Do What You Do Well, But Know Everything About What You Do

A man wearing round-framed glasses with a goatee sitting in a huge, motorized wheelchair is meandering through an art exhibit at the Whitney Museum in New York. The man is artist Chuck Close; the exhibit is of the work of Japanese artist Yayoi Kusama. Chuck Close is dyslexic and physically disabled; Yayoi Kusama is crazy.

Chuck Close had a spinal cord hematoma at the age of 49 and is quadriplegic, but still paints. Yayoi Kusama has voluntarily lived in a psychiatric hospital in Japan since 1977, but still paints.

Yayoi Kusama has danced naked in Central Park in the 1960s. Chuck Close recently “danced” at the Parish Art Museum Gala this summer in the Hamptons.

Different artists, yet what they have both stressed is the need to educate oneself about art before trying to create art. Each did their homework and developed their own styles. They both do what they do well, but also know everything about art itself, not just their own art.

Most of us have done our homework. Most of us treating vein disease know all about every aspect of vein disease. Some of us don’t. Some of us jumped in before we had the complete knowledge base. People are still jumping into the deep end before really knowing how to swim. This educational disconnect needs to be changed. We need to insist that everyone does what they do well, but knows everything about vein disease.

Well, almost everything. Everyone treating vein disease needs to attain global knowledge before making choices as to what type of vein disease he or she wants to treat.

There is a reason why it takes five to seven years to become a vascular surgeon. A global knowledge base needs to be incorporated into the procedural aspect of the specialty. I am a vascular surgeon. I am sure some ENT surgeon could teach me how to place tubes into a child’s ear or to remove someone’s tonsils. Yet I would have no knowledge base as to when to perform these procedures, when not to perform these procedures, or when to pursue alternative management choices. Sounds a lot like vein disease treatment.

The problem we have created is that most vein procedures are relatively simple. The problem we need to address is how to modify and focus our educational programs so that everyone treating vein disease realizes that it is not acceptable for one to be satisfied with the minimal amount of knowledge necessary just so that a procedure can be done. We need educational programs that stress a comprehensive knowledge base before a procedural base. These are programs for the “beginner.” We as educators need to emphasize knowledge first. Intensive procedural training is not the issue; intensive knowledge training is the issue for many of those who are just starting.

Many practitioners treating vein disease have been in a medical or surgical practice before learning the entirely new discipline of vein treatment. Many of the earlier educational courses were procedure oriented with a cursory discussion of the disease process. They were learning how to do laser ablation and not learning about vein disease and where laser ablation fits in.

We (industry, venous oriented societies, physician educators) need to construct our courses for new physicians who want to become vein specialists from the disease oriented approach and not the procedure oriented approach.

A general surgeon is not first taught how to remove a gall bladder. First he is taught about biliary disease and management options, and then he learns how to remove a gall bladder.

Perhaps learning about a disease process is the “boredom” that Yayoi Kusama mentions, but it is important in the life of the vein specialist. Many physicians skip the “boredom” (comprehensive knowledge base) and go right for the “sunlight” (the procedure).

The description of most educational vein courses sound pretty much the same. The aspiring vein specialist should seek out courses that are more heavily weighted towards vein knowledge and not vein procedures. If those new to the field attend courses that highlight the “how” and not the “when” or “why,” they will have trouble correctly caring for patients with vein disease.

When the vein specialist has a comprehensive knowledge base and some procedural experience, the next level of educational vein courses would be appropriate. Many already exist. Courses which address specific issues of vein disease: the American Venous Forum’s Annual Meeting, which may highlight pelvic venous disease; the American College of Phlebology’s Annual Meeting, which has a Big Veins course; the Society of Interventional Radiology’s Annual meeting, the International Vein Congress meeting session which discussed credentialing and its inherent issues or the Expert Venous Management course addressing the advanced care of complex venous disease, just to name a few. There are others.

Vein specialists are not learning disabled (well, most of us aren’t), but each one of us needs to understand what drove us to treat vein disease. We need to choose what aspects of vein disease we want to treat. We can only make those choices by first learning about all aspects of vein disease, and then we can decide what our “style” will be.

Yayoi Kusama and Chuck Close developed completely different artistic styles, yet they first understood art history and the discipline of art before they embarked on their signature style.

The vein specialist, too, must first learn and understand art before embarking on his or her signature style.


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