One More Turn of the Wrench*
James H. Herndon, MD

President Tolo, members of the Academy, and guests:

Thank you for giving me this opportunity to speak to you this morning and the honor of serving our Academy and its members. As your President, I pledge unflagging commitment and dedication to the support of orthopaedics. I also pledge to you, the leaders of our profession, to help our profession to focus on some whole truths about a situation that threatens the things we value most—the trust of our patients and our autonomy as professionals. When our health-care system began its strained relationship with managed care, leaders forecasted that enormous change would continue for ten years before the marketplace stabilized. Nothing could be further from the truth. Today, just as ten years ago, we are continuing to experience tremendous turmoil in our troubled health-care system. Physicians, patients, employers, and policy makers seek stability, but change is constant and will continue. The current wave of change is being driven by increased concerns about costs, quality, and accountability. Is our system delivering to its potential? Are patients receiving the right care of the highest quality?

The truth is that the orthopaedic surgery being practiced in this country is the finest in the world. The truth is that our medical school faculty and residency faculty teach the best medical and surgical practices in the world. The whole truth is that we can do better. We can and we must do better to ensure our patients' safety or risk losing what we cherish most, the trust and respect of our patients. Concerns about quality and safety are having a tremendous effect on the relationship between physicians and patients—in the best case, we act as equal partners and, in the worst case, as adversaries. The truth is that our Academy is the premier professional organization offering …

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