We need to get better in contrafactual thinking

This probably also applies to other medical subspecialties, but we orthopaedic surgeons are very bad at contrafactual thinking. For the sake of our patients, we need to understand better a hypothetical situation in which we could have done otherwise. Once again, something like this was written:

Extremely medialized repair of large and massive tears not able to be repaired using conventional techniques led to improved clinical outcomes compared to preoperative conditions.

This was from a recent study published in the Arthroscopy (https://www.arthroscopyjournal.org/article/S0749-8063(23)00306-7/fulltext). This is a millionth example that we cannot justify these treatments in our patients if we have no comparative data. Patients seek our help when they are at their worst. It is very well that chronic conditions such as a degenerative rotator cuff tear may improve during a simple act of watchful waiting.

From this study we can only conclude that there was an effect. An effect in time. It is impossible to conclude anything about the effectiveness of this procedure.

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