Loss aversion was introduced by Daniel Kahneman and Amos Tversky. While rooted in economics, the idea captures a fundamental feature of human decision-making across domains. The image is CC from Jim Choate
In orthopaedic trauma, translating evidence into practice is hardest when the evidence tells us to stop operating. Stig Brorson’s excellent review of proximal humerus fractures (the book is open access) illustrates just how difficult surgical de-implementation can be. Multiple randomized trials, most prominently the ProFHER trial, have shown that surgery offers no long-term advantage over non-surgical treatment for most patients. Yet, despite this, surgical rates have remained high, with a growing tendency to replace rather than preserve the joint. This persistent gap between evidence and practice is not primarily explained by ignorance or lack of data. It is better understood through the lens of human decision-making.
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