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The Experience of an Orthopaedic Traumatologist When the Trauma Hits Home: Observations and Suggestions
Paul E. Levin, MD1; Emily J. Levin, BA, MS-I2
1 Department of Orthopaedic Surgery, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467. E-mail address: plevin@montefiore.org
2 Stony Brook University, School of Medicine, Health Science Center, State University of New York at Stony Brook, Stony Brook, NY 11794
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Sep 01;90(9):2026-2036. doi: 10.2106/JBJS.G.00914
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My daughter Emily and I were skiing in Vail this weekend. She has skied a few times since her accident, but she hadn't attempted the "bump" runs. Prior to her accident, she was an expert on these challenging trails. The conditions were good and she did it! The tears were coming to my eyes. It has been nearly seven years since she was a victim of multiple trauma. The wonders of modern trauma care along with expert physicians saved Emily's life and miraculously restored her to essentially normal function.
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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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    Paul E. Levin
    Posted on October 25, 2008
    Dr. Levin et al. respond to Mr. Krikler
    Albert Einstein College of Medicine/Montefiore Medical Center

    Emily, my wife, and I all appreciate Mr. Krikler's kind support of the value of articles highlighting the need for improved attention to the psycho-social aspects in the care of the trauma patient. We have read the report of his experience as a critically injured trauma patient and have reached many similar conclusions. Identifying a “conductor” or “captain of the ship” to oversee the management of complex trauma patients is crucial. This person must be immediately identified to the patient, the patient’s family, and the entire medical team. Although this individual should remain in regular contact with the patient and family, this individual does not necessarily have to be the primary communicator. Every institution has its own style, and in addition to the “conductor” they may also wish to identify an individual who can be a readily available source of current information and also act as a patient advocate. This individual may be a nurse, PA, or physician. (Assigning a house staff officer to this role could serve as a wonderful learning experience to a physician-in training). This individual must have enough time in an otherwise busy daily schedule to spend time with the patient and his/her family to explain in understandable language what is happening and what each physician is doing and ensure that the physician’s plans are being followed. Child life programs in childrens hospitals across the country have trained individuals who serve this function of both supporting the hospitalized child and the child’s family.

    Mr. Krikler also describes a loss of continuity of care as he was transferred from one unit to another; we experienced this as well. A loss of continuity of care reflects the need for better communication between the primary physician and consulting physicians as well as between a transferring and accepting physician. A verbal communication is an invaluable supplement to the usual consult note or “transfer summary”.

    We are truly hopeful that reports such as Mr. Krikler's and ours have a positive effect in improving patient outcomes following hospitalization for both major and minor traumatic events.

    Steve Krikler, BSc
    Posted on September 22, 2008
    Still closer to home
    University Hospital, Coventry, England

    To the Editor:

    I read with interest the account of a traumatologist experiencing trauma care from the wrong end (1). I too am an orthopaedic trauma surgeon; I too had the privilege of seeing what it's like to be injured (2). It is clear from both stories that the system could have done better. The question is, how do we educate our current and future colleagues to provide a better standard of care? Not surprisingly, this is a topic to which I have given much thought since my own experiences.

    I agree that the problem is most often one of communication; someone on the care team needs to take the lead, not only in managing the overall care of the patient, but also in communicating with the patient and their family. I prefer to think of this person as the conductor of an orchestra, rather than the captain of a ship, but whatever metaphor we choose, exactly who this is may not be as important as making sure that someone accepts and acknowledges this role. In addition, the identity and role of this person must be made explicitly clear to the other members of the team and to the patient and family. Ideally, this team structure with a lead manager and communicator should be in place from the outset and be involved in the patient's care until full recovery.

    Articles such as yours(1) are certainly helpful in raising the issues and, hopefully, prompting some recognition and discussion of the problems.

    The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of his immediate family, is affiliated or associated.

    References

    1. Paul E. Levin and Emily J. Levin The Experience of an Orthopaedic Traumatologist When the Trauma Hits Home: Observations and Suggestions J Bone Joint Surg Am 2008; 90: 2026-2036

    2. Krikler S J AMUART - Trauma From the Wrong End Injury. 2006:37:213-7

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