I hope to burst your bubble with this month’s epistle. Yeah, that’s right. You are living in a bubble, practicing your art within a bubble and, for that matter, you may be living your life in a bubble. If I can break your bubble, this may lead to a new bubble, which may be a little larger and even more comfortable than the one you are in right now.
Why do we have “bubbles”? Living in a bubble gives us comfort and probably allows us to function at higher behavioral and functional skill levels. Think about it. Bubbles are comforting. You go out of your way every day to insulate your bubble. You drive that same way to work every morning, stop at the same Starbucks on the way, shop at the same stores and order the same menu item every time you go to that favorite restaurant.
Similarly, in the operating room, you may perform in a very similar manner every time. This gives us the ability to control things and we all want control. Control is good, especially in the intraoperative environment. By flourishing in our bubbles, we exercise control by decreasing the variables or at least limiting the variables to a smaller degree or managing them better. How many variables are there in the surgical equation? Incalculable. Blow one variable and maybe the whole equation sinks.
Most of our bubble is experiential (and therefore really not that well constructed). You might say, “I’m not going to do that again. Mrs. Jones took forever to heal with that new dressing I tried. I am not using that one again.” As a surgeon, you could have done 100 of the same operations and the first 96 turned out fantastic, but the last four had a suboptimal outcome. So what does the surgeon do?
“This procedure stinks,” you might say. “I am changing my game. I am going to get me that new device I saw in that journal the other day. That will change it.” The surgeon brain has horrible recall and cannot remember the first 96 that went great. No, sir, the only thing that counts is that the last four performed really had a subpar outcome. For that matter, I would proffer that the “surgeon” brain is so flawed that you can only think quickly of a name or two of a patient from all the patients that you operated on more than five years ago who happened to have had a less than desirable outcome. Try calling up 20 with a great result and no complication. We simply are marred by the negatives and expect the positive. So what will the surgeon’s brain remember?
Humans live in a bubble and the majority of surgeons are human most of the time when they are not trying to do the “God” thing. Accordingly, surgeons tend to practice in a bubble. By occasionally breaking our bubbles and stepping out to a new level of comfort and control, we may be able to expand our bubbles and provide greater care for our patients. Let’s face it. Some of our patients do not get better because our bubble is too constrained to allow for a proper diagnosis and appropriately matched treatment. I know it is dangerous to the psyche but let us try and see if we can break the bubble’s film. Then you will have some new experiential feedback to control more or different variables.
“OK, bubble boy,” you ask, “how do I go about breaking my surgical bubble?”
“Well, that’s not so easy,” replies the bubble breaker. “You have to step out of your comfort zone, which is difficult, and you might have to ask your ego a few simple but difficult questions.”
“Hey, ego! Can you let me do a couple of things?” (Of course, this is all silent mental chatter in your brain because if you do it out loud and someone hears you, you might have an issue.)
Now your ego comes back with a loud and deep, almost biblical sounding voice (maybe with a Charlton Heston intonation): “Are you kidding me?” I’m the ego. I don’t like answering questions but all right, go ahead if you must.”
With a gulp in your throat, you fire back: “Well, ego, this bubble breaker came along and intimated that I might be able to be a better surgeon if I were able to ask you a couple of questions. That would allow me to break out of the comfort zone I am in now so my individual surgical universe could be expanded and this could maybe help me help more patients.”
Your ego is now twisting you like the taffy maker at a county carnival. “Break your bubble? Nonsense. Look where you are now,” says your ego. “You are smart, you are well trained and you have some really cool gadgets. Not to mention the really expensive house and car, high alimony payments and the fact that everybody respects you (except the ex-spouse who does respect that the payments are on time). So as your ego, I am telling you that you really do not need to ask me any questions.”
You are now in a mental fistfight with your conscious cortical thought processes fighting that guerilla subconscious egocentric counter-hero who lives so deep in your core you could not find him even with the best GPS system. You muster the courage.
“I’m asking you anyway, ‘ego man’ (ego man can live in women as well but when writing this, “ego woman” didn’t sound right). What would be so wrong if I called a colleague and told him I want to have him mentor me because I do not know some things and perhaps he could assist me with some new techniques?” The mental taffy is now so twisted that all the different colors have congealed into a very ugly indefinable one, which cannot be found even in the largest Crayola box.
Now ego man has morphed into a force that oozes out of every pore in your being. “You know everything, stupid (hey, if he is calling me stupid maybe I do not know everything?). What can you learn from him?”
Well, here is what I have found out about comfort zones and breaking your own bubble. First of all, it is hard to do but comfort zones lead to contraction of our bubbles while the podiatric profession has lead to wild, unimagined expansion.
If you don’t believe that, look at how many subspecialties there are now in our “subspecialty.” The body of knowledge within our profession is so expansive now that there is no way you can even get to a level where you can really be an expert in all podiatric surgery. Can you really be a world-class expert, with world class skill in wound care, biomechanics, diabetic salvage surgery, rearfoot reconstruction, peripheral nerve surgery, forefoot reconstruction, arthroscopic surgery, and on and on?
“No” is the simple and complete answer. If you think the answer is yes and disagree, you might need to call in some reinforcements to fight your ego man.
Malcolm Gladwell poignantly points this out in his excellent book Outliers: The Story of Success. Essentially, he boils it down to the simple fact that to be great and “world class” at something, you need to spend at least 10,000 hours of working on a specialty with a honed concentrated focus on whatever passion it is that you want to be world-class at doing. You have to work hard not only on what you are already good at but be dedicated enough to work on what is not so good.
Now consider this bubble breaking nugget. There is nothing more academically appealing than when someone who is esteemed and respected as a thought leader for some particular area of excellence says: “I don’t know but I will try to find out for you.” Take your work seriously but be able to laugh at yourself. Acknowledge quickly how you do not know something rather than trying to pretend you do. See how quickly the fistfight ends with ego man bruised and bloodied into a tranquil pussycat. This is truly liberating stuff that will break the constraining bubble and allow the genesis of a newer, bigger and better bubble.
I encourage you to read different journals, go to different meetings in different specialties or within our specialty, but something you have not been to before. The Association of Extremity Nerve Surgeons (AENS) is one for example. “Just do it” as Nike says. Check out something different. Go to a pain management meeting or a dermatology meeting for example.
Just do something different. Learning to break the bubble will allow your new bubble to be that much bigger. (Please check with your state board though because some are very closed minded with the rule that it must be an accredited podiatric meeting in order for you to be credited with CMEs. I guess if you went to a dermatology meeting and actually learned something, it would not count because apparently there is no skin on the lower extremity.
Happy learning and bubble breaking.