Are Textbooks Correct?
Textbooks particularly have a curious quality of the sacrosanct. My colleague Prof. Green was giving a ward round to postgraduates when he was critically questioned by a resident. The resident was well aware of this professor’s name when he blurted “but in Professor Green’s textbook it says something else, and therefore you are wrong!”
Jargoneering is one form of misdirection. The correct English term is jargonizing, but jargoneering has a better feel for me, as it relates phonologically to engineering which implies that it is a deliberate construct rather than a style or inadvertent habit. It seems to penetrate almost every aspect of the para-medical literature.
What possible usefulness does a photograph of an MR scanner have in a book about podiatric surgery? Likely it has been inserted to give the author credibility by implying “This author is sufficiently qualified, experienced, and entrenched in the medical profession to know all about MR scanners, and to prove it here is a picture”.
I have often wondered whether the authors of textbooks have actually encountered the conditions they talk about and performed the surgery which they describe. The following is an illustration from a textbook of orthopaedic surgery. I think it prudent to not give credits.
This illustration purports to explain the mechanics of a “hammered” great toe. It is nonsensical of course, because if over action of the extensor tendon was the culprit, the result would be as in my illustration below.
Matters get worse when the text describes lengthening of this tendon in order to “correct” the deformity. Since one of the prime functions of the extensor tendon is to straighten the interphalangeal joint, lengthening the tendon (and so rendering it less active) will worsen the deformity, with the risk of a toe which (dangerously) catches on the floor or carpets.
Has the author done the surgery which he advocates? If so, how is it that he does not recognize that his surgery has failed?
The next picture is an incision recommended by the same author.
Linear scars tend to contract if placed axially over a joint, and can inhibit future movement. This scar will abrade against the shoe, particularly if the clawing of the toe increases. It does not take much experience of operating on toes to recognize that transverse incisions heal better, scar better, and better meet the foundation principles of incisions. At worst a curvilinea or zig-zag would be a better compromise. Note how the incision divides the gernerative matrix of the great toe which will cause a permanent deformity of nail growth.
Like many attributions to authority it is widely believed that text books are “correct”. I often hear the comment “Medical books must be correct! It is so important that medical information is exactly right. The authorities must keep a check on things like this. Someone must be ensuring that this information is appropriate.”
Much of human belief rests with illusionary, intangible “authorities” and the etherial “someone-who-must”. It is this misplaced belief in the “higher powers” of administrations and administrators which allows damaging perpetuations of faulty practice, whether economic, societal or in healthcare.