Thank you, Dr. Bucholz, for the opportunity to address the American Academy
of Orthopaedic Surgeons (AAOS). For me, the chance to welcome the newest
members of our Academy, the Class of 2005, is a special gift. In fact, that is
the title of my talk this morning: "Orthopaedic Gifts."
Here is the good news right off the bat: There won't be any bad news. If
you are a doom and gloom guy—hit the road. Furthermore, if you wanted to
hear about the good old days, I am not the guy for the job. New Academy
fellows, have you noticed when old guys talk about the "good old
days," somehow they always ended just before you got there! Nonsense.
"Now is the good old days."
It is true that there are challenges facing this new generation of
orthopaedists, and they are significant. I do not have to list them; you have
heard them many times before. But, today, I choose not to talk about the
malpractice crisis, Medicare, managed care, or government health insurance.
This morning, thanks to Dr. Bucholz, I am driving this train for the next
twenty-five minutes. Sit back and smile because you will be hearing things
that are right with our specialty in 2005.
I want to tell you, young men and women, whom we all salute today, our
newest Academy members, that you should be glad you chose a career in
orthopaedics. I picked this career thirty-five years ago; I have never
regretted it. This morning, I am going to suggest ways so that you won't
regret it either.
First of all, there may be a few in this room, perhaps a new member's
family or a nonmedical friend, who might not understand the important work
that orthopaedists do. It has been said that orthopaedic surgeons, unlike
heart surgeons and brain surgeons, have given up the traditional role of a
doctor, that is, we don't save lives. Orthopaedists have heard it
before—we are "bone carpenters," "body
mechanics," and "jock docs."
But I submit to you that orthopaedics, perhaps more than any specialty, is
about really saving lives. For an orthopaedic surgeon, life is more than just
the absence of death. Our work preserves the quality and dignity of the lives
of our patients. We keep them walking, we keep them using their hands, we keep
them doing their work. We keep our patients truly living. The great French
physiologist Duchenne said it best almost 200 years ago: "Motion is
life." Unlike some of our less fortunate medical colleagues, we
orthopaedists are not in the business of prolonging death. Armed with our
orthopaedic skills, we have the power to preserve a person's dignity, keeping
the patient at work, active at home with his family, enjoying his avocations,
and living independently. So, the next time someone asks you what an
orthopaedic surgeon does, tell them: "Orthopaedists save lives."
This is our mission. You might even say that it is our gift to our fellow
man.
"Orthopaedic Gifts" is the title of my address this morning.
Since gifts don't cost us anything, too often we take them for granted; we
don't look after them like we should. I encourage all of us in this room this
morning, new members and old, to pause and reflect on some of these gifts.
One gift we all have is our hard-working, underpaid president! You and I
are fortunate to have him. Let's give him a hand. But this morning, Dr.
Bucholz, I remind you and all of us in the American Academy of Orthopaedic
Surgeons that we have also been given a gift, a very special gift—that
gift is the new members in the Class of 2005. The soul of our Academy is a
surgeon who is young, enthusiastic, and anxious to achieve in this great
surgical specialty.
Ladies and gentlemen in the Class of 2005, we thank you for the gift you
have given the AAOS today. You are the cream of the crop, the best and
brightest of American medicine. You are better educated and practicing a more
developed clinical science than any of us who have come before you. You have
worked hard and have already accomplished great things. The Academy salutes
you this morning. Your class has every right to expect much in return for your
gift to the AAOS. It is the mission, the only mission, of the American Academy
of Orthopaedic Surgeons to help you to make your practice of orthopaedics as
safe and effective as it can be. You deserve no less. In fact, you should
demand it.
But here is the kicker: Starting today the American Academy of
Orthopaedic Surgeons is... you!
Your Academy will be as effective and significant as you choose to make it.
Today is the first day of the rest of your orthopaedic career. Today also
begins a new AAOS, your AAOS. It can be all you want if you decide today to
live up to its mission: to make your practice as safe and effective as
possible. Starting today, I ask you to take on that responsibility.
But first I want to talk again about you, the Class of 2005. I ask each of
you to pause and take a look at yourself today. Where are you this very minute
in your life? Today is an important mile-stone in your life. Take a moment and
think back about what it took to get you here. Roll the clock back thirty
years or so ago when most of you were born.
For most of you, that date is around 1971. Your parents were children of
the outrageous sixties—hippy parents like me! We must have done
something right because your Class of 2005 has had a long run of successes.
Let's take a look at some of them.
You managed to do well enough in high school to get into college.
After four years of studying at least some of the time, sweating your grade
point averages and MCAT scores, you made it into a medical school.
Somehow you managed to be not just a good medical student but an
out-standing medical student. I know that about you because orthopaedic
residencies are among the most competitive of all postgraduate medical
programs. My friends, the word is out on us; this stuff is fun and it pays
well.
After eight years of post-high-school education, you couldn't wait to sign
up for five more years of hard work and study. In your residency, you worked
all night frequently. You had never heard of something called the
"eighty-hour workweek!"
What's more, after five tough years of your residency, 70% of you did yet
another year of post-residency fellowship. Like me, you got to know some of
the true mentors in our specialty as a colleague and as a friend. You and I
both loved it.
A few of you may have added a couple of years of military service like I
did. Finally, at the ripe old age of thirty-something, you began your career
as an orthopaedist. As my father, who was a farmer, told me thirty years ago:
"At last, you have a real job."
In addition, you have been in orthopaedic practice for two years and have
proved you could really do it.
Furthermore, you have passed examination after examination—both oral
and written. You got the ticket and finally became a board-certified
orthopaedic surgeon.
It has been a lot of work to get where you are this morning—a new
member of the American Academy of Orthopaedic Surgeons. You should be very
proud of yourself. Give yourself a pat on the back.
But, now what?
We have looked at where you have been. Now I ask you to think about where
you want to go from here. Let's roll that clock forward thirty years from now
in your life. This morning, you think it will never get here. But, I promise,
it will seem to come in the blink of an eye.
I suggest you begin this journey, this orthopaedic life of yours, with the
end in mind. What is it you want out of your career in orthopaedics? You can
make it most anything you want it to be. You are in possession of powerful
tools. You have been given incredible gifts.
One of those gifts, a very important one, is your intellect. You did not
earn it; it was given to you. Think back in your residency when you were
working in a pediatric orthopaedic hospital—as I do now. Remember those
children with cerebral palsy. You and I and everyone in this room this morning
were all only a couple of minutes of anoxia away from the plight of our
patients. There is no place in orthopaedics or anywhere for an arrogance of
intellect. It has no place in medicine; never participate in it. Your
intelligence and your manual abilities are gifts. While it is true that you
have done much to develop them both, you did not really earn them at the
start. Cherish them, keep on improving them, and use them wisely.
Your health is a gift. Today you think you are immortal. You aren't. Take
care of yourself. Find time for daily exercise. Find a personal physician and
see him or her regularly. And don't forget—take time for your mental
health. Orthopaedics is stressful but intoxicatingly enjoyable, a unique
combination. It can be addictive. Take some time off regularly; you and your
patients will both be better off for it. Cultivate a life outside of
orthopaedics. Get some friends who are not doctors, and spend time with them
doing other things besides medicine.
Your family is a very special gift. Orthopaedists often forget to make time
for their family. I have seen this many times; I have been guilty of it
myself. It is a miracle to me, and thanks to my great wife Susie, that both of
our sons are successful and responsible adults. She taught them at an early
age: "Who you are is not what you have accomplished. What really defines
you is the kind of person you are inside—at your core."
Psychologists call this self-respect. Your children need their parents
around to help them achieve it. My new colleagues, remember that someday your
family will not be just another important thing; it will be the only thing.
Too many of us don't make time for that piano recital, that homework problem,
or that baseball practice. My wife Susie was our son's baseball coach, for
goodness sake!
Here is another tip: enjoy your patients. They are a gift to you. Without
them, what is the point of all this? Right now, you are busy building a
practice. Volume is everything to you. Someday soon, the velocity of your
practice and the sheer numbers of your patients will overwhelm you. Starting
today, cultivate the ability to really listen to your patient. When you go
into the examination room, sit down, even for a minute. They will think you
spent an hour. Begin the visit by asking them a nonmedical question about
their lives. You will discover that your patients can often enrich your life
in ways you could not imagine. When you are in the examination room, really
examine them, touch them. Your patient is the problem, not the x-ray. Roentgen
was awarded the first Nobel Prize; but, in important ways, he did orthopaedics
a disservice when he discovered the x-ray. We are tempted to think we don't
have to listen to the patient, we don't have to examine the patient, and we
don't have to touch the patient anymore. Bone scans, magnetic resonance
imaging scans, and computed tomography scans have only made it worse.
Another thing I would suggest is to take the time to learn to draw. Yes, I
said draw. Learn to draw well the anatomy of the patient's problem. All of us
are visual learners; a quick sketch will help the patient to understand. When
your patient sees that you can draw the problem and the solution, he knows
immediately that you understand it. He begins to trust you because you have
explained it to him in a way that he can grasp.
And right before you walk out to see another one, ask your patient whether
he or she has any questions. Frequently, this has been the time when I finally
found out the patient's chief complaint!
Problems. Problems are everywhere in orthopaedics today. Medicine has
always been mostly about problems. But problems can be one of the best gifts
of all because they are opportunities for solutions. Never forget this:
problems are opportunities. But you must listen and think.
You will continue to encounter problems and, unfortunately, you will create
some of them. You will make mistakes. Both you and your patient will suffer.
Have you noticed how often learning is painful? Knowing is what is fun;
learning hurts. Anyone who says learning is fun, chances are, hasn't done much
of it. You will make mistakes; you will feel that pain. But aim high and err
honestly. If you are honest with yourself and your patient, that problem can
become an opportunity for a solution. Listen and think. This is exactly what
our forefathers in orthopaedics did in the days before we got here, in those
"good old days." Because they listened and thought of solutions,
they gave us the methods that you and I use every day.
Furthermore, when you get back to your hometown after this meeting, I
suggest you look around. You will find a diagnosis, which for some reason you
see more frequently than the next guy. Read all you can about it; study hard
to learn what others have done. Get to be the expert in your community at
whatever it is. Chances are you will make a contribution to our orthopaedic
knowledge. The knowledge base that you and I now have and use is a gift. We
learned it but others discovered it.
Our orthopaedic heritage came to you and me as a gift. It was delivered
from generations of orthopaedists and their patients who have come before us.
These surgeons had problems and made mistakes. They struggled with poor
equipment, no antibiotics, dangerous anesthetics, and little scientific or
peer-reviewed data. Patients suffered, some were made worse by their surgeons.
But these surgeons learned. Remember: listen and think. Our
forefathers in orthopaedics saw the opportunity that the problem presented,
and they looked for a better way. Thank goodness for you and me and our
patients that they found it. Many took the time to write it down, to share it
with all of us. Respect your orthopaedic heritage. It is a gift. We owe a debt
for the privilege of using this orthopaedic gift.
Here is the only way you and I can repay that debt—teach. Education
is the payment we all owe for the privilege of using this knowledge. The
orthopaedic heritage debt is one we must constantly service, knowing that we
can never fully repay it. Pass along the knowledge you worked so hard to
learn. Every time you get the chance, teach.
Teach your patients; they can understand the basics. When they understand,
they will help you get them well because they won't be so afraid. All of us
fear what we do not understand.
Teach your nursing staff; teach other physicians who are not orthopaedists.
Their patients will benefit, and your practice will grow because of it. In my
opinion, education is the only ethical marketing. To be a teacher, you don't
have to be in a university, you don't need the title of professor. You already
have the only title you need. The word doctor comes from the Latin,
docere. It means: to teach.
Most of you are in private practice, like I was for twenty-five years. I
loved it. Practicing medicine in America is a gift. There is no place on earth
where you can practice the quality of medicine that you are able to here, plus
be generously paid for it. Americans appreciate what their doctors do. You can
earn enough to do some important things for yourself and your family. If you
spend less than you make and if you use it wisely, the money you earn can give
you independence and freedom. But remember something: Earning a living is
important, and is sometimes even interesting—but sooner or later...
making a difference is what counts.
I encourage all of you to find some time to do what you do best for someone
who really needs it, and then give it away. You will be repaid in ways you
cannot begin to expect.
Let me tell you a story about how an orthopaedist friend of mine is making
a difference in a third world country. Charlie Hamlin doesn't need a passport
to work in this third world country because it is right here in the United
States. Over ten years ago, Charlie started a small hand clinic on the Navajo
Reservation in Chinle, Arizona. The primary economy is farming and ranching.
Hand injuries are endemic; rheumatoid arthritis is a common
diagnosis. But listen to this—on the Navajo Reservation, the
unemployment rate is over 60%. Fifty percent of the residents of this
community do not have electricity or running water.
Charlie or one of his hand surgery friends, including myself, has been in
Chinle seeing Native American patients on Thursday and operating on Friday
once every month for over ten years. We have never missed a single month. None
of us have received any cash payment for our services, but I promise you we
have been repaid many times over in other ways: experiencing the spirit of our
patients, the beauty of their land, and their way of life.
In orthopaedics too, earning a living is important and sometimes even
interesting, but sooner or later... making a difference is what counts.
My friends, you and I have the best job on earth. Live it and love it every
day of your lives.
Finally, I want to pay homage to the men and women in the trenches. I
salute orthopaedists who are in the operating room in the middle of the night,
struggling to reassemble the broken bodies of their patients. Then, the next
morning that same surgeon is back in the office helping patients to find
answers to orthopaedic problems, to improve the quality of their lives, to
help them really live. Remember Duchenne: "Motion is
life!" These men and women are on the front lines; they are the marines,
the infantry of our specialty. All Americans owe them respect and support.
Nowadays, I am a member of academia. I reside in one of the most ivory of
towers, but I try to remind myself every day that I am really only one of the
support troops. In the end, it is all about those surgeons in the trenches and
their critical and historic work.
We must cultivate the important partnership between those surgeons in the
trenches and we professors in the ivory towers. Today, I honor the crucial
roles of each. I have already talked about the importance of education. But I
remind myself, and my academic and basic-science colleagues, of the
intellectual sophistication of the work of a gifted clinician, solving
clinical problems for individual patients. Medicine is intrinsically a
humanistic science. Solving orthopaedic problems is a special and
intellectually demanding activity. Today, I pay homage to this work, the
cutting edge where all of our efforts (teacher, basic scientist, and clinical
surgeon) come together. The work of basic scientists, hospital committees,
academia, and surgical societies—all of it is secondary to this great
and historic pursuit: the treatment of an individual patient. Solving
orthopaedic problems. Keeping them moving.
It is the success of generations of surgeons doing this work that has
earned us the trust of our patients. It has been so since the beginnings of
medicine, and thanks to the men and women of the Class of 2005 of the American
Academy of Orthopaedic Surgeons, it can continue. It must continue. I have
always liked the way my mentor and first professor of orthopaedics, Charles F.
Gregory (Fig. 1), said it to me
thirty-five years ago when I was an orthopaedic resident: "The patient
trusts—the surgeon must never betray that trust."