Letter from the Editor: Highlighting Outside-the-Box Thinking in Otolaryngology

One of the things that I enjoy most about reading ENTtoday each month is the opportunity to see otolaryngology from so many different angles and perspectives. One of the most common complaints that I hear amidst the physician burnout crisis that has arisen with the corporatization of medicine is feeling like a cog in the wheel. I certainly feel this way from time to time. Life in clinical practice is very rewarding, yet invariably becomes routinized to an extent from day to day. Clearly, there are some good sides to routinization. I find that routines contribute to a sense of stability and predictability in my life. They reduce chaos and improve my feeling of control in a world that frequently seems unstable and unpredictable. Yet too much routine can contribute to feeling uninspired and bored, and can conjure the notion of “another day, another dollar” in my mind. 

While we all have heard the idiom, Variety is the spice of life, the roots of the saying are less well known. It is a line from a poem entitled “The Task,” by William Cowper, written in 1875. The full line is Variety is the very spice of life, That gives it all its flavour. William Cowper suffered from recurrent bouts of severe depression, and the insights in his simple phrase are applicable to all of us trying to balance the negatives of routinization. I find I can turn to ENTtoday to find new inspiration from colleagues and insights into topics that don’t often get covered through the eyes of an otolaryngologist. The articles in ENTtoday help me “think outside the box,” and this issue is no exception.

The digital era has led to rapid changes in how we as lifelong learners consume new medical information. One article dives into 10 novel ways of disseminating novel content from visual abstracts, from the minimalist poster to webinars, live streaming, and podcasts. With the seemingly ubiquitous access to high-powered computers in the palms of our hands, opportunities abound to learn and grow outside the box of the traditional medical journal and the in-person meeting format. Read about the new visual abstract competition that is being launched at this year’s Triological Society Combined Sections meeting at the Hotel Del Coronado in San Diego from January 23–25, 2020.

Another area of outside-the-box thinking in clinical otolaryngology is featured in two articles discussing off-label use of therapeutics in various head and neck applications. The relative paucity of funding for de novo treatments in our field leads to many situations where we use therapeutics outside of FDA-indicated applications. One article explores common clinical situations of off-label treatments across the spectrum of otolaryngology, and another reflects on the ethical implications of their use.

Physician entrepreneurship in otolaryngology is a way some are thinking outside the box as well. In this issue, several otolaryngologists discuss their experiences in product development to benefit patients and may serve as inspiration for other out-of-the-box thinkers who have ideas they hope to bring to reality.

The first article in the new ENTtoday column called “The Voice” launches in this issue. This column features conversations with colleagues in otolaryngology, touching on their personal and professional journey, by Dr. Sarah Rapoport. Dr. Ashok Shaha is interviewed in this first inspiring segment. Additionally, Dr. Gayle Woodson and her new acclaimed novel, entitled After Kilimanjaro, is featured in this month’s Surgeons after 7 column.

I hope you find that these articles highlighting outside-the-box thought in our field give you inspiration for actualizing William Cowper’s simple but sage adage regarding variety, spice, and life.

Michael M. Johns, MD
Director, USC Voice Center
Division Director, Laryngology
Professor, USC Caruso Department of Otolaryngology
Head and Neck Surgery
Los Angeles, Calif.