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Friday, March 17, 2000

Bone and Joint Decade: What's in it for you

By Bruce Browner, MD With economic and time pressures impinging on the practice of orthopaedic surgery, one is tempted to ask of the Bone and Joint Decade, "What's in it for me?" There is so much in orthopaedics to master, and so many masters to serve that our colleagues can be forgiven for not making the Bone and Joint Decade a high priority in their daily working lives.

Articles in recent issues of the Bulletin and a variety of other communications have provided the Academy fellowship with background information on the Bone and Joint Decade and its goals. The global significance of musculoskeletal disorders in terms of suffering, disruption of quality of life, and economic losses deserves attention. As Professor Anthony D. Woolf, chairman of the Bone and Joint Decade Monitor Project, stated, musculoskeletal conditions worldwide are "underrecognized, underappreciated, and underresourced." So, we need to make some changes.

Changes will be brought about by the collaborative activities of professional and patient groups working in an integrated Bone and Joint Decade National Action Network. The goals of raising awareness, educating and empowering patients, improving methods of prevention and treatment, and increasing funding for research are laudable, but the direct benefits to individual practicing orthopaedic surgeons may not be obvious. However, there are benefits and they are important.

Decreasing reimbursement, increasing regulatory scrutiny and loss of physician autonomy from years of practicing in the managed care environment have made us more cynical and protective. Academy fellows will be skeptical or uninterested in an overarching, altruistic public relations and lobbying campaign unless it offers definable benefits for them. It is quite reasonable to ask, "How will the Bone and Joint Decade help the individual practicing orthopaedic surgeon and his or her patients?" There are several clear answers to this question.

Patients highly educated about musculoskeletal conditions.

By accessing medical information available through the Internet, patients have expanded their understanding of their own problems and have started to become more active participants in discussions with their physicians. Educational projects launched by groups within the National Action Network of the Bone and Joint Decade in the United States would provide expanded, accurate, quality information for patient education. Patients would better understand their musculoskeletal disorders and injuries and the risks and benefits of the different options for treatment. Better educated patients would improve the patient-physician relationship to one in which communication is two-way, not one-way.

As studies have shown, a more realistic expectation of the process of care, stages of recovery and the ultimate outcome lead to better patient satisfaction. The active participation of orthopaedic surgeons in this education process and more patient-physician dialogue will improve our image as physicians and reduce the risk of malpractice litigation.

Potential for more patients in your practice.

A major goal of the Bone and Joint Decade is to provide patients with new forms of clear, understandable information about different musculoskeletal conditions and the options for treatment. Better patient material on orthopaedic surgery will demystify our procedures and, we hope, leave patients less frightened of this option for treatment. A better understanding of the mechanics of surgery, pain management strategies and expected outcomes will expand understanding of the value of orthopaedic surgeons and make patients more likely to seek their consultation for the solution of their problems.

Potential to improve your orthopaedic practice.

Advances in orthopaedic surgery always have been the product of basic science or clinical research. The Decade of the Brain resulted in a substantial increase in the funding available for neuroscience researchers. In many medical schools in North America and Europe, new, well-funded neuroscience departments were created in response to this newly available funding. Expanded research in this area led to advances in the treatment of Alzheimer's disease, head injury and stroke.

Increasing public awareness of the significance and economic impact of musculoskeletal disorders will facilitate lobbying and developing efforts to increase the funding available for musculoskeletal research. While this will be of more immediate benefit to PhDs and clinical researchers on medical school faculties, the enhancement of research funding will speed the translation of their efforts to real clinical improvements.

Health service research studies of orthopaedic surgery and other medical specialties have shown widespread differences in therapeutic choices for the same diagnosis. These small area variations suggest to the (continued on p. 46) public and government officials that we do not know what really works and are making our clinical decisions on the basis of tradition and individual experience. This type of information undermines the patient's confidence in technologically oriented specialties such as orthopaedic surgery and causes them to seek alternative remedies.

We must continue to press for an evidence basis for medical care and to embrace those therapies which have the highest level of cost effectiveness. The availability of increased funds for research will enable us to more rapidly determine which are the most effective orthopaedic treatment methods. Creating and communicating this information will be the best way to improve and protect the practice of orthopaedic surgery and to make advances on behalf of our patients.

More and better data collection about the burden of musculoskeletal conditions.

Increased awareness about the burden of musculoskeletal disorders and our lack of knowledge about its epidemiology will galvanize groups to advocate for more and better data collection efforts on measuring this burden and how to decrease it. In the past, our public and government focused greater attention on health problems that caused death such as cancer, heart disease, AIDS and stroke. In the United States, the increasing age of the population, extension of life span, and higher expectations for active lifestyles in the senior years are placing a new emphasis on health problems that affect the quality of life. Osteoporosis, osteoarthritis, traffic and sports injuries and back pain and spinal disorders will be growing areas of concern. Measured in terms of suffering, disability, and economic impact, these problems will become particularly acute in another 10 to 15 years when the enormous population of baby boomers begins to reach retirement age. Also, musculoskeletal conditions in children are a continuing concern, where new research can have a great impact.

An important component of the Bone and Joint Decade will be a major effort to increase our understanding of musculoskeletal conditions concerning health status and economic impact. A more detailed collection of this type of data will highlight the significance of musculoskeletal problems. If this information can be tied to the studies demonstrating cost-effectiveness and value of orthopaedic surgery, public and government support for orthopaedic surgery will increase. Such appreciation might lead to protection against further losses in reimbursement or even increases in the future.

At the time of this writing, the Bone and Joint Decade has been endorsed by more that 750 professional and patient organizations from around the world, 20 national governments, the World Health Organization, the World Bank, and Kofi Annan, Secretary-General of the United Nations. However, President Clinton has not yet proclaimed the years 2000-2010 the Bone and Joint Decade in the United States.

Bruce D. Browner, MD, is a member of the International Steering Committee of the Bone and Joint Decade

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Last modified 24/February/2000 by IS