I write in response to “Basing Practice on Evidence” by Terry Stanton (October 2010). I write to you prouder than I’ve ever been to be a member of the AAOS.

When the Evidence-Based Practice Committee of the AAOS and the Journal of Bone and Joint Surgery—American jointly developed Levels of Evidence and Grades of Recommendation for orthopaedic surgery, the hope was that these tools would change the practice of orthopaedics. The recommendations and practice guidelines on the use of surgery in the treatment of osteoporosis and spinal compression fractures—specifically the recommendation against the use of vertebroplasty—represent a pivotal moment in the history of orthopaedic surgery.

These guidelines signal two important messages. First, despite what might be financially beneficial to an individual practitioner, the practice of orthopaedic surgery can be governed by high quality evidence. The AAOS has clearly shown that our primary role as physicians is to base treatment decisions on the best evidence possible.

Second, this guideline shows that our primary focus as physicians is to “do what is best for patients.” No doubt this story will continue to evolve, and it is possible that vertebroplasty has some value in some subset of patients, but at this point, the AAOS and its members are committed to doing what is best for patients.

My congratulations go to Stephen I. Esses, MD; the members of the guideline work group; and John J. Callaghan, MD, and the members of the AAOS Board of Directors for putting patients first.

James G. Wright, MD, MPH, FRCSC
Toronto, Ontario

I noted with interest the AAOS Headline News Now story, “Physicians rarely use e-mail to connect with patients” (Oct. 8, 2010). In the Permanente Medical Groups, close to 100 percent of the orthopaedic surgeons correspond with their patients via secure e-mail messaging on a regular basis.

The Permanente Medical Groups contract with Kaiser-Permanente Health Foundation to provide medical care to Kaiser patients. The nearly 400 Permanente orthopaedic surgeons may represent the largest number of orthopaedic surgeons in a single group practice in the United States. Our surgeons use “Secure Messaging” to answer questions, relay test results, schedule surgeries, and sometimes just “chat” with patients. In fact, many of our patients and surgeons indicate that secure e-mail messaging is now their preferred mode of communication.

Secure e-mail messaging was introduced to our entire medical group by Thomas C. Barber, MD, a former member of the AAOS Board of Directors and past chair of the AAOS Board of Councilors, through his “Cyber-Kaiser” program. It has now been fully integrated into our Health Connect electronic medical record in the form of “Secure Messaging” e-mails.

Ronald Wyatt, MD
Walnut Creek, California