Trip Report from Dr Lim Yi-Jia

This year's 20th Congress of the European Society of Shoulder and Elbow Surgeons was held in Athens from 20th to 23rd September 2006. My visit here was made possible with SingHealth’s kind sponsorship.

It was apt for the meeting to be held here. Afterall, Athens is the birthplace of not only modern thinking and civilization; scientific medicine also came into existence in the person of Hippocrates.

Touching down, it was apparent how far we have come since antiquity in our progress in science, medicine, and technology. Athens is where the ancient ruins and all things modern co-exist in harmony. However, in the course of the congress, it also became quite clear how much there is still that we do not know or understand, and it was obvious, too, that the Art of Medicine takes off from where the Science of Medicine leaves. More often than not, both Art and Science are so tightly intermingled as we do not live in a controlled environment, and disease and injury do not present in a controlled fashion in humans of different shapes, sizes, and psychology, and who are all of body, mind, and soul.

My objective in coming was three-fold- to rest my tired mind & body, to recollect my thoughts & re-evaluate, and to review the latest advances in shoulder and elbow surgery.

During the congress, there was heavy emphasis on shoulder arthroplasty. In particular, reverse shoulder arthroplasty. The 10 year results are now just emerging, and the problems of glenoid component loosening, scapular notching, and instability were clearly emphasized. Modification of technical and implants have evolved to deal with these problems. However, I could also see how clear indications for use are required in newly-emerging implants despite the pressure from the industry.  Pascal Boileau, one of the foremost European shoulder surgeon after Gilles Walch, was ready to point this out as well.

There was less time allocated to elbow problems. However, in one symposium on lateral epicondylitis, it was surprising that surgeons on both sides of the atlantic confessed how little we still really understand of the all too common 'tennis elbow', and there is still no fail safe method of treatment. The only consolation was that all concurred that, happily enough, the condition is often self-limiting. Far less total amount of research on such and similar diseases, compared to those of disease and injury requiring implants of variable nature. This reflects how much lack of understanding we have on some common conditions, and may also demonstrate somewhat how funding from the Industry dictates the direction and type of research.

While I was there listening to the various speakers, ranging from residents, heads of departments,and the Presidents of both the American and European Societies, I could not help but think of the challenges in a changing world faced by the next generation of doctors like myself. While we face increasingly demanding patients, we must yet remain compassionate, and competent clinicians, updated and constantly improving in skills as surgeons, and cognizant of the latest advances. In the face of such challenges in clinical practice, passion and patience is required in our research as well. In clinical practice, balance must sought in our sacrifice for our patients versus personal needs and goals. In research, we have to balance between competing to find the Holy Grail, and yet conduct ethical, patient-centered, clinically relevant research. Not to forget, we also need to manage our time between work, personal study and reflection, family, and religious commitments where present.

While we continue in these struggles daily, in my life as a surgeon, I believe that good patient care and well-indicated, well-timed, and well-performed surgery must remain central. While we do what we can as humans, Dr Lafosse, one of France’s leading arthroscopic shoulder surgeons from Nancy, kindly reminded me that "we can perform the best surgery, but it is God who heals".

Even as I now return to my hectic work schedule, I have to remind myself that we may not always be the best clinician or surgeon, but we can do our best, we may not be able to cure, but we can be kind, we may not be the most brilliant researcher, but we can be an honest one. And being all this is not easy when clinics are packed, operating schedules are tight, and multi-tasking is required daily - and the dear doctor is seldom quite well rested sufficiently. But with God's help, we might just make it through.