When The Science Of Surgery Becomes An Art

Christopher F. Hyer DPM FACFAS

What is the “art” of surgery? The term intimates there is a creative and constructive spirit to the practice. Obviously, an artist is one who is talented and skilled in the practice, and has some natural aptitude as well. True, both of these descriptions can apply to surgery as well so perhaps it is an art.

Clearly, there is a tremendous amount of science, precision and calculated decision-making within the practice of surgery. Still, there is that “something” that just seems to make the outcomes better for some than others. Much like artists, surgeons learn skills by training with others and then make those skills their own through individual enhancements and modifications. Perhaps this personalization of the trade is where the “art” comes from.

Lecturing and speaking at regional and national conferences is where I really appreciate the diversity of this art. I listen intently as other speakers discuss their technique or approach to certain conditions, and I compare them to my own approaches. Not that one technique is better than the other but to see how different physicians can correct the same problem in different ways is fascinating. One surgeon may get beautiful results with a scarf bunionectomy while another may get the same outcome with a Lapidus arthrodesis. Is one better than the other? No but different tools can produce the same outcome.

In my opinion, this is where the art lies. Surgeons develop their tools of the trade and know intimately which tool they can use to get a particular job done. Some can do much more with an Austin/Chevron bunionectomy than I can. Others can do much more with a Scarf than I. Does this really matter? No but what it does mean is that we all use different tools to deal with similar problems.

Where I think we can go astray is when everything looks like a nail and all we bring to the table is a hammer. Ask yourself and ask your colleagues the following question: In a given year, how many different types of procedures might you do for problem X? Maybe use bunions as an example to keep it consistent. I think you will see the art in action when you hear the answer. It is usually something like, “Well for this type of bunion, I go with X. For that type, I go with Y and when it is this other type, I go with Z.”

Now how did they get to X, Y and Z? It is years of training, experience and honing of their skill to master the “art.” Just like with an artist, surgeons reinforce and practice this mastery to constantly improve and fine-tune the skill. So at the next conference or seminar, ask the faculty or others in attendance how they deal with this issue or that challenge and ask why. I think you might find that there are artists all around us who have a skill they have mastered and can share.

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