This issue of AAOS Now reports that the AAOS has adopted two new SOPs—bringing the total to six. A six-pack of SOPs isn’t quite the same as some other six-packs I’ve known, but according to some fellows I’ve spoken to, they could be just as much trouble.


Published 6/1/2007
S. Terry Canale, MD

A six-pack of SOPs?

S. Terry Canale, MD

So what are SOPs? It’s not a new soap, or a new handheld device. Until 4 months ago, I thought SOPs were simply “standard operating procedures,” or maybe “scope of practice,” or “sign operative permit.” Considering the reaction to the first issue of AAOS Now, I guess many of our readers were also in the dark. But gradually, we’re coming around to accepting one more acronym.

For AAOS members, SOPs are “Standards of Professionalism.” But just what does that mean?

“Standards” are some minimal level of ethical behavior, determined by the membership, that AAOS fellows need to follow.

As for the meaning of “professionalism,” well, we obviously are not talking about white-collar jobs, nor being superior to an amateur, nor wearing a uniform. Acting professionally means practicing ethical behavior in the work place or, for that matter, practicing ethical behavior—period. Then, what does being “ethical” mean? The simplest, most cornball definition I know is simply “doing the right thing when no one is watching.”

How are SOPs “born”? The current SOPs have arisen from concerns of the fellowship, which have been brought to the attention of the Board of Councilors (BOC), Board of Specialty Societies (BOS), or Board of Directors. The two most recently adopted SOPs were authored by the BOC/BOS Professionalism Committee. The dedicated members of this committee drafted minimum standards of ethical behavior, which were reviewed, revised, and refined multiple times, presented to the BOC/BOS, the AAOS Committee on Professionalism, and the AAOS Board of Directors, and finally voted on by the entire Academy fellowship. (For more on how SOPs are developed, see the sidebar on page 48.)

The first SOPs, considered the “gold standard,” are on Orthopaedic Expert Witness Testimony. Most recently, the fellowship adopted SOPs on Advertising by Orthopaedic Surgeons and Orthopaedist-Industry Conflicts of Interest. The reasoning behind the advertising SOPs is outlined nicely in this issue of AAOS Now, in an interview that Jake Jaquet, our new Executive Editor, conducted with Murray Goodman, MD, chair of the BOC/BOS Professionalism Committee (page 46).

Most of the SOPs to this point seem straightforward, but now on the horizon are two SOPs that appear controversial. The draft SOPs on Orthopaedic Surgeons Treating Athletes included a section on the financial relationships among the team orthopaedist, the players, and the team itself. The draft SOPs on Orthopaedic Surgeons’ On-Call Professional Responsibilities deal with trauma and the obligation of the orthopaedist to take call—whether or not the surgeon is compensated for his or her time and services. As we report on page 40, the SOPs on the Orthopaedic Surgeons’ On-Call Professional Responsibilities have been sent back to committee to be reworked with input from the Orthopaedic Trauma Association, and the SOPs on Orthopaedic Surgeons Treating Athletes have been removed from consideration, with the recommendation that some of its provisions be included in the SOPs on Providing Musculoskeletal Services to Patients.

I believe the Academy is proceeding properly in developing new SOPs. Each SOPs is critically examined and developed with input from all those involved.

There is a very fine line between encouraging people to do the right thing and coercing them—under the threat of public exposure and expulsion—to follow restrictive guidelines. But we all realize that standards need to be maintained and penalties imposed to ensure that our patients, our colleagues, and even our government see our profession as serving the best interests of patients.

As Gordon Aamoth, MD, a past chair of the Ethics Committee and past member of the Board, has stated, this is the first time that AAOS fellowship has been able to put some “bite” in its “bark.” On the other hand, we don’t want to over-regulate ourselves to the point where it is no longer advantageous to be an AAOS fellow. As AAOS President James H. Beaty, MD, has said, “We want to circle the wagons, but not shoot inward at our members. So the message is to go slow and make the SOPs work for the members—not against them.”

If you, as an AAOS fellow, don’t believe you have a voice in these matters, send me your comments, and we will publish them right here, in AAOS Now!

Raising the minimum standards uniformly for all of our fellows will raise the overall standing of our Academy and our profession. As usual, the AAOS is ahead of the curve. We are in uncharted waters, with most of organized medicine cheering us on but fearing to follow.

I know we will do the next right thing, regardless of who is or isn’t watching us.