January 2019 Edition. Volume XIX

When the editor, as part of  his neurosurgical training at Johns Hopkins Hospital in Baltimore, was sent for a 6 month rotation as chief resident in neurosurgery at Baltimore City Hospitals (now the Francis Scott Key Medical Center) the Chief of Surgery was Dr. Mark Ravitch.  Dr. Ravitch was the “surgeon’s surgeon” and proud of his stewardship of the Baltimore City Hospitals training program.  Before any resident participated in surgery (under direct supervision) Dr. Ravitch would personally review the case in a preoperative group conference.  When the editor presented a case of carpal tunnel release he was told by Dr. Ravitch that this “was not a neurosurgical procedure.”  The editor’s naive inquiry as to when “the median nerve stopped being part of the nervous system” was not received well by Dr. Ravitch.

This encounter served as food for thought.  Who owns the wrist?
Is it the:

General Surgeon?
Neurosurgeon?
Orthopedic Surgeon?
Plastic Surgeon?
Hand Surgeon?
Someone Else?

No one owns the wrist.  Who is best prepared to treat the specific infirmity being addressed?  That all depends on the training, experience, skill and outcomes of the surgeon who steps up to the plate.  Who is the umpire?  The umpire is the patient.

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