Save us Jack Ramsay!

In 1976, when the NBA season started, the Portland Trail Blazers were not considered contenders at all. The team won the championship, and with a player like Bill Walton on the roster, the future was bright. Then Mr Walton had foot issues. Injuries sidelined him and he was never the same player again.

In 1984 Sam Bowie was drafted by the Portland Trail Blazers. Famously, he was drafted at position two, one selection prior to the GOAT, Michael Jordan. Sam Bowie soon had a fractured femur, and never developed into a franchise cornerstone. 

The draft of 2007 the 'Zers selected Greg Oden, ahead of Kevin Durant. Greg Oden showed us enough flashes of brilliance to know what we missed out on. He had leg injuries too, of various kinds. 

Three of the most impactful decisions the Portland franchise have made concerning drafting players resulted, ultimately, much too short of success secondary to lower leg injuries. It feels like the franchise has been snakebit, but each decision can be defended by being the right one with the information available at that time. 

For the sake of discussion, lets suppose that the Trail Blazers somehow get the number one pick next year, and while I have no idea what kind of draft class next year is shaping up to be, let us also say that their is a dominant big man who pundits predict will be a literal game-changer in his career, just like all the previous big-men that the franchise had put faith in. Perhaps there is another smaller player, a wing or a guard who is undeniably talented -- what should they do? 

It is painful to have past choices analyzed; decisions made put into question. And this is exactly what medicine is -- a constant process of evaluation of decisions made. At this point in my career I still have an external observer and evaluator, with the ultimate goal being a proficient and effective process of self-evaluation and recognition when different courses of action are indicated. The field of medicine requires this, yes, because aspirations are for continued harm reduction through past experience. Well, I would argue that all fields should require this, and furthermore, all of our lives, in some way, at least, have this as a underlying, ongoing if not at times, subconscious process.

Death of Ego

As mentioned above, the painful aspect of this is related to our insecurity. I believe everyone has, either hidden away or not, an aspect of self-doubt. A physician can be full of experience and the wisdom that stems from a competent analyzation and course corrections and this, in conjunction with a diligent and attentive habit of knowing evidence based medicine publications and still wonder if the right decision was made. This is normal, in my opinion. 

In medical school there is a story often told about horses and zebras and hearing their respective hoofbeats. When hearing hoofbeats, knowing which is more common and expected is important to keep in mind. If I am in California, and not in the Zebra area of the San Diego zoo, for example, I should expect the sound of hoofbeats to belong to the horse, not a zebra. While this seems exceedingly obvious, one must know that medical education, especially when standardized tests are a way too common tool of assessment, that knowing diseases that represent zebras are most frequently tested topics. Part of this is that knowing a disease process, the etiology, the symptoms, diagnostic tools and management of a pathology is often indicative of valuable testable topics in that physiology, anatomy and their consequence in the health of a given human. I work with medical students on a regular basis and see the process of moving from lecture hall to hospital on a regular basis. Differential diagnoses provided by students, either in discussion or associated with a new admission in the ED have a higher 'zebra-to-horse' ratio than my own. At this point in my career as a resident physician, I know the type of hoofbeats and what they are associated with quite well. Through this process of forming a wide, but appropriate differential when working a new patient up the clinician can build their experience and acumen as a diagnostician and become better with every new patient encounter. 

Remember this: woe to those who never consider a zebra's presence. 

Something that may seem like a slam-dunk community acquired pneumonia can be a pulmonary embolism. I've already seen it happen multiple times. Granted, a PE should not be a zebra, no matter if you live in zebra-land or horse-land. 

Did the Blazer's decisions through the decades represent someone who is suspecting zebras in the land of horses? I don't know. And the comparison that contrasts the draft decisions of an NBA franchise with the decisions that comprise medical management breaks down fairly quickly in that there is no going back on a draft decision; even if the player is traded you can never undo the decision to draft a player. In medicine, we frequently order tests to ascertain the likelihood of certain maladies and we do this at the same time. The real question though, and where the analogy serves us well, is the question of whether we will allow our psyches and egos the luxury of seeing every decision made as independent of the last. What I mean is that, while it may seem that a curse has been placed on the careers of big-men associated with the Blazers I maintain that this is ridiculous and don't ascribe to the superstitions of willingly ignorant humanity. Each decision to draft Bill Walton, Sam Bowie, and then Greg Oden is defendable. Overwhelming evidence exists to support drafting Sam Bowie versus Michale Jordan and Oden before Durant -- and yes, evidence compiled since the draft day now proves them to be the absolute wrong choice, but this is only significant in the eyes of a fool. 

Likewise, a physician who defends his or her decision making process through documentation while it occurs should be immune from the disease of hindsight. Unfortunately, one cannot rely on the absence of fools in high places, can one?