[HSF] The Great con....

[Tea Acuff]

One of the questions raised by this thread was why do we do what we do as surgeons. In answering a little more of that question I would like to shift the focus from what we do to who we are, that is, what are some of the elements that make successful surgeons. I made a comment earlier about effort over talent on which I would like follow up. Consider the following excerpt:
 
"The emerging picture from such studies is that ten thousand hours of practice is required to achieve the level of mastery associated with being a world-class expert – in anything. In study after study, of composers, basketball players, fiction writers, ice skaters, concert pianists, chess players, master criminals, and what have you, this number comes up again and again. Ten thousand hours is equivalent to roughly three hours a day or twenty hours a week, of practice over ten years. Of course, this doesn't address why some people don’t seem to get anywhere when they practice, and why some people seem to get more out of their practice sessions than others. But no one has yet found a case in which true world-class expertise was accomplished in less time. It seems that it takes the brain this long to assimilate all that it needs to know to achieve true mastery."
        From: This is Your Brain on Music by Daniel J. Levitin
Daniel J. Levitin runs the Laboratory for Musical Perception, Cognition, and Expertise at McGill University, where he holds the James McGill Chair and the Bell Chair in the Psychology of Electronic Communication. Before becoming a neuroscientist, he worked as a session musician, sound engineer, and record producer working with artists such as Stevie Wonder and Blue Oyster Cult. He has published extensively in scientific journals and music magazines such as Grammy and Billboard.
 
 
Levitin further states that this repetition matches well with the brain's reconnection process of neurons. Therefore if we may be conscious of some of what we do as experts, it not exactly like a linear link of rational logic that enables us, but an extra logical pattern of associations that we perceive and are transformed in our brains without specific grammatical logic. It becomes neuronal "logic"(my term). This in turn informs and associates with the rational logic and language constructs that we use to describe our actions and beliefs as we consciously interact with others as in my writing and your reading this paragraph. 
 
As to Ani's point about surgeon's belief in themselves regardless of the evidence, which is either true or not, the brain remembers better and associations become more important if we have emotional connection to what we believe. We tend to remember what we believe in and dismiss that which we do not or that which does not match our patterns of association. So it is important and good for Hal to believe that he is right, even if it seems unlikely or provisional to me, assuming it is also working okay for Hal. If not, which is a judgment call since past traditional thought always has some benefits, it would be better for him to look for other ways of thinking about things. He of course does precisely that when he decides that, say, robotic surgery now makes sense as do incomplete rings.
 
This begs the question of how do agnostics or skeptics like myself or Ani achieve anything if we seem to be conditional or provisional in our understanding of our techniques or solutions. I would point out to those of you that consider yourselves "non-believers" be it medicine or religion that the meaning of things is an emotive position based on the "facts" or lack there of. It is "better" to believe in something that "works" however you see it.
 
Another way (also borrowed from Levitin) to think about doctors and their theories and particularly surgeons and their surgery is to compare it to learning a language. On and off pump surgery for CABG can be thought of as different languages. We could argue whether English or Spanish is a better way to think about medicine. I would presume that some medical words don't translate well into Spanish and the English is used and visa versa. The English lexicon is apparently twice as large as the Spanish lexicon, but clearly the personal lexicon of the speaker is much more important than either extant lexicon in its importance to thinking.
 
These patterns cognitively and associations neuronally are both reinforcing or empowering and limiting. That is why, perhaps, some artists and practitioners are always playing with new combinations and approaches to stimulate new associations to build different hierarchies in their minds. It is why, or why I think,  I spend so much time off topic (OT) and tearing down and trying to rebuild categories of evidence and thinking. It builds patterns of patterns. It is also a tool to move to a possible new world and new future for those of us without the genius to imagine one de novo or the obsession to work through all of the present world's unnamed possibilities.  
 
tea