‘You could look it up’

Editor’s note: The Final Cut is a recurring editorial series written by a member of the AAOS Now Editorial Board.

Communication affects everything surgeons do. Success in our practice depends on how well we communicate with our patients, our colleagues, government officials, and the public at large. Education, social media, and online forums have now become vital parts of our practice.

Legendary New York Yankees Manager Casey Stengel, who won more World Series than any other manager and was a master communicator, had a saying when reporters asked him a question: “You could look it up!” And certainly now, with so much information at our fingertips in the digital age, it’s easier than ever to “look it up.”

The shift to digital
The world has gone digital. Print newspapers and magazines are slowly going out of existence or transitioning to online formats. Cable TV subscriptions are declining as younger viewers are “cord cutting” and moving to digital streaming platforms. Even the Academy’s Journal of the AAOS^®, “the yellow journal,” has recently announced that it will cease sending out a print edition in favor of an online format.

At this point, it makes sense to look back at how orthopaedic communication has changed over the years.

I started practice in 1980. Although it has been fun to watch the growth of our field and the expanding surgical techniques and technology, it has been just as interesting to follow the evolution of communications.

When I started in orthopaedics, medical records were often written by hand; some were dictated and transcribed. Records had to be copied and then mailed or hand delivered. A new technology, the facsimile machine or “fax,” had just arrived on the scene. Suddenly, it was possible to send records from one office to another or to get lab and imaging results as soon as they were ready.

Back then, it was important to make sure that your practice had the correct listing in the telephone book. To market aggressively, you might take out a quarter-page or half-page ad in the commercial directory known as the “yellow pages,” or you might buy an ad in some of the smaller local directories printed commercially not by the telephone companies themselves. And, of course, a practice grew by reputation and word of mouth.

It’s been a long time since anyone picked up a real telephone book. Marketing is now done online or, in some cases, with bigger media, such as billboards, broadcasting, or cable advertisements. In some situations, your hospital might even market your practice. It used to be taboo for physicians, large practices, or even hospitals to market themselves on billboards or television. Now, physicians and hospitals advertise their skills and results directly. Even cost is a factor, as some surgeons will market a procedure as “covered by insurance.”

How patients interact with physicians
Studies show that at least 59% of all patients get information about their physicians and medical treatments from the internet. Among patients aged 45 years or younger, the percentage is much higher.

Just as we used to take out an ad in the local telephone book or in the “yellow pages,” we now must have a presence online.

Virtually every physician’s practice has a webpage, whether it be a specific page for the individual or a page on a group website. Some companies, such as implant manufacturers, even have web listings of surgeons who use their products.

About 35% of orthopaedic surgeons have a presence on social media, such as Facebook, X, or LinkedIn. Many younger surgeons have moved away from these sites and now use non-legacy social media such as TikTok or YouTube Shorts. A presence on social media allows you to comment on local events and also promote the things you have done.

This online presence also means that patients know everything about you before they visit your office. They know how old you are, where you went to school, and where you trained. They know whether you have had any malpractice suits or board actions. Anecdotally, they know about both your good and bad results from online patient reviews.

Beyond finding a new physician, the digital world is also changing the clinical visit itself. Thanks in part to the COVID-19 pandemic, telehealth visits have become a popular option. They are a good way for a surgeon who has already examined a patient to recommend and discuss a surgical procedure once MRI results have been obtained, for example.

Increased access to information
Many physicians now have portals where patients can review their records and get their latest test results. Patients may also get their results from a hospital or private testing center. It does create a problem, however, when patients get results but don’t know how to interpret them. I know one breast surgeon who makes it a practice to get biopsy results first, before the patient sees them, and call them right away, so that the patient will not be alarmed or take the results out of context.

Patients have many more sources of education than they used to. Years ago, patients had to go to a medical library and read a textbook or journal to find out about a disease or surgical procedure. Now, all that information is online, and most of it is free.

As surgeons, we have to provide more information than ever before.

I was lucky enough to be on the ground floor when AAOS started online patient education. Your Orthopaedic Connection first appeared in 2002 as a collection of informative articles written by AAOS staff with basic, cartoon-style illustrations. Over time, the site changed its look along with its name — OrthoInfo — with new fonts and indexing. More picture illustrations were added, along with animations and videos. In 2017, the current site was developed with drop-down menus, better navigation, and behind-the-scenes content management. The updated site was created to be “responsive,” so that it has the same appearance on phones or tablets as it does on a desktop computer. Patient interest was high, with more than 37 million visitors per year.

It is our responsibility to make sure that our patients get the best information.

We can encourage them to visit reliable sites, such as OrthoInfo, by providing references, links, and QR codes when they come to our offices.

Orthopaedic education in the digital age
Communication with patients is important, but how we as surgeons communicate with one another is also vital. In the past, if you wanted to learn how to do a procedure before you went into the OR, you pulled out an orthopaedic text and looked at the illustrations. An industry representative might give you a technique brochure for a new product. Over time, that same representative may have advanced to giving you a surgical video on a VHS tape and later a DVD. Now, you can go online anytime, from anywhere, and see that same video.

It’s not uncommon to see residents sitting in the surgical lounge, looking at their phones and watching a video before they go scrub in with the attending.

It used to be that to communicate and learn from other surgeons, you either had to pick up the phone, go to the hospital lounge, or travel to a meeting somewhere. Now almost half of AAOS courses are virtual.

With online group forums, you can reach an unlimited number of surgeons at one time from around the world. You can post pictures and videos to explain a challenging case or problem. Chances are that if you have a problem or complication, you’re not alone.

Much like the practice of orthopaedic surgery, communication has changed and evolved over my professional lifetime. But no matter what form it takes, it is still a vital part of our practices.

More than ever, if there is something you need to know, “You could look it up!”

Stuart J. Fischer, MD, FAAOS, is an orthopaedic surgeon in private practice in Watchung, New Jersey. He also serves on the AAOS Committee on Ethics and Outside Interests, AAOS Adult Reconstruction-Hip Program Committee, and the AAOS Digital Health Task Force. Dr. Fischer is also a member of the AAOS Now Editorial Board.

Reference

1. Fox S, Duggan M. Information Triage. Pew Research Center. Jan. 15, 2013. Accessed Oct. 6, 2025. https://www.pewresearch.org/internet/2013/01/15/information-triage/