Chuck Burton, my most important clinical mentor, died in late 2020. He’s been much on my mind as a celebration of life on September 12th approaches.
Chuck was a neurosurgeon who specialized in restorative spine surgery. He helped thousands of patients by performing surgery, but probably helped even more by refusing to operate.
Chuck was a disciple of I.M. Tarlov, the famous neurosurgeon and author of The Principle of Parsimony in Medicine. The principle, also known as Occam’s razor, takes many forms including this version on the back of Chuck’s business card
And “less” often meant counseling sometimes desperate patients that they were unlikely to benefit from surgery.
Chuck, more than any other physician who I’ve met, practiced primum non nocere (first, do no harm). This began early in his career and intensified over time as he saw the actual harms of surgery in all of the second opinions that he rendered.
A few other dictums (and here):
- Osler’s Rule: Treat diseases, not symptoms
- Gabel’s Rule: Don’t just do something; stand there
- Holmes’ Rule: Surgery is guilty until proven innocent
where the latter means that the clinical trials need to be compelling and patient selection must be meticulous.
Chuck has left a void in my life—but that void means that I had the opportunity* to be mentored by a great physician and remarkable human being. He’ll live on in the care that I deliver and the students and residents who I mentor. ✸
—
* I owe that opportunity to Bob Moravec, M.D., former medical director at St. Joseph’s Hospital in St. Paul Minn. It’s a great story and post for another day.