Practice Makes Perfect

How many times have you heard the saying above, especially when you were growing up? I heard it so many times I got sick of it. Somehow my idea of 15 minutes of piano practice and 2 hours of baseball practice did not seem to satisfy my mother’s idea of making my activities perfect! I think everyone would agree that to become proficient at a task does require doing it and doing it a lot. But how much is enough? During my tennis days I read a book by International Tennis Hall of Fame Master Player Bill Tilden who said one must play 5 sets of competitive tennis a day, 5 days a week for 7 years to develop a “reliable” forehand and backhand.¹ My heart sunk—I could never play that much tennis in my junior career. Interestingly, as my college tennis career was coming to a close, I realized that I had played just about that much tennis, and my strokes were reasonably “reliable.” 

In his book, Outliers: The Story of Success, Malcolm Gladwell examines what makes people outstanding in their fields.² In examining very successful people, this main question was asked: “How many hours have you practiced?” He found that truly successful people practiced their skill, no matter what it was, “purposefully and single-mindedly… with the intent to get better.”³ The magic number of hours of practice to become truly proficient and master a task is 10,000 hours.⁴ That startling number of hours of practice seems to hold true for mastering most any endeavor including music, sports, math, science, or even computers. It seems the brain requires this much repetition to achieve mastery of a task or subject.

Since this information has been known at least since 2008, it seems strange to me that regulations requiring resident physicians—especially surgeons, who are trying to master some of the most complex tasks a human can perform—should be limited in the number of hours they can work. Do you want an internist listening to your heart with a stethoscope and trying to make a diagnosis of your heart condition if he or she has only spent 1 or 2 hours listening to hearts? Personally, I want the one who has spent 10,000 hours listening to hearts deciding my treatment. Would you want a surgeon operating on you if he or she had only done a few hundred hours of operations? Again, I want the one who has spent 10,000 hours or more operating on patients doing many types of operations. Is it any wonder we are seeing more and more complications and bad outcomes? The other side of this coin is that if these physicians have not mastered the skills required to be good doctors, they will order more tests to try to fill their skill gap; thus, the cost of medicine rises. Does that sound familiar?

What about wound care? Are you sufficiently skilled in wound care to treat your patients appropriately and get good outcomes? The 10,000 hours of study and work to gain proficiency in treating wounds applies to all of us as well. As I have mentioned before, when I started treating wounds full time, despite my general and vascular surgery training, it took me 3 years of intensive study to learn enough to feel comfortable treating the patients I was seeing in the wound center. I assure you I still do not know near enough about wounds. Learning how to treat patients with wounds is an ongoing process. Hardly a day goes by that I don’t try to read or learn something that will help me be a better wound care physician.

A young reporter asked Pablo Casals on his 95th birthday, “Mr. Casals, you are 95 and the greatest cellist that ever lived. Why do you still practice 6 hours a day?” Mr. Casals answered, “Because I think I’m making progress.”

I hope you are making progress toward your 10,000 hours for proficiency in wound care.