By Carlos O. Gargollo, MD

I was fortunate enough to spend my fellowship training under the guidance of James B. Bennett MD, in Houston, TX. He not only taught me the fine points of Hand Surgery, but also his passion for Fly fishing, and in all these years I have found many striking similarities between them. In both you must study and practice a lot, you should be very precise and “soft handed” if you want to succeed.

We all know there are not kitchen recipes in Medicine and particularly in Surgery, but more often than not I found doctors who want to treat all patients with the same “Recipe.”

They’ll show me an X-ray (sometimes just an AP view!!!) and say this fracture is a classic Fernandez type III (Or Frykman, or….) and say “This is the ideal case for volar plating,” period.

Well……. I’ll ask whose fracture is this. Is very different, even though is a Frykman VIII, if it belongs to a young athlete who sustained a sports injury or a very ill person that fell because he suffered a stroke, is in ICU, non-dominant hand, etc….

As in Fly fishing that you must “match the hatch” (try to imitate what the fish are eating with some artificial lure); what works for any given fish one day may not work for the same species on another day, even in the same river!! This applies to patients as well.

In Hand surgery, we must “match the treatment” to the patient. Know the character of any given fracture, know how it will “behave” in the next weeks and with that information give our patients a custom treatment. Don’t treat X-rays, treat human beings.

Unfortunately, this knowledge comes after witnessing several bad treatment decisions. With some luck, they were made by other doctors, but even our own mistakes are great teachers if we are humble enough to accept and learn from them.