By Albert R. Harris, MD

I must admit that being asked to contribute something to ASSH Perspectives came as a bit of a surprise.  As a community plastic surgeon whose practice is only about one third hand surgery, I wondered what clinical pearl I could possibly offer the hand community.   What I decided upon is really more advice than clinical pearl. I have had the opportunity to work with a number of younger surgeons, and I find that I am often advising them similarly.  I find myself preaching patience.

While there are problems that require urgent or emergent surgery, not all do, and many will benefit from a conservative approach.  As younger surgeons, the dictum “to cut is to cure” is very prominent in our minds; we spend our years learning how to solve problems with an operation.  Our patients often see surgery as a magical solution to what ails them.  Patients will come with their MRI findings and their google search results imploring you to fix them.  Whether it’s vague ulnar sided wrist pain, a mildly displaced fracture that is a month out from injury, or a workman’s compensation case, there will be pressure to operate.  The pressure may be internal, as is the case sometimes with your own less than perfect post-operative result.  My advice is to be patient.  Do not be afraid to immobilize.  Do not be afraid to wait to see how functional the patient is once they have had time to heal.  Many things improve with time.  Pressure will come from a variety of places; we all want instant gratification.  Be patient.

Consultant, Plastic Surgery
Mayo Clinic Health System