Yes, we orthopedic surgeons are shamans or spiritual healers. And I don’t mean the magic of surgery. There is nothing magical about the majority of our operations. We are shamans because we trick ourselves and our patients with the same principles as shamans and spiritual leaders of the past.
Firstly, Stuart Green wrote an excellent letter regarding the cost-effectiveness analysis of the FIDELITY trial published in CORR. He refers to the hypersuggestibility of the human mind when exposed to fasting. During fasting, blood sugar levels get lower, and the body becomes hypoglycemic. Hypoglycemia causes hypersuggestibility. This means that our minds are more prone to interactions with other humans and especially associated acts. Green writes that this is why shamans instructed their patients to fast before coming to the “appointment.” When a human being is in a state of hypersuggestibility, they are more likely to “benefit” from shaman “treatments.” Our body believes that words and rituals will help and make us better. And if the mind believes it, we might experience actual physical changes. Sure, this is very often just regression to the mean and the natural course of the disease.
But the very same happens in modern-day surgeries. Patients come to the operating room with hypoglycemia and witness how modern-day shamans, or “surgeon-healers” as Green writes, and their staff go through surgery “that will help.” As Green writes: “The surgeon-healer then commences a sequence of highly specialized activities to bring about the desired outcome.” Everything is set for maximal contextual effects of unproven, low-value treatments. Eventually, the patient is glad that “everything went as planned.” The benefit of a low-value treatment is ready to happen. This writing from Dr. Green is just golden!
My esteemed colleague Dr. Teemu Karjalainen held a presentation at the ICSES meeting last September. He spoke about how human sacrifice was an integral part of the Chimu culture in Peru in 1500 AD. Sacrifices were performed to end a rainy season with floods. Often, sacrifices seemed to work causally, and the Chimu people thought it was a truly efficacious act from the gods. Why did it seem to work? After a certain period of heavy rains, it is quite likely that the next day will be dry due to regression to the mean. There is an average amount of annual rain and rainy days, and after many rainy days, the dry day must come. When you are most desperate because of a rain and floods, you sacrifice even more, and it seems to work because if your rainfall from the last week is +4 SD, you are at the extreme. It is extremely likely that the next couple of days regress toward the mean, and it stops raining. Simple as that.
This is exactly similar to our sacrifice. A patient with shoulder or knee pain will see their doctor when they have exhausted their tolerance for pain and self-remedies. Usually, patients are first instructed to try some non-operative treatment, such as physiotherapy. After a “failed non-operative treatment,” we think there is an indication for subacromial decompression or meniscectomy. And sometimes it seems to help. But the observed change often has nothing to do with the surgery. Patients simply improve because of regression to the mean and the natural history of the disease. This is similar to human sacrifice in the Chimu culture. The difference is just that we are sacrificing our patients on the altar of useless surgeries, and for some, we cause only harm.