Orthopedics

Orthopedic surgeons, physiatrists, and their patients writing on KevinMD about musculoskeletal care: back pain and the procedures that can weaken a young spine, knee and joint surgery, spinal stenosis treated least invasive first, non-opioid pain management and how it is paid, orthopedic residency and the women entering it, and what a patient in pain needs to be asked. Two maintained records draw on this archive: Opioids: what physicians and pain patients say, in their own words and Surgeons and surgery: what surgeons say, in their own words.

MKSAP: 67-year-old woman who takes diclofenac

mksap

Conditions and Diseases

August 5, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 67-year-old woman is evaluated during a routine examination. She has a history of hip and knee pain related to degenerative joint disease. The joint pain is now well controlled with diclofenac, which was started 3 months ago. A previous trial of high-dose acetaminophen was not effective. She does not have any …

Think you can do anything you set your mind to? Think again.

Thomas D. Guastavino, MD

Health Policy

June 8, 2017

During my salad days, I — like a lot of physicians — thought I could take on the world. Despite working in a smaller, community hospital, our ER saw a lot of the same type of orthopedic trauma I saw during residency. And my young partners and I took virtually every case that came in except spinal trauma. We did this whether we were on unassigned ER call or not …

Are you now, or have you ever been, a bad doctor?

Thomas D. Guastavino, MD

Physician

May 11, 2017

While I was in full-time practice, as far as I can tell, I received one bad anonymously written online patient review. It was on one of the numerous sites that exist but allows written reviews. The star rating is not much better since here you have no idea what the complaint is. However, the weight these reviews carry will increase, so we better take heed. Plus, given the fact that …

Beware of worthless procedures and epidural steroids for your back pain

Cathryn Jakobson Ramin

Conditions and Diseases

April 29, 2017

An excerpt from Crooked: Outwitting the Back Pain Industry and Getting on the Road to Recovery.

Near my office, there’s a breakfast-and-lunch joint where strangers sit down at shared tables. When Joseph, an attorney …

MKSAP: 79-year-old man with right hip pain

mksap

Conditions and Diseases

April 8, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 79-year-old man is evaluated for a 3-month history of right hip pain. He points to the center of his right buttock when asked to identify the location of the pain. He has no radicular symptoms. He reports no focal trauma but believes his symptoms began after he stepped off a curb that …

The unintended consequences of bundled payments

Peter Ubel, MD

Health Policy

February 28, 2017

Knee replacements are booming. Between 2005 and 2015, the number of knee replacement procedures in the United States doubled, to more than one million. Experts think the figure might rise sixfold more in the next couple decades, because of our aging population. Since many people receiving knee replacements are elderly, Medicare picks up most of the cost of such procedures. In response to this huge rise in expenditures, …

MKSAP: 68-year-old man with a right intertrochanteric fracture

mksap

Conditions and Diseases

January 28, 2017

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 68-year-old man is evaluated in the hospital for a right intertrochanteric fracture sustained in a mechanical fall. He reports right hip pain but no other symptoms. He has hypertension and type 2 diabetes mellitus and was in his usual state of health prior to the fall. He checks his blood glucose level several times …

MKSAP: 34-year-old man with progressive left knee pain

mksap

Conditions and Diseases

November 19, 2016

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 34-year-old man is evaluated for progressive left knee pain. The pain causes difficulty with his work as a mail carrier, particularly when walking. His occupation does not require repetitive bending. He played football in college and experienced left knee trauma during sports participation; he underwent left meniscectomy and stopped playing sports. His …

Can we break the cycle of chronic pain in patients following orthopedic injury?

Melissa Yu and Maureen McCunn, MD

Conditions and Diseases

August 30, 2016

A guest column by the American Society of Anesthesiologists, exclusive to KevinMD.com.

“You are the only one who truly understands your own pain.”

As one trauma survivor from the University of Maryland Shock Trauma Center in Baltimore told us: “The pain is with you 24/7. It is nonstop. And that is the hard part, you cannot escape …

The urge to create controversies in medicine can harm patients

Jonathan D. Gelber, MD

Physician

August 19, 2016

As an orthopedic sports medicine surgeon newly in practice, I read with interest Gina Kolata’s article “Why ‘Useless’ Surgery Is Still Popular.” As a doctor with a research background, I often champion the importance of research and promote a practice rooted in evidence-based medicine. It also came to me as no surprise when my partner and several physician assistants in the practice pointed out the article to me. …

Can chiropractors be saved? Only they can decide.

Roy Benaroch, MD

Physician

August 17, 2016

Can the chiropractic profession evolve and renew itself as a legitimate part of the health care system? Prominent Australian chiropractor Bruce Walker, who is also the editor-in-chief of the Journal Chiropractic and Manual Therapies, has proposed a 10 point plan to ensure that chiropractors create a profession based on science, knowledge, and genuine healing. He makes a strong case that chiropractors need to embrace research, shun “nonsensical elements,” …

How duty hour restrictions are hurting residency training

Anonymous

Medical Education

April 10, 2016

As I get near the completion of an intense 5-year orthopedic surgery residency program, I had an interesting interaction with our hospitals sub-committee specifically tasked to address duty hour and resident fatigue issues.

As they gave examples from other departments about changes made to their programs regarding duty hours, a clear-as-mud connection was continually made. They spoke of “improvements” made as the result of residents stepping up to serve as whistleblowers …

What surgeons aren’t saying about sex after hip replacement

Troy A. Miles, MD

Conditions and Diseases

April 2, 2016

As far as follow-up appointments go, this one was routine. My 65-year-old patient had undergone hip replacement surgery two weeks prior, and we discussed her pain level, progress with physical therapy, and eagerness to return to everyday activities. But as she stood up to leave the exam room, I could tell there was something left unsaid. She stepped out the door then stopped, turned around, and leaned in close to …

A physician puts his welfare in the hands of others

Samuel M. Chen, MD

Physician

November 20, 2015

“I have always depended on the kindness of strangers.”
– Blanche DuBois, A Streetcar Named Desire, Tennessee Williams

It was near the end of 2008 that I developed symptoms that I recognized as sciatica. The Internet is a wonderful source of information (and some misinformation). I decided to educate myself. In my reading, I encountered one study that indicated that patients who underwent surgery were better at one year, but about the …

Technology in health care requires context

Howard Luks, MD

Health Technology

November 15, 2015

Robert was the picture of health. He had run eight marathons and finished countless 5K and 10K races. He tracked everything from sleep to food intake, logging his exercise parameters religiously.

A seven-minute mile was a routine workout for Robert. But over the course of a few days, he noticed that he felt more winded during his run. One morning, when he awoke and checked his heart rate variability (HRV), it …

An emergency physician goes to the ER, and is shocked at the care she receives

Karen Shackelford, MD

Physician

November 2, 2015

I have lately been discussing the state of health care with a lot of doctors. I’m a doctor, and I’m also a consumer of health care services.

Imagine my surprise when I visited a local ER on a three day weekend, hoping to get some advice from someone who might be able to use the panoply of diagnostic tools available in the ED to help me mitigate the pain of a …

An orthopedic surgeon’s appreciation for personal trainers

James Amis, MD

Physician

October 23, 2015

Dear personal trainers,

I’ll admit it: I was skeptical.

In the past, I doubted that personal trainers — at least for me — could offer real value.

It’s not that I gave it much thought, or had anything against personal training, but if the idea were brought up, I’d laugh it off and say, “No personal trainer can push me harder than I push myself.”

But I’m writing this to say that I was …

The sad story of how “never events” prevent obese patients from getting new hips

Thomas D. Guastavino, MD

Physician

July 30, 2015

Daytime TV advertising is dominated by two players. Pharmaceutical companies with direct to consumer pitches and the so-called “toxic tort.” How confusing it must be to the average person to see a new drug pushed by one commercial, to be immediately followed by another commercial from a lawyer trying to sue for the known side effects of the exact same drug. It …

The day this physician was labelled as disruptive

Thomas D. Guastavino, MD

Physician

July 13, 2015

There can be little doubt that these days that political correctness has run rampant. Terms like “racist,” “sexist,” or “homophobic” are thrown around so frequently and early now that one has to wonder what is actually being accomplished. If you were to ask a physician what PC label they most fear, it would be “disruptive.”

Let’s face it. We are no longer …

The saga of the boot illustrates the problem of health care costs

Hannah Hayes

Patient

June 15, 2015

While there are worse times to sprain an ankle and chip a bone than just one week before a longawaited trip to Venice, I couldn’t think of one as I sat in the emergency room for eight hours last fall.

Venice, the place of canals and not cars; ancient bridges sans escalators. How ironic that just a few days before I was crowing to my husband over my hotel coup. A …

Orthopedics

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