of diabetics as the only FDA approved drug for diabetic foot infections at that time. Could anyone have known about the "bad batch" that fatally damaged a certain number of patients' livers? It was pulled off the market quickly but its benefits were also well documented.

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