Amazingly, orthopaedic surgeons rated themselves lower in these same qualities in 2008 than they did in 1998. This can be interpreted as a sign that they are more aware of their limitations and shortcomings, and awareness is the key to change. Orthopaedists have realized that it’s about the patient and have stopped thinking that “it’s all about me.” (See “How are your interpersonal skills?”) Congratulations to John R. Tongue, MD, and the Communication Skills Workshop mentors for helping bring about this change in attitude.


Published 9/1/2009

Say what you mean, mean what you say, but don’t say it mean!

Recently, the AAOS completed a follow-up of a 10-year-old survey about what the public and patients think about orthopaedists (“Low-touch surgeons in a high-touch world,” AAOS Now, May 2009). I am pleased to announce that, compared to the 1998 survey, the 2008 survey found that people are more aware of what an ortho­paedist is and what he or she does. In 2008, 59 percent of consumers associated “bones/surgery” with orthopaedists, compared to just 46 percent who made that association 10 years ago.

Both surveys also asked about interactive communication skills such as listening. In 2008, patients rated orthopaedists significantly higher in areas such as “spends time answering questions” and “is caring and compassionate” than they did in 1998.

S. Terry
Canale, MD

A disturbing finding
The survey did include, however, one disturbing finding concerning how orthopaedists think about other orthopaedists. Although camaraderie may be too much to ask for, support and respect should at least be present. When 55 per­cent of the public rates ortho­paedists as caring and compassionate, and only 32 percent of orthopaedists rate their fellow surgeons as caring and compassionate, that’s almost embarrassing (
Table 1).

These figures were discussed by the Communications Cabinet, and this is what I really want to talk about. This is not about expert witness testimony against a fellow orthopaedist—the AAOS can handle that through its professional compliance program. No, this is about a more subtle, but probably larger, problem.

The scenario goes something like this: a patient comes to the office seeking a second opinion for a recommended treatment or is dissatisfied with the outcome of treatment provided by another orthopaedist. Orthopaedic surgeons, including me, generally are very competitive and have large egos; this can be a very specific communication problem. Patients eagerly await our opinion—or our second opinion—on how they were treated by the other surgeon or orthopaedist. How we, as orthopaedists, respond and the message that we send are important. It’s more than what we say or don’t say; it’s also our body language (raised eyebrows, shoulder shrug, authoritarian demeanor). Patients pick up on every word and attitude and we need to realize this.

Several articles have been written on professionalism and ethics concerning an orthopaedist’s obligation to objectively give his or her opinion on the treatment by another physician or orthopaedist. I think we can all agree on this point. If the treatment has been poor, then ethically we should say so, but how we say this is important to avoid conflict and litigation. I remember being advised to “say what you mean, mean what you say, but don’t say it mean.”

How you say it is important
Patients are notorious for misinterpreting what physicians say, so we need to be careful about how we respond concerning other physicians. It’s easy to push our own agenda at the expense of the other orthopaedist. It’s easy to agree with the patient’s anecdotal description of his or her treatment by another physician even when we have no objective evidence. We must learn to guard against this. We must learn to communicate objectively with these patients. Our communication skills have improved, but we need to improve our skills in responding to inquiries about other orthopaedists. Although it’s difficult to change how you feel about someone or something, how you communicate that feeling can be changed (say what you mean, but don’t say it mean).

Many times, the problem is our own egos as we compete with the orthopaedist down the street (it’s all about me). Having been in orthopaedics for 35 years and having seen more than 170,000 patients, I can tell young orthopaedists that if a patient goes to another orthopaedist or is “stolen” away, the initial resentment means nothing over the long haul. We need to leave our egos and competitiveness at the door and give every patient our best effort—remembering that it’s all about the patient and not “all about me.”

This requires a certain amount of humility. I am certainly no expert on humility, because I have so little of it! Humility is difficult to define, but one of the best definitions I have heard is knowing exactly who you are, no more and no less. If you stay within the boundaries of “who you are,” you won’t have to worry about what—or how—the other fellow is doing.

Besides leaving our own egos at the door when we enter the exam room, I think it’s important to realize that it’s easy to disparage a result when you weren’t there and don’t know all of the circumstances that contributed to the result. We need to give our fellow orthopaedists the benefit of the doubt.

Say what you mean, mean what you say, but don’t be mean about it.


  1. Capozzi JD, Rhodes R. Ethics in Practice. Poor clinical results. J Bone Joint Surg Am 2001; 83:1595-1597.
  2. Cornwall R. Ethics in Practice. Teaching professionalism in orthopaedic residency. J Bone Joint Surg Am 2001; 83:626-628.