A reflective personal essay by Professor Roger Emery, written during the COVID-19 pandemic. It traces the institutional lineages, historical figures, and patient communities that shaped his career in shoulder and elbow surgery. The central question: what truly forms a surgeon's judgment beyond formal training?
Trainees often assume their clinical judgment comes purely from textbooks and operative experience. Emery's essay makes the case that who you treat shapes how you think about treatment — a consultant practicing in a deprived multiethnic borough will develop different operative thresholds than one in a tertiary referral center.
The practical implication for consent: shoulder surgery outcomes data are dominated by registry series and enthusiast-reported results. The patient's perspective on living with a complication is almost entirely absent from this literature. When counseling patients before shoulder stabilization or reconstruction, acknowledge that your complication data may not reflect how patients actually experience those events.
The historical note on competing instability procedures is directly relevant to understanding why the Bristow-Latarjet vs. Bankart debate persists today. The field's tribalism has deep roots, not just recent controversy.
The essay also reminds trainees that Codman's work on the shoulder, published in the 1930s, is still the intellectual foundation on which modern shoulder surgery sits. A reason it remains required reading.
A reflective personal essay by Professor Roger Emery, written during the COVID-19 pandemic. It traces the institutional lineages, historical figures, and patient communities that shaped his career in shoulder and elbow surgery. The central question: what truly forms a surgeon's judgment beyond formal training?
Trainees often assume their clinical judgment comes purely from textbooks and operative experience. Emery's essay makes the case that who you treat shapes how you think about treatment — a consultant practicing in a deprived multiethnic borough will develop different operative thresholds than one in a tertiary referral center.
The practical implication for consent: shoulder surgery outcomes data are dominated by registry series and enthusiast-reported results. The patient's perspective on living with a complication is almost entirely absent from this literature. When counseling patients before shoulder stabilization or reconstruction, acknowledge that your complication data may not reflect how patients actually experience those events.
The historical note on competing instability procedures is directly relevant to understanding why the Bristow-Latarjet vs. Bankart debate persists today. The field's tribalism has deep roots, not just recent controversy.
The essay also reminds trainees that Codman's work on the shoulder, published in the 1930s, is still the intellectual foundation on which modern shoulder surgery sits. A reason it remains required reading.