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Dr. Tomaino's Blog


August 3rd, 2008
In April I had the opportunity to deliver a lecture in my community at the Chatterbox Club. I selected the topic of Innovation--and talked not only about its role in our lives visa vis commercially available products and services that have improved our lives, but also about the role of Innovation in the Upper extremity. Innovation may be risky, at the outset, when embracing the "status quo" is clearly safest. But without courageous innovators, progress would come to a halt. In medicine, the stakes are arguably highest, since "outcomes" for our patients are the most important metric, and yet the current "standard" may not be totally ideal. So, there is unquestionably a seminal role for Innovation, but--as I suggest, in an Editorial I authored for an August 2008 Journal Supplement focused on Innovation in the Upper Extremity, it must be Responsible and Relevant. My Editorial is included below.

Value-Added Innovation Should be Responsible and Relevant

Our capacity to deal with novelty is largely a function of the right side of our brain. Though traditionally described by some neuroscientists as the “inferior” hemisphere in terms of cognitive functions---because it is the left side that governs our abilities in language and basic or linear logic, it is now clear that the right hemisphere is the “exploratory” part of the brain, dedicated to discovery and learning. It has been stated that people who remain engaged in life often display an attitude of openness to new and unexpected experiences. And people who are receptive to novelty and innovation also tend to be good in a crisis, because they are open to seeing opportunity in the most challenging of situations.

As physicians, we understandably take comfort in relying on time-honored edicts and existing data. Too often, however, we may rely on information that supports only our existing instinct or point of view, and we may settle for the best available “mediocre choice”. Our desires for certainty may rule out innovative approaches, perpetuate the status quo, and slow incremental improvement in patient satisfaction and functional outcomes. The challenge is balancing the responsibility of providing “evidence-based” treatment with a desire to provide a value-added, relevant, “cutting-edge” solution.

Having an open mind--what Buddhist monks refer to as the “beginner’s mind”—reflects a willingness to step back from prior knowledge and existing conventions in order to start over and cultivate new options. In “Zen Mind, Beginner’s Mind”, Shunryu Suzuki acknowledges that “In the beginner’s mind there are many possibilities, but in the expert’s there are few.”

In this supplement, I have asked the authors –each of whom are uniquely qualified as both expert and innovator--to highlight responsible and relevant innovative treatments for thumb, wrist and elbow arthritis. I encourage you to study each article with an open mind, to follow the evidence-base as it develops, and to conscientiously include novel, value-added treatment alternatives in your armamentarium.




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