Sinister SurgeryBritish Medical Journal (2005)
It is 40 years since Sir Theodore Fox reflected on a lifetime in medical journalism. He distinguished between the 'recorder' and 'newspaper' functions of medical publications.1 Whereas the former provide an archive of facts for future reference, the latter may have greater impact because they shape knowledge and opinion. It would therefore be disappointing if the British Medical Journal should apply lower standards to its newspaper role. Marian Annett has studied hand preference for 40 years.2 This work stands in marked contrast to the survey on which Roger Dobson's article regarding left-handed surgeons was based.3 It is very unlikely that this web-based uncontrolled survey would have passed even the first round of selection as a scientific paper for this Journal.4 Its impact with its erroneous advice is now greater than if it were published as a scientific paper. Even worse, the author of the Journal's news article has uncritically incorporated poorly substantiated claims that left-handed surgeons are clumsy, prone to error and injury. An unfixable flaw of an uncontrolled survey is that is that the questions are inevitably leading. Web-based data collection is open to considerable abuse. At best this survey merely states that it is difficult to open right-handed ratchet instruments in the left hand. Hand preference of the holder was not tested and probably doesn't matter. Not much of a news story there. The paper also discusses the role of ipsilateral eye dominance in surgery. Even though I have spent quite some time working in surgery, I must admit that I don't know any one-eyed surgeons and I have never heard of a one-handed surgeon. Left-handedness is prevalent in 10% of the general population but is more common among surgeons. Even the authors of the survey managed to find 68 left-handed surgeons in New York. There are no studies to determine if hand preference alters facility with surgery. Nor are there studies to suggest the best method to train and use the non- dominant hand. Marian Annett's theory of inheritance of handedness suggests that it is right-hand dominance that is genetically determined. For non-inheritors of the right-shift gene, hand dominance or ambidexterity occurs by chance and may be environmentally dependent. Most, if not all, surgical maneuvers require two hands. Non-inheritors of the right-shift gene may well have an easier time training both hands to oblige. The survey found 31% of the left-handed surgeons to be ambidextrous, an astounding number compared to the general population. As a left-handed surgical mentor, I advise use of right-handed instruments by the right hand and that the procedure be learned as a two-handed maneuver. When challenged by a patient who observes the surgeon writing with the left hand, I suggest to the surgical trainee that they reassure the patient by offering to operate with both hands.
- medical journalism,
- surgical error,
- surgical education,
- medical education,
- surgical mentor.
Publication DateJanuary 5, 2005
Citation InformationMcAlister VC. Sinister Surgery [letter] BMJ. Jan 2005 http://www.bmj.com/content/330/7481/10.7?tab=responses (accessed - insert date)