Jarrod Shapiro, DPM
Practice Perfect Editor
Assistant Professor,
Dept. of Podiatric Medicine,
Surgery & Biomechanics
College of Podiatric Medicine
Western University of
Health Sciences,
St, Pomona, CA

Chance Favors the
Prepared Mind

This past Labor Day, I had the rare chance to spend time in school with my son and wife. For the past year, my wife has been homeschooling my now 7 year-old son. We decided to homeschool due to our dissatisfaction with public school, and as a novice teacher, my wife has done an incredible job with my son, who is flourishing. During our day together, I noticed an interesting similarity between what my wife does with my 7 year-old and what I do as an academic podiatrist with adult students.

During one point, my wife was going over the daily schedule, and my son lamented they're not doing a social studies section this day (my son loves history, especially when it has to do with war). My wife's response was, "You have to be flexible. Don't worry, we'll do it another day."

Her comment struck home because I have found myself increasingly telling my students the same thing. As intelligent as my students are (yes, they are the best ones in the country), many of them lack a sense of flexibility when it comes to the unknown. For example, students on their clinical rotations are in a constant state of ignorance about what is occurring each day, week, and month.

Once they get used to a particular rotation, the month is over, and it's time to change to a new one. Finish school, and you become a resident, where you know everything that's going on, right? Wrong. All podiatric residencies require a certain number of nonpodiatric rotations, during which the resident is again in the dark. Unfortunately, the students spend a lot of effort trying to control their futures and expend a lot of energy worrying about things they have no control over.

Tonight's Premier Lecture is
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Similarly, my students, during their early didactic years, love to hear black and white answers, want to know exactly what information will be on the upcoming examinations, and want their grade results now. They loath living in limbo. They detest gray answers. They hate the unknown. I don't blame them for this attitude; I had the same opinion when I was a student. I had a challenging personal readjustment when I started my clinical rotations because I was taught every question had a right and a wrong answer.

Take, for example, a commonly debated issue, equinus. We're taught ankle equinus is defined as less than 10 degrees of dorsiflexion present when the knee is extended. Then you start reading the literature and find out the definition varies, and we don't even have a solid measurement method. So much for that. Incisions should be kept dry while sutures are present right? Not necessarily. This one varies by doctor, and no studies exist to show dry is better than allowing the foot to become wet.

In reality we are all swimming in a sea of uncertainty. "Unknown" is the rule, not the exception. Am I going to be in a car accident on the way home from work? Who knows? Will there be an earthquake in Southern California that swallows me whole? No clue. Will my surgical patient actually follow up after his surgery? Probably, but you never know.

You might be thinking, "These examples are all very good, Shapiro, but they're quite subjective. "How about if I give you a more "scientific" one? We're taught our solar system has 9 planets, right? If you've watched the news lately, you'll know we now have 8 planets. Pluto has been downgraded to a dwarf planet by the International Astronomical Union (IAU). Sorry, Pluto lovers. Did you also know that we actually have 13 planets (including the 8 planets plus 5 dwarf planets – Ceres, Haumea, Makemake, Eris, and of course, Pluto)? I just learned this in school with my son. Not so inviolate, huh? Actually, science as a human pursuit is fully cognizant of the complexity of the universe and the changing nature of our understanding of it. Change is the rule, not the exception.

My personal philosophy on this uncertainty is to simply accept that it exists, and there's very little to be done about it. Be flexible. Understand that you're just not going to know all the answers, and that the questions do not have black and white answers. Live in harmony with the unknown. I don't know what complications my occur during my next surgery, but I'm not going to lose sleep worrying about it. Better that I have a full night's sleep, so my mind is sharp and available to handle the unexpected.

For those who need to feel more in control, consider the famous quotation by Louis Pasteur, "Chance favors the prepared mind." You might not know what's going to happen, but you can be ready if it comes. Preparation requires flexibility. Granted, I don't know if I'm going to have a car accident tomorrow, but I can be prepared for one if it happens by driving carefully and having a safe car. Similarly, I can be ready for that noncompliant patient that does not show up after surgery by getting to know that patient beforehand and then not doing the procedure if I am concerned.

Either way, dealing with the unknown requires flexibility. Along with preparedness, flexibility endows us with strength to deal with the unknown. Don't' be afraid of the unknown. It's fear that paralyzes. Don't worry so much about creating rigid habits; these won't allow you to deal with the unexpected. Although you can reduce risk, you can never eliminate it. Instead, like being on a roller coaster, just go with it. Relax into the unknown and enjoy the ride.