I have been on vacation this week visiting family and friends in Los Angeles.  We have family here with whom we remain close with despite the distance.  We have friends here as well because 20 years ago we lived here for over a year while I did a fellowship in Joint Replacement.  To become an Orthopedic Surgeon you spend 4 years in college, 4 years in medical school, 1 year of internship and 4 years of residency.  Many of us go on to study an additional year in an area of specialization; this year is called a Fellowship.  I spent mine in Los Angeles with Dr. Larry Dorr.

The teaching of medicine has changed somewhat over the years.  In medical school the first two years are still spent learning the basic medical sciences in books and labs.  Anatomy, physiology, biochemistry are the building blocks upon which further education is layered.  In the later clinical years, learning and teaching have become “evidence based”, rather than experience based, that is you have to be able to support your decisions and treatments with literature evidence.  In my educational days the ward attendings, the senior doctors who supervise the residents and students, would almost always start a discussion with the phrase “In my experience…” Now that statement can be “The Cochrane guidelines state…”.   This works well in Internal Medicine and to a degree in clinical surgery, however when it comes to the OR there is no substitute for hands on experience.  This where Larry Dorr made me the surgeon I am today.

Different people think in different ways.  In chess, some players analyze their moves by trying to figure all the possible outcomes of each possible move, and then choose the best alternative.  Others use pattern recognition.  That is they look at the board and think “I have seen this before” and base their decision on the known outcome of that previous similar situation.  The best players use a combination of both.  As novices play more games and study other games they recognize more patterns.  In speed chess there is a clock as well; you cannot spend forever pondering one move.  You must move on. Surgery is similar.  You start with basic book knowledge and memorized techniques. You then spend years assisting and observing and then you perform surgeries while being observed.,. Ultimately you need to be able to assess a situation and react quickly on your own.

That year in Los Angeles I assisted Dr Dorr with over 700 surgeries.  In the beginning I watched.  Then I began to do more and Dr. Dorr watched. When I got in trouble he would take over and bail us out. I would be lying to say that when he did take over Dr. Dorr was gracious or supportive.  Usually there was a look and a comment that made me feel two feet tall.  At the end of the day I was expecting to be told I should look for another profession, instead Dr. Dorr would invite my wife and I out to dinner on the spur of the moment.  We would talk with his wife about children and politics, but never surgery.  It was not until years later that I realized his annoyance was not entirely with me but with himself as well, for not preparing me better. Though he was probably at least a little annoyed with me too.

Dr Dorr also taught me about people. Surgery is a team sport. You cannot do it alone and if your think you can you are bound for failure. Just as he nurtured me and boosted my spirits when I was most dejected, he knew how to take care of his team. He expected nothing less than complete dedication and perfection from everyone he worked with, and led by his own example. In exchange for their dedication, those who worked with him were treated as family. Dr. Dorr hosted several events a year to thank his team for their hard work. When working for Larry Dorr you never felt unappreciated.

This is beginning to sound a bit like and obituary and it most certainly is not. The day I spent with Dr Dorr he did 5 surgeries. I saw that he did some things differently, some the same. He is developing a computer navigation system, not unlike a GPS for surgery. This system offers great promise in increasing the precision of joint replacement surgery.  I will incorporate some of the changes I saw into my technique, and hope to utilize the computer system here at Coney Island in the near future. I also saw the complete dedication of Dr Dorr to his patients,and the staff to Dr. Dorr.  Some things do not change.  

            Luckily I will have the chance to see Larry Dorr soon at a national meeting next month. We have an alumni group of former fellows that will be gathering a day prior to the meeting to teach and learn from each other and Dr. Dorr. We had our first such meeting 19 years ago. It was a much smaller group then, and some us got together and purchased a bottle of fine wine to give to Dr. Dorr in appreciation.  As I left him this week he mentioned that he has kept that bottle all this time and will bring it to the meeting for us to drink and enjoy.  He thinks it may have gotten better with age, I know it has.

Jeffrey Passick, M.D.

Dr. Passick is the Director of Orthopedics at Coney Island Hospital. He can be contacted at 718-616-3440

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