Observational and Deductive Reasoning Ability for Plastic Surgeons

When you have eliminated all that is impossible, then whatever remains, however improbable, must be the truth. —Sir Arthur Conan Doyle

When I visited Edinburgh, I enjoyed looking around Surgeons’ Hall Museums. Among the many famous surgeons from that city, Dr. Joseph Bell (1837–1911, Fig. 1A) caught my eye. He was the model for Sherlock Holmes (Fig. 1B), the protagonist of the famous detective stories written by Sir Arthur Conan Doyle (1859–1930).

Fig. 1.

Portraits of Dr. Joseph Bell (A) and Sherlock Holmes (B). Available at: https://uploads.disquscdn.com/images/8c5097f928af9024000cad554ace64793a4ff5bbf3a4669bec12fa6a46b8c0db.png. Accessed July 15, 2019.

A letter from Doyle, a doctor as well as writer, to his teacher Dr. Bell, was displayed there. Doyle wrote, “It is most certainly to you that I owe Sherlock Holmes ... Round the centre of deduction and inference and observation which I have heard you inculcate I have tried to build up a man.” In fact, Dr. Bell not only had the medical knowledge for diagnosis but also a great skill for being able to simply look at a person and tell their trade, their place of residence, their status in life, and many things about them. Reading the displays, I realized that observational and deductive ability is very important to detectives as well as physicians.

On my way home, I was reminded of my previous article and new idea about the reasoning which a good surgeon should have. I had written that a good doctor is the physician or surgeon who solves the patients’ problem: correctly diagnoses their illness, cures them with safe evidence-based procedures, and is honest to them. A good surgeon should know how to operate, when to operate, and when not to operate.¹

In medicine, decision-making relies upon empirical knowledge as well as rational thinking to understand natural phenomena and determine causal inference.²

In the 16th and 17th centuries, empiricism was developed by Francis Bacon and John Locke, where perceptions of natural phenomena were considered the ultimate source and judge of knowledge for assessing causality.³ However, observations alone are not sufficient. Thereafter, inductive reasoning is needed to create causal inferences from observed instances to future instances.

Surgeons as well as physicians need to have an ability to see a problem and find out what steps are needed to solve that problem. When the scattered information is given to a surgeon, inductive reasoning: the ability to combine information to form conclusions is needed.

For cardiovascular surgical training, Spencer found 4 activities very helpful in the development of deductive reasoning: (1) considering imperfect results to be more educational, (2) origin of imperfect result (a. diagnosis, b. technique, c. concept), (3) creating a hypothesis consistent with the data, and (4) the process of decision-making.⁴

Like Dr. Bell, the skills of deduction and inference, the deductive reasoning, are also mandatory to plastic surgeons as well as cardiovascular surgeons. This is the ability to use general rules to find specific problems.⁵ It is applying medical principles to the specific problem of the patient, as Sherlock Holmes did.

When a female patient, accompanied by her husband, appeared in my clinic with a swollen cheek and said that she had fallen down the stairs, I needed to grasp the atmosphere between them to ensure there was reasonable doubt about the possibility of assault. Deductive reasoning was needed in my observation and diagnosis.

Thinking about the above abilities that good plastic surgeons should have, I reached the conclusion that plastic surgeons, including cosmetic surgeons, should be as scientific and logical as they can be. Also, they should be humble, because the human body is a holy dwelling place for the soul.

ACKNOWLEDGMENTS

I thank Nooraini Mydin, a journalist, for English editing. This study was supported by a grant from National Research Foundation of Korea (NRF-2020-003744).