To The Editor:
I am writing to comment on the American Orthopaedic Association Position
Paper "Leadership in Orthopaedics: Taking a Stand to Own the Bone"
(2005;87:1389-91). The overall
encouragement for orthopaedists to take an interest in bone fragility seems
sound, since all would agree that we should feel a responsibility for
understanding the systems that we are trained to diagnose and treat. Whether
or not a busy operating orthopaedic surgeon can provide the best medical
management for osteoporosis (particularly in elderly patients who often are
taking multiple drugs with associated risks for drug interactions) remains to
be determined. I would note that we are also in the midst of an "avoid
medical mistakes" campaign and that poor knowledge of drug interactions
is a common source for medical errors.
My main reason for writing is to object to the phrase "own the
bone." This catchy phrase may have some rhythmic value, but I find it
inappropriate. To my ear, "own the bone" sounds aggressive, making
us sound like people who might be difficult to work with. A colleague noted
that only a possessive dog would have a strong need to "own his
bone."
Proper treatment of fractures of all types, particularly those possibly
related to metabolic bone disease, requires sophisticated interchange and
cross-consultation among specialties, including internal medicine, radiology,
endocrinology, and pediatrics. Much of what I learned about metabolic bone
disease, osteopenia, and/or osteoporosis has come from internists,
pediatricians, endocrinologists, and pediatric endocrinologists. For example,
work by twentieth century physician scientists such as Fuller Albright
(Harvard; 1900-1969) allowed us to fully understand renal physiology,
hyperparathyroidism, and its relationship to bone disease. I am certain that
the late Professor Albright would be shocked to find that orthopaedic surgeons
now claim to "own the bone."
Making a bold statement that orthopaedists should "own the
bone" seems counterproductive, with the potential to reintroduce
outdated prejudices regarding the intellect of the average orthopaedist
("strong as an ox and twice as smart").
I compliment the authors of the position paper on their good intentions and
would be interested in hearing their opinion as to whether moderation or
revision of their title might improve the chances for their campaign to
succeed.