You have all begun your professional career, have experienced some of the vicissitudes of assuming total responsibility for a patient, and are relying on your background to guide you as an orthopaedist. As one embarks on this journey, what are the essentials that contribute to success? What can you add to the mix to carry you forward?
What are some of the critical ingredients? First and foremost, an obvious critical ingredient for all is knowledge. Your current knowledge base is an accumulation of many, many years of education, beginning as a child, following a course throughout the educational process, and culminating in an orthopaedic residency. This lengthy process has provided you with a large amount of theoretical and practical knowledge. You have sharpened your ability to solve problems, to approach diagnostic dilemmas, and to function under difficult circumstances. During this period of time, there has been a gradual evolution toward professionalization. Remember how you looked and behaved as a first-year medical student? Part of the professionalization process has been the necessity to develop both intellectual and emotional discipline. This allows one to practice orthopaedics in an effective, competent manner. Your knowledge accumulation has become discipline-specific. You are beginning to tune in to outcome measures and evidence-based medical practice.
An obvious corollary of the critical ingredient of knowledge is that of a commitment to continuing your quest for knowledge. Osler stated: "Education is a life long process, in which the student can only make a beginning during his college course."3 You must develop a lifelong passion for maintaining and increasing your knowledge and skills. These will subsequently be translated into ever-improving patient care.
The American Academy of Orthopaedic Surgeons provides important opportunities to learn in many forms—continuing medical education, home study, a comprehensive review journal, and access to an orthopaedic learning center. So we find ourselves with the necessity of continuing to upgrade our knowledge base.
On a personal note, reflecting on a career as an orthopaedist that extended over thirty years, perhaps the most important component was the relentless pursuit of increasing my knowledge base—late nights, early mornings. Remember Winston Churchill's words: "Only the mediocre are always at their best."1
A second critical ingredient is skill—defined as the ability, coming from one's knowledge, practice, and aptitude, to do something well. Skill involves dexterity and expertness. What are some of the necessary skills? It's obvious that you have learned the skill of data collection—namely, listening to your patient, performing physical examination, and using the laboratory and imaging techniques to arrive at the appropriate diagnosis. Continue to refine and hone these skills.
It is critical to develop certain motor skills, as they are the cornerstones for attaining proficiency in surgery. It is necessary to practice and practice and practice to improve your motor skills—use all available materials, including cadavers.
To interject a point, the future may well hold the opportunity to develop motor and procedural skills in a virtual operating-room setting. This is under development at Penn State's College of Medicine—an exciting program!
Another skill includes the ability to manage huge amounts of information—to embrace the digital age. The diagnostic and technological tools now available to you as an orthopaedist are nothing short of remarkable. New procedures have been introduced, treatments are different, change is everywhere—and you must keep up! The technological revolution has led us to know how to do things perhaps more than knowing why. One must always guard against doing what is possible medically rather than what is reasonable. It is clear that, in the current health-care environment, you will need to ration the use of certain diagnostic procedures, to be on the lookout for the inappropriate use of therapeutic procedures, and to guard against creating an environment where patients have heightened, unrealistic societal or personal expectations, or both, believing that science has progressed to the point of being able to cure all diseases or conditions, especially theirs.
To the critical ingredients of knowledge and skill must be added those of values and attitudes. Essential to one's success is a commitment to excellence and to the public that we serve. It is important to carry into practice the theme with which most of you began medical school—namely, service to others and the recognition of the central position of the patient; one must be compassionate as well as knowledgeable. Compassion should not be achieved at the expense of downgrading science or technology. One does not wish to be cared for or operated on by a compassionate ignoramus.
It is crystal clear that one's integrity has to be maintained throughout one's professional life. Losing that results in an erosion of public confidence and a breakdown of the patient-physician relationship. In addition to attention to detail, it is critical to be able to function within a health-care team in a collaborative manner. The era of the "geheimrat" physician-leader is over.
In order to develop one's knowledge and skills and some of the values and attitudes viewed as critical ingredients, perseverance takes rank. A favorite Welsh proverb of mine is: "Talent without perseverance is barren."2
Medicine is both exciting and demanding. It remains a profession in which one can make a difference. We have talked about some of the qualities of a humanist, including compassion, integrity, and service to others. These, in conjunction with the essential ingredients of knowledge and skill, lead to an orthopaedist who really can make a difference. Never lose sight of Peabody's exhortation: "The secret of the care of the patient is in caring for the patient."4
Obviously, there are many more critical ingredients. There are personal characteristics that must be considered. Many of these have been already developed in each and every one of you—stamina and the ability to work hard have been part of your life. The stage has been set for you to embark on a challenging and rewarding career in orthopaedics, never failing to use the critical ingredients: knowledge, skill, values, and attitudes.
Before concluding, let me add the overarching factor—the mother of all critical ingredients—the central link—the very core—the factor that is germane to all learning: it is the parachute factor.
The parachute factor is the true philosopher's stone, which transmutes all of the base metal of humanity into gold. It will make the bright person brilliant and the brilliant steady. To the youth it brings hope; to the middle-aged, confidence; to the aged, repose. It has been the very core of advances in science, medicine, the arts, and the humanities during the past many centuries. Hippocrates made it the basis of observation. It underlies scientific discovery through the ages as humans have attempted to discover the relationship of the heavens to the planet, the elusive and mysterious dimensions of time, the vast and colorful arrangement of plants and animals, the intricate workings of one's own body, the surprising variety of human societies past and present. Not only has the parachute factor been the touchstone of progress, it has become the measure of success in everyday life. It has been responsible for your early successes.
What is the parachute factor? You may have guessed the answer. It is an open mind! Why the parachute factor? Because minds, like parachutes, only function when open. I repeat: minds, like parachutes, only function when open.
So, to conclude: given these critical ingredients, you will be able to shape your own performance, to make a difference to your patient, and to influence your community as well as your profession as we enter the next millennium.
Finally, to the class of 1997: were I possessed of Fortunatus's lucky amulet to generate flights of fancy, I would wish for each one of you preservation of the sparkling ferment of the springtime of life throughout your career, a spirit of sustained perseverance at your tasks, and an enduring fidelity to the critical ingredients so necessary for the practice of medicine.
Welcome to The American Academy of Orthopaedic Surgeons.
†The Milton S. Hershey Medical Center, The Pennsylvania State University, 500 University Drive, P.O. Box 850, Hershey, Pennsylvania 17033-0850.