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Likewise, AAOS quality efforts—such as our clinical practice guidelines (CPGs) and appropriate use criteria (AUC)—are respected by payers and government agencies because they are developed using systematic, well-defined methodologies that make it possible for readers to scrutinize every aspect of the decision-making process. We do not “cut corners.” It may take up to 2 years to prepare one guideline, and guidelines are reviewed every 5 years to ensure that they remain current and accurate.


Published 4/1/2014
Frederick M. Azar, MD

What Keeps Me Awake at Night

It may seem a little early in my presidency to be talking about what keeps me awake at night, but as Chief of Staff for the Campbell Clinic as well as a member of the AAOS Board of Directors for the past 6 years, I have had lots of sleepless nights. It is not only the big issues—whether we will be ready to make the switch to ICD-10 in October, what the impact of Obamacare will be on our patient load and payment mix, whether the Grizzlies will make the playoffs again this year—it is also the little things that assume importance in the context of larger issues.

One of those “little things” relates to professionalism. It is one of the reasons that the AAOS has such a leadership position in so many arenas. For example, the Journal of the AAOS, Academy-sponsored continuing medical education courses and AAOS texts are consistently ranked among the best in orthopaedic offerings because they reflect the quality, skill, and professionalism of our volunteer editors, faculty, and staff. The online Orthopaedic Video Theater presents high-quality, fair, and balanced programs that have passed a rigorous peer-review process. Unlike many “free” video sites that purport to be “surgical education,” the online Orthopaedic Video Theater includes outcomes data so that viewers can have a more complete understanding of the validity and efficacy of the techniques presented.

As for advocacy, the American Association of Orthopaedic Surgeons Office of Government Relations in Washington, D.C., is one of the most professional outfits I have been privileged to be associated with while serving the Academy. The Orthopaedic Political Action Committee (Orthopaedic PAC), under the leadership of Stuart L. Weinstein, MD, is the envy of other medical PACs. If you want to meet with your Congressional representative, staff and the volunteers on the Council on Advocacy will help ensure that you have the facts at your fingertips, whether the issue is payment reform, the in-office ancillary services exemption, or antitrust legislation.

When it comes to getting the word out and the message across, our communication professionals are tops. AAOS public service announcements, campaigns such as Decide to Drive and A Nation in Motion®, and publications such as AAOS Now, Headline News Now, and Advocacy Now have not only won awards, but also made a real impact on how the public—including media and legislators—perceives orthopaedic surgeons. And we have the data to prove it.

With all those premier examples of professionalism by the AAOS, why should I be lying awake at night worrying about the professionalism of our profession?

Me? “Old school”?
Part of the answer may be tied to generational differences. As I recalled in my remarks last month in New Orleans, when I was a resident, I prepared for surgeries by reading books in my program’s library the evening before. Today, my residents prep for the same cases by pulling up a video on their phone or tablet in front of the scrub sink. I am not sure about the degree of confidence that might engender if the patient on the operating room table was aware of that. As a quick refresher, watching a 2-minute video while prepping for surgery may be acceptable. But learning to perform surgery in 2-minute bits is not optimal without a solid foundation of knowledge.

Likewise, the image most patients of a certain age have of a doctor corresponds more closely to the gravitas of “Marcus Welby, MD” than the antics of “Scrubs” or “Gray’s Anatomy.” And when I think about it, even patients who grew up watching the crazy antics of the residents at the fictional Sacred Heart Hospital would probably prefer meeting a doctor who is well groomed and polished than one who looks like he or she just tumbled out of bed or off the couch.

With an increasing number of healthcare professionals who are not physicians but who have doctoral degrees and may be addressed as “Doctor,” it is important that we who are physicians stand out from the crowd. As much as I respect and appreciate the dedication of nurses, physician assistants, physical therapists, and healthcare administrators who have pursued higher education to such levels, I want my patients to understand that I am their doctor.

It may seem like a little thing, but being perceived as a professional—not only by your patients, but also by your peers and other stakeholders in the healthcare system—is important. In some arenas (notably legislative and regulatory areas, which govern so much of medical practice today), it is critical to look the part. You would not give testimony to a Congressional subcommittee wearing jeans and sneakers; why should you meet a new patient—who is just as critical to your success—wearing them?

To advocate effectively for our patients as well as ourselves, we must “take the high road,” and be professional in our demeanor as well as our arguments. We will be judged, individually and collectively as a profession, by how we respond to these unprecedented times of uncertainty and change. To quote George Bernard Shaw, “I learned long ago never to wrestle with a pig. You get dirty, and besides, the pig likes it.” Instead, to build credibility, we must focus on issues, build coalitions, propose solutions, and create common ground. One of the ways we can do this is by “maintaining professionalism in our profession.”

High-tech, high-touch
A decade ago, an image survey conducted by the AAOS found that patients identified orthopaedic surgeons as “high-tech, low-touch.” We had the tools and the skill set to improve people’s lives, but we were not seen as caring much about the people themselves. Today’s technology threatens to label all physicians that way. Busily entering data into electronic medical records, physicians may forget to look at patients. Trying to meet process measures, they may forget to listen to what the patient is saying.

So we must find ways to touch our patients. Not only with our skills, but also with our caring. I once read that a patient’s favorite thing to hear a physician say is the patient’s name. And here is where high-touch blends with high-tech. The Academy’s A Nation in Motion website enables you to tell your story—why you became an orthopaedist, what you find most rewarding about this profession, what you do in your “free” time, and which volunteer activities mean the most to you. These “surgeon stories” can tell patients as much about you as the cryptic reviews on healthgrades.com or vitals.com because they let your humanity and your professionalism shine through.

I encourage you to share your story and to urge your patients to share their stories as well. Our new campaign of “Second Firsts” lets patients share the moments after orthopaedic surgery that were so important to them because their surgery enabled them to return to an activity or occupation they loved.

In addition, these stories provide the grist for so many of our Academy’s efforts on both Capitol Hill and in state capitols. Whether we are advocating for a fair payment formula, for the convenience and coordination of care that in-office ancillary services provide, or for quality measures that reflect clinical outcomes rather than just clinical processes, patient stories and support are critical.

Over the course of this year, I hope to share with you other issues that keep me awake at night. Issues such as the paradigm shift in the education of physicians, the challenges of maintaining a united front for orthopaedics, and the multiple survival issues that face all of our members in today’s healthcare environment, from those in private practices to those in training institutions. They are just as critical to our profession as following the “Standards of Professionalism” established under the AAOS Professional Compliance Program.

Consider your own talents, strengths, and interests; then consider using them to help make our profession even better. In return, your Academy will do its best to support you on all fronts. And we can all sleep better.