August 2003 Bulletin

From our readers

Write to The Editor, AAOS Bulletin, 6300 North River Road, Rosemont, Ill. 60018-4262

Military orthopaedics

I would like to thank the AAOS Bulletin for the very kind coverage in the June issue. As an update, through July 18, 2003, Walter Reed has treated approximately 625 patients from Operation Iraqi Freedom since the war began, 164 of whom have been battle casualties. Of the 164 battle casualties, 119 have been treated as inpatients and 45 as outpatients. The vast majority of patients have had orthopaedic injuries. We have treated a large number of casualties from Operation Enduring Freedom in Afghanistan as well.

Many significant extremity injuries continue to arrive. Our lead orthopaedic traumatologist, Lt.Col. Richard B. Islinger, MD, continues to lead the care for these complex and potentially devastating injuries.

In addition to the efforts cited in the article there has been a focused effort on the care and rehabilitation of those who have sustained amputations. We at WRAMC have appreciated the genuine, national outpouring of support from the AAOS, the Amputee Coalition of America, the American Academy of Orthotists and Prosthetists and many, many individuals and other organizations. This has truly facilitated care for these sons and daughters of America.

David W. Polly, Jr., MD, FAAOS COL, MC
Chief, Department of Orthopaedic Surgery and Rehabilitation
Walter Reed Army Medical Center

Medical liability reform

Thank you AAOS!

In May, the AAOS demonstrated true leadership and created a fund to bring about national liability reform. As part of the AAOS commitment to bring about national and state medical liability reform, the organization has generously earmarked funds for state medical liability reform campaigns, committing $1,000,000 from its reserves for this purpose. The Texas Orthopaedic Association (TOA) successfully applied for a very sizeable grant to assist in the passage of Proposition 12 on September 13. This is the vote for the constitutional amendment that will allow the recently signed liability reform legislation to stand unchallenged in the courts. Texas is the first state to receive these allocated funds.

In this ongoing effort to help to promote medical liability reform across the nation, the AAOS is asking all orthopaedic members to contribute to this fund by writing a check for up to $1,000.  Please do not rely on a few to carry all the weight.  Keep supporting your national and state PACs, as well as this special medical liability reform effort.

TOA's campaign will begin with asking our members to communicate the importance of Proposition 12 to their patients and communities.  We will send you materials to display in your office and waiting rooms to help "get the vote out."  Thank you for your generous support of this worthy initiative. 

Maureen A. Finnegan, MD
President, Texas Orthopaedic Association
Chair, Board of Councilors
Dallas, Texas

Patient safety

The two articles in the June 2003 Bulletin that deal with the quality of medical care and wrong site surgery have caused me to respond. In the wrong site surgery article it states, "Participants also agree that taking a moment in the operating room before the surgery begins to verify the patient's name, procedure, and the site of the procedure would be one way to reduce the number of wrong-patient/wrong-procedure surgeries." I am amazed that this statement is even in the article. I thought that as a surgeon this was standard practice.

Before I retired from surgery, I knew each patient that was scheduled for elective surgery and made certain that I knew exactly what was to be done on an emergency patient. Apparently, this is not common practice anymore. I have a good friend who recently had two thoracotomies for a mass in her chest who has yet to meet her surgeon. I have done independent medical evaluations of patients who told me that the first time they saw their surgeon was when they were wheeled into the OR.

What in the world has happened to our profession? Do modern-day orthopedists not know their patients enough to be aware of the pathology, what procedure is to be done and where they are to make the incision?

I performed orthopedic surgery for over 22 years and never even thought to "sign the site" because I took the time to become acquainted with my patient, to read the chart and the x-rays and to make sure the surgery was going to be done on the proper limb.

In the article by Michael L. Millenson regarding quality of care, I believe that a lot of the mistakes he discusses fall into the category of the doctor and the nurses not knowing their patients. Don't hospitals any longer list a patient's allergies in bold letters in a place in the chart where they can't be missed?

I am afraid, as Augusto Sarmiento, MD, has said in numerous articles he has authored, that our specialty is becoming a collection of "surgical technicians" who have forgotten that they were physicians before they became orthopedists. If surgeons would take the time to get to know their patients, much of the emphasis on "sign the site" would be unnecessary.

John W. Thompson, MD
Lake Oswego, Ore.
Emeritus Fellow, AAOS

Diversity and affirmative action

I read with interest the editorial by Dr. White about diversity and affirmative action (April 2003), the latter currently under review by the Supreme Court. (Editor's note: The Supreme Court issued its ruling on this petition on June 26.) I congratulate him on his achievements and thank him for his scholarly works, which helped educate me during my residency. As a Hispanic, I too have been a victim of discrimination, so I share many of his concerns.

It is interesting that in the past the justification for affirmative action was to redress past grievances, not to provide diversity. If diversity is now the new goal, why should we stop at using only skin color, when we could choose other selection categories such as religion and political views, for example, to achieve even more diversity?

I do agree wholehearted with his comment that there can be no such thing as "reverse" discrimination. There is in fact, only pure and simple discrimination, which the dictionary defines as the act of making a distinction in favor of or against one person as compared with others.

Discrimination on the basis of skin color is wrong and inconsistent with the fundamental values of equality held by most in this country. If we are to achieve the dream of Martin Luther King, that a man should be judged by the content of his character and not by the color of his skin, we need to stop using skin color as a discriminating factor in any process of selection.

Dennis P. Rivero, MD
Albuquerque, N.M.

Would you like to comment on something you read in the Bulletin? Let's hear from you. Send your letter to the Editor, Bulletin, AAOS, 6300 N. River Rd., Rosemont, Ill. 60018. Fax (847) 823-8026.

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