October 2004 Bulletin

Cancer within

I read Dr. Brian Ziegler’s remarks during the Town Hall Meeting as printed in the Bulletin and emphatically agree with his call to end false and misleading testimony by members of our professional community. The title, “Time to stop the cancer within,” made me think of another pernicious cancer that often causes a suit to be filed. Unfortunately, it is a cancer whose etiology is also the orthopaedic surgery community.

I have had opportunities, as an academic physician, to review cases filed in my locality. I identified a common denominator that could be found in the plaintiff’s testimony under oath in more than 80 percent of these cases. The plaintiff would either be sent for a second opinion or independently seek a second opinion from a sub-specialist. That sub-specialist or one of his residents or staff would comment negatively, and sometimes disparagingly, about the care provided to the patient up to that point.

Some example comments include: “He put up the X-rays and asked, ‘Who did this to you?’”, “This wouldn’t have happened to you if you had started your care with us” and “We’re used to fixing other people’s screw-ups all the time.” I am sad to say that I could provide several more examples from depositions I’ve read. I am ashamed that so-called colleagues of mine have made such comments, especially when there was no departure from the preoperative, operative, or postoperative standard of care in nearly all of the cases. The defendant orthopaedic surgeon’s treatment approach may have differed from that of the orthopaedic surgeon providing the second opinion but was almost never inappropriate or negligent.

In my opinion, comments like these are inappropriate, unprofessional and unbecoming of anybody, especially a physician. Some of my theories as to why a medical professional would make such comments include: 1) intending to “punish” other orthopaedic surgeons with whom the second-opinion physician may disagree; 2) creating an opportunity to generate supplemental medicolegal income; and 3) trying to make oneself look better to the patient by making the previous physician look bad.

My guess is that the third reason is most likely, given how often I witnessed such behavior during medical school and residency. There is no question that medical school, residency and the practice of orthopaedic surgery are highly competitive; however, behavior that is injurious to one’s competitors benefits nobody and, in fact, hurts our profession as much, or more, than false and misleading testimony. This “cancer within” is easily preventable with professional behavior and remembering to “do unto others as you would have them do unto you.”

Anthony D. Watson, MD
Pittsburgh, Penn.

Correction — Helmet Safety

As an orthopaedic surgeon for 20 years and a bicycle racer for almost 40 years (who has fallen and cracked more than one helmet in his day), I have a keen interest in bicycle safety and helmets. The child shown in the article on page 55 of the August AAOS Bulletin “Helmets Key To Child Safety In Sports” is wearing her helmet incorrectly!

The article states that the helmet should be “level, square to the top of the head and covering the top of the forehead.” She, however, is wearing her helmet on the back of her head like a beanie, as most children do.

While discount department stores sell helmets for a few dollars less than bike shops and every helmet sold in America is CPCS-certified regardless of price, to be effective a helmet should be fitted by a knowledgeable individual. The only place to find someone who can do this correctly is at a bike store and the extra few dollars are well spent.

Joseph Meis, MD

Lincolnshire, IL

Editor’s Note: Dr. Meis wasn’t the only one who caught the discrepancy between the correct description of how to wear a helmet in the article and the incorrect depiction shown in the illustration. The illustration does not appear with the article on the AAOS patient education Web site, and the Bulletin apologizes for using it without a disclaimer.

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