Today's News

Saturday, March 18, 2000

This is the year of the patient, says Dr. Canale

This will be the year of the patient, S. Terry Canale, MD, pledged at the Business Meeting March 17, 2000 where he became the new AAOS president.

"For the last several years, managed care has been our focus and our patients have taken a back seat," Dr. Canale said in his first vice president's address. "It is time we move from the plan to the patient."

He reminded members that when they took the Hippocratic Oath, they were willing and dedicated to take care of anyone. "As we specialized in orthopaedics, we wanted to provide the best care for anyone with a musculoskeletal problem," he said.

"Ability to pay never entered the equation. However, in the new order of business, a patient is first asked what kind of insurance, not what his medical condition is.

"We must turn this around and become aware of who we are. We are orthopaedic surgeons, that is what we do, nothing more or nothing less. We are not entrepreneurs, not insurance brokers, not managed care gurus, and not the landlords of outpatient surgery centers. We are physicians treating the patient first."

However, Dr. Canale said, "personalized service has been lost and replaced by speed of service. We've become the drive-through fast care center. While the public demands speed and impersonalization in many aspects of life, they want personalized medical treatment and a personal relationship with their physicians.

"Because of the increased financial burden of managed care, we have been forced to sacrifice the quality of care for quantity of care. And we have spent most of our time learning about managed care at the expense of our orthopaedic education and thus at the expense of our patient."

To solve these problems Dr. Canale said, "We need to rededicate ourselves to continuing education so that we can learn the very best treatment options."

Several times during his address, Dr. Canale stressed the importance of continuing medical education for orthopaedic surgeons. And, he told members they should be aware of alternative care. "It's not going away," he said.

"Our Academy believes this to be so important that a new committee on alternative care has just been formed. This year, it will provide the membership with pertinent up-to-date information through publications, CME programs and electronic media, so that we can inform our patients about the scientific validity of different forms of alternative medicine."

AAOS members also must focus on the art of communicating. "We must reeducate ourselves by listening to and communicating with and caring for our patients," he explained. "The Academy is putting forth a new public relations effort beginning the year 2000 in an effort to differentiate orthopaedists from other musculoskeletal providers and to send a message to providers and the public about what musculoskeletal care we provide."

In developing this public relations program, the Public Relations Task Force found that orthopaedic surgeons would like to be perceived as caring, compassionate, informative (communicative), supportive of the patient, accessible, and the primary care physician for musculoskeletal disease.

However, Dr. Canale said the public and patients perceived an orthopaedic surgeon, as "highly trained and educated" and "held in high esteem."

"Patients felt that orthopaedic surgeons were somewhat impersonal, and aloof, listened poorly and were costly caregivers who were difficult to see on short notice," he said.

"And even more important, they believed that we were not necessarily the only quality musculoskeletal care provider. The public did not care so much about how well we were trained and what degree we held, or whether we were orthopaedists, osteopaths or chiropractors. What mattered was whether the caregivers were caring, compassionate and accessible,; whether we listened to the patient. The public expects the medical profession, above all others, to be personal, caring and compassionate."

These qualities can be taught, but that's not necessary because, Dr. Canale said, "we just have to remind ourselves of these qualities that we already possess or we wouldn't be in the patient care field to begin with.

"We need to emphasize to ourselves and our members that physician-patient communication is the mechanism by which the qualities of caring and compassion are perceived."

The Academy is working with an expert in the physician-communication field on research that may lead to creating the ideal office encounter. Orthopaedists and patient encounters are being taped and graded. Dr. Canale said research also needs to be done on how to relate to the elderly, to people with disabilities, and to other diverse groups of patients at different socioeconomic levels.

One of the charges of the new Council on Communication is to determine how to best communicate our educational message via the web. This year, AAOS will put considerable resources into its web site, not only for member education, but also for patient and public education. "We must give our patients and the public correct orthopaedic information and make the Academy web site the gold standard for patient satisfaction and information," Dr. Canale said.

He told members that orthopaedic practices can sign up to link with the AAOS web site and give their patients easy access to patient education on the web through their own orthopaedic office's web site.

During his presidential year, he said AAOS will institute CME courses in communications at the graduate level for fellows and later at the resident level, and then ultimately in the medical school curriculum.

"If we are going to fall in love again with our patients and the profession," Dr. Canale said, "we must rededicate our efforts to providing our patients the very best and up-to-date treatment by reedu-cating ourselves through CME efforts and second, to rededicate ourselves to the ideals that led us into medicine to start with: caring, compassion and communication."

"Patients don't care how much you know until they know how much you care."

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