AAOS Bulletin - April, 2006

Letters from our readers

Physician work stoppages

I write in response to Dr. John Hill’s article “Should surgeons join work stoppages?” (December 2005) I appreciated Dr. Hill’s personal experience with work stoppages. I must, however, disagree with his conclusions that “as a result of these uncontrollable disruptive influences on the practice of medicine, we need to reassess our ethical precepts. Unless we wish to forfeit our traditional role as practicing physicians, we have to consider the possibility of taking actions that, in most cases in the past, would never have been considered.”

I believe this is a fundamental error in judgment that will lead to our collective loss of status as professionals. We, in the orthopaedic surgery/medical community, are granted status and privilege by the public because of our consistency in upholding our traditional role as practicing physicians. If we forgo this critical responsibility, society will likely respond with greater legislation and interference with the doctor/patient relationship, reducing our status to technicians and increasing public concerns that we cannot be trusted with the patient’s well-being. Our traditional ethical and professional precepts must be upheld at all costs, lest none of us have personal physicians whom we can trust to act in our best interest.

Societal ethical standards continue to evolve, and the circumstances Dr. Hill describes so well are beyond our control. We do, however, control our responses to these circumstances, and in the view of many in the medical professional community, our best chance for maintaining our trusted status is to continue with the “traditional role.”

Marc F. Swiontkowski, MD
Minneapolis, Minn.

Cuban Visit

Juan L. Gomez, MD, a friend, recently showed me the article by William B. Stetson, MD (“Building bridges to Cuba,” December 2005), and asked me to respond. Dr. Gomez and I were born in Cuba and came to this country after the arrival of “President” Fidel Castro. Since 1962, I have had the good fortune to live and raise a family in a truly free country with a true president—one that is elected every four years. It is a country where I can openly criticize any president and not fear reprisal. If I don’t agree with his policies, I can vote him out of office.

Cuban citizens do not enjoy the same luxuries. They haven’t for 47 years. But to Dr. Stetson, Cuba is a tortured soul, and America is the primary catalyst for its misery. As he writes, “The trip was to create awareness among health providers of the effects of the U.S. trade embargo against Cuba.”

Perhaps Dr. Stetson is not aware that more than 180 nations have never ceased commerce with Cuba. More than 100,000 Americans visit Cuba through other countries every year. At last estimate, our own exiles send a billion dollars annually.

Where does all that money go? Isn’t it all supposed to be shared in a socialist society? Dr. Stetson asserts that it is. Yet, there is no sterile tubing in the operating room. As he walks through old Havana, he notes that there hasn’t been a new building or renovation in 50 years. If the Cubans are so well taken care of, why are humanitarian missions needed? Why is Castro shipping hundreds of Cuban doctors to Venezuela in exchange for oil when his people are so in need?

Evidently, the thousands of Cubans who crossed the Straits of Florida—or the untold and unknown number who died trying—were not sharing in Castro’s abundance of basic necessities.

I appreciate the good doctor’s effort to depoliticize his five-hour visit with Castro. But everything is politics with Castro, and having prominent American doctors as guests only serves his agenda to underscore the “pain” his country is suffering at the hands of the United States. Dr. Stetson needs to understand—or perhaps is not aware—that thousands of Cubans were sent to death by Castro and the man who ran his firing squads, Ernesto “Che” Guevara, a physician.

It is impossible for me to describe what Cuba was before Castro. It wasn’t perfect. And I’m not perfect, either. For that reason, I would like to take the opportunity to open a dialogue. I invite you to meet with me or any number of Cuban-American doctors, at my home in Florida or at my son’s in California. Perhaps we can discuss the true basic necessity missing in Cuba: freedom.

Manuel J. Coto, MD
Orlando, Fla.

Retired Orthopaedists

I particularly enjoyed reading the article about retired orthopaedists (“Retired Orthopaedists: A wasted resource,” December 2005) for I am a semiretired orthopaedic surgeon. I like the basic premise that orthopaedic surgeons represent a resource and a fund of knowledge and experience that should not be wasted. However, the analogy used is incorrect.

Everyone who has watched the History Channel has seen the helicopters being thrown over the side of the ship at the final evacuation of Saigon at the end of the Vietnam War. My best friend was the air boss of that aircraft carrier. Those helicopters were not being thrown overboard because they were useless. They were being thrown overboard because there was no more room on the flight deck! The line of helicopters coming out of Saigon at that time was so heavy it completely overwhelmed the storage space of the nearby U.S. carrier group. There was no place to land them.

I certainly agree with the basic premise, and there is doubtless plenty of room on the “flight decks of the world” for the expertise of retired orthopaedists.

Michael J. Singelyn, MD
Newport Beach, Calif.

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