tag:blogger.com,1999:blog-7655407863660711763.post2628308435902409179..comments2023-04-13T15:43:17.917-04:00Comments on Billy Rubin's Blog: Billy Rubin To Orthopods: Man Up or Drop DeadBilly Rubinhttp://www.blogger.com/profile/04850166742797443954noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-7655407863660711763.post-63878262566608303122013-10-02T08:58:00.165-04:002013-10-02T08:58:00.165-04:00Thanks for your feedback, Doctor Week. Another yea...Thanks for your feedback, Doctor Week. Another year passes and still getting feedback on this piece! I'm just awestruck by the internet.<br /><br />I agree with everything you said with one exception. I don't dispute that, in the highly specialized, Balkanized world of modern American (Canadian? European? Japanese? can't comment, but probably) medicine there are all sorts of issues raised by who-should-care-for-what and what happens when you lose even basic medical knowledge when you don't use it on a daily basis. Likewise, I agree that every specialty requires a wealth of knowledge that outsiders may be clueless about, with a naïve take about, say, orthopods as being dumb jocks. (I was surprised when coming into medicine about how many stereotypes play out that one normally associates with high school, as I can't tell you the number of times I've heard slip about the nerdy, know-it-all ID folks.) <br /><br />That being said, my point--and I still think this holds true, unfortunately--was that I have found the problem, in private/community hospitals at least, to be -disproportionately- represented by these Sports Medicine types. Whence the source of my rant, which a) I wasn't seeing for the first time in this instance, and b) I've calmed down about mostly over the last two years. I do fret over the culture of Orthopedic Surgery and what leads someone to behave this way, and as I noted, the full time ID guy whom I was covering for didn't even blink when I told him this story in signout. I gather from your thoughtful reply that you are less likely to end up like this, and God Bless for that. I suspect that I would be served well in your care, which, by the way, are you in the southern New England area? I think I have completely fucked up my left rotator cuff and need an eval. Just in case.<br /><br />Best, BillyBilly Rubinhttps://www.blogger.com/profile/04850166742797443954noreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-82759131954224979472013-09-29T12:12:13.811-04:002013-09-29T12:12:13.811-04:00Billy, I completely understand your frustrations. ...Billy, I completely understand your frustrations. As Anon said, this isn't a strictly orthopedic problem but an individual problem. To extrapolate Anon's point, would you like the Orthopedic surgeon operating on your family member to be calling and looking up what another patient's Magnesium or blood sugar is with your family member asleep on the table? It's not that we don't know how but we do not have the time and that is not what we are trained in. Like the old adage goes, "If you don't use it, you lose it." We do not continue to maintain our competency in reading EKGs, for instance, and would be hesitant to not consult medicine for a patient with chest pain or uncontrolled blood sugars. <br /><br />It is interesting when other residents from other specialties spend time with us and leave with a new understanding of how hard we work and how in depth orthopedics is. It may not be "medicine" by your definition and may just be "bones" but we also understand our limitations and want to do what is best for the patient. A prosecutor would drool when reading a chart about an orthopod treating a post op complication medically on their own just as he would an ID doc who splinted a fracture (it's easy, right? I did it as a third year medical student). They also realize that it isn't as simple as they thought (i.e. press-fit vs cemented). When I get consulted about something I see as "simple" I try to see the consulting physician's perspective and it is easy to see their reason for the consultation. <br /><br />As an ortho resident we have experienced the same frustration you have. Patients have not been seen by a general surgeon, vascular surgeon, hospitalist, ID doc for days. Unfortunately it happens. There is no excuse, but it is a problem that is widespread throughout every specialty and seems to be provider and sometimes group dependant. I would be pissed if any provider didn't visit a patient for eleven days.The Weekhttp://medschoolweekly.blogspot.comnoreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-65111719813556698562012-06-29T07:53:12.116-04:002012-06-29T07:53:12.116-04:00Thanks, Anon, for your thoughts. It's been int...Thanks, Anon, for your thoughts. It's been interesting to see people giving feedback on pieces written 18 months ago! The magic of the internet.<br /><br />I had not thought of the reimbursement angle, to be honest. I tend to live in a cocoon about reimbursement, approaching my job with a child-like naivete about billing and just take care of whatever damn issue I think I can with medical competence. But that's because I generally get paid flat fees, either per shift or per weekend coverage, so I don't fret much over billing, letting someone else deal with that. Had I to be a workaday doc, I suspect my perspective would change. So I'm mindful of your point.<br /><br />Though that said, I fear the darker side of your point about reimbursement is that we have collectively shifted as a profession to the aptly-but-scarily named "health care providers" and away from "doctors". This orthopod in question was caring for a patient who was suffering a complication, and he did not visit her <i>for eleven days</i>. No good <i>doctor</i> would have allowed such a thing to happen.<br /><br />Thanks for reading up, and best, BillyBilly Rubinhttps://www.blogger.com/profile/04850166742797443954noreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-35316432410356045762012-06-28T23:41:11.259-04:002012-06-28T23:41:11.259-04:00I don't doubt that there are bad doctors out t...I don't doubt that there are bad doctors out there (of every kind including the orthopods you described) I could tell you about IM docs that have nearly killed their patients even though they were seeing them every day. These orthopedic surgeons are without a doubt horrible people but I would like to make clear that it is not the orthopedic surgeons do not know how to manage diabetes (its not very difficult). but it is time consuming and there is no reimbursement. Plus if the surgeon puts in a consult the IM doc WILL get paid for his extra effort. Lastly, dumb and smart is intrinsic and is only lost with pathology(i.e. dementia). Knowledge on the other hand will escape you with time. I challenge any doctor to read any page Miller's orthopedic review book and honestly ask themselves if they really understood what they read.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-42348025359003623452011-09-15T05:03:51.360-04:002011-09-15T05:03:51.360-04:00Orthopedics may be "clownfishes," but wi...Orthopedics may be "clownfishes," but with them filling up their pockets on that rate, that wouldn't be any problem.<br /><br /><a href="http://www.summitmedicalcenter.org/joint" rel="nofollow">summit orthopedics</a>Jennhttps://www.blogger.com/profile/00861945826052731439noreply@blogger.comtag:blogger.com,1999:blog-7655407863660711763.post-17648803235142265872011-01-20T02:03:46.063-05:002011-01-20T02:03:46.063-05:00I have always said "Smartest medical students...I have always said "Smartest medical students, dumbest doctors."Anonymousnoreply@blogger.com