Is the Wave Worth Catching?
Written by: Dr. Michael Weiss

It was early spring. The waves were small and weak. Trying to stand on the surfboard in those conditions was like riding a bicycle slowly. I kept falling over.

Since then, I’ve ditched the big board, taken up body surfing and learned a lot more about waves.

The small, weak ones are feeble nonstarters. They’re not worth the ride. The large, powerful ones are obvious, towering forces. They also attract a crowd. You have to get on early and position yourself well. The waves in between are harder to read. I’ve found that the strength of the new wave is generally proportional to the force of the receding one. I use that as a guide when picking my ride.

But that’s when we’re talking about choosing waves.

What about when we’re evaluating new therapies, surgical procedures, management philosophies, operating systems or emerging industry trends?

When the therapy, philosophy or trend is neither small and weak (like health-care reform) nor large and powerful (managed care), when do you commit, and when should you pass?

If you’ve ever fallen off a slow-moving surfboard, you know the dangers of committing. These include expending your limited energy and resources on initiatives that may not take you very far. If you’ve ever hung back from a good, strong wave, you know the risks of passing. These include missing important or exciting opportunities that may never present themselves in quite the same way again.

This brings me to my real question. Should I offer femoral head resurfacing to my arthritis patients?

Variations of this procedure have existed for as long as I’ve been a surgeon. Femoral head resurfacing is interesting in concept, but a high complication rate eventually pushed the procedure out of the mainstream.

Now, it’s back. But is it different?

The first time around, femoral head resurfacing was like one of the small, weak waves I tried to surf as a medical student - not worth the ride. This time, refinements in our thinking, instrumentation, technique and post-surgical management may have succeeded in minimizing the complications. If that’s the case, this therapy warrants a second look.

The operative word here is "if."

My training, experience and instinct tell me that femoral head resurfacing is the same nonstarter it was 20 years ago. If I’m correct, my patients will benefit because I will have spared them exposure to unnecessary and unacceptable risk. But what if I’m wrong? I will have missed the chance to offer at least some of my patients a cutting-edge therapy.

While I can always play catch-up if improvements in femoral head resurfacing succeed in correcting the major flaws, I’ll still have to live with some regret at having caught the wave late.

Spotting opportunity early is only part of the challenge. Avoiding tsunamis is the other.

Recently, I read that silicone breast implants have been reintroduced to the market. If this is true, how can the manufacturer be sure that it won’t take another multibillion-dollar pounding this time around? Then, there are the Cox-2 inhibitors. Is it still safe to stay in the water?

And what about electronic medical records? This wave is certain to build. So when is the best time to climb on?

One of our employees, Jillian, used to be a competitive surfer. The other day, I asked her how she knows which wave to catch.

"When you eye up a wave," she answered, "you want to make sure you have time to get into position, paddle into it, pop up (from lying on your stomach or standing on your board) and drop in from the crest to the base. If it looks promising and feels right, you go for it."

The well-being of our patients and the health of our practices depend in part on our ability to know what looks promising and feels right. For me, popping up and dropping in are some of the trickier parts of being a doctor.

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