August 2003 Bulletin

Across the President's Desk

The importance of listening:
A commitment to our members

As physicians, we all know the importance of listening to our patients, not only to what they say, but also to how they say it. I have found that a too eager "Whatever you say, Doc," can be just as problematic as a hesitant, "Well, if you think that’s the right thing to do…" In both cases, the patient is abdicating responsibility–deferring the decision to me rather than partnering with me and personally committing to a course of action.

In the months that I have served as your president, I have found the same is true with associations. It is imperative that Boards of Directors listen to their members. We do this in several ways: by talking with colleagues in our institutions and our practices, by participating in discussions with committees and councils, and by expressing viewpoints during Board meetings. But I’ve also found that this may not be enough, particularly with the diverse membership in the AAOS today.

I have long been an advocate of the "team and systems" approach. That approach works not only for changing the culture of patient safety, but also for changing the culture of an organization. To make the AAOS an organization that is truly both responsive and responsible to its members, your Board is reaching out in several ways.

Every week, the members of the Presidential Line have a teleconference. Over the past several months, we’ve been involving members of the Fellowship in these conferences as well. Three to five different AAOS members join us each month as we discuss issues of concern to the organization. It’s a way of broadening our thinking to new viewpoints and voices.

The Board has also realized that polling the membership on issues of importance is an effective way of making decisions. Advancements in technology enable us to reach practically every member in a matter of hours by e-mail or fax. That same technology enables members to respond at their convenience, and captures those responses for analysis and review.

This approach was first used after the 2003 Annual Meeting, when an all-Fellowship vote was taken on several resolutions. The response far exceeded our expectations. Not only did more members actually vote on the resolutions than had during previous Annual Meetings, but the voting demographics accurately reflected the member population in terms of gender, practice description, practice type and age. As a result, the Board concluded that Fellowship polls on issues of significant impact could result in better decision-making and greater support for actions on these issues. For this reason, we will be using Fellowship polls over the coming year to better understand your views on specific issues

The first of these polls is on the issue of expert witness testimony and the AAOS disciplinary process. Over the years, many individuals have contacted the AAOS to ask for assistance in dealing with other orthopaedic surgeons whom they believe have inappropriately or fraudulently testified as expert witnesses. Last October, the Board of Councilors recommended that the AAOS establish a mechanism to discipline members who provide inappropriate expert witness testimony. A project team headed by Richard H. Gelberman, MD, was established and charged with investigating several systems and making recommendations to the Board.

At the June Board meeting, Dr. Gelberman reported on the research done by his team on professional conduct disciplinary programs, which basically fall into two categories or levels of action: education/remediation and ethical/disciplinary. As a first step, the Board has adopted a program of educational and remedial activities to address the issue of orthopaedic expert witness testimony. This program includes the following actions:

All of these steps are consistent with AAOS actions on similar issues. The second category, involving the questions of the assessment of and possible disciplinary action for inappropriate expert witness testimony, would be a departure from previous activities. Under such a system, the AAOS would receive complaints from Fellows who believed another member’s expert witness testimony was inappropriate or failed to comply with ethical standards. An expert review panel would consider the testimony and recommend disciplinary action if appropriate.

Direct administrative costs for such a program are estimated to be between $150,000 and $175,000. In addition, there would be the costs of time and litigation if the disciplinary decisions were challenged in court, and a likely increase in insurance rates (assuming that the AAOS could even obtain such coverage). Obviously, such a program would have a substantial impact on our budget.

Before making a decision to proceed or reject such a program, the Board felt it would be valuable to hear what YOU have to say. Because of the substantial financial consequences of adopting such a program, the Board also felt it would be appropriate to ask about funding. Would you support a dues increase or an annual assessment to fund this activity? Would you be willing to make a contribution and if so at what level, if there is an adverse judgment against the AAOS?

The results of the poll will be available shortly and will be announced. It is my sincere hope that every member of the AAOS responds on this important issue. Your participation will make you a partner in the decision process and will ensure a successful outcome.

James H. Herndon, MD, MBA

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