Patient Communication

The Opioid Epidemic: What is our role?

“To see what is in front of one’s nose is a constant struggle”.  – George Orwell The United States is grappling with an epidemic of prescription opioid medications, and the statistics are frightening. Opioid prescribing remains higher in the United States compared with anywhere else in the world, and 80% of the world’s opioids are prescribed and consumed in this…
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Patient Communication

Forgive and Remember

Since I was informed of New York State’s investigation of my practice in 2010, when a drug-seeking patient complained that I did not prescribe postoperative narcotics, I have had ample time for introspection and self-evaluation. Indeed, I have asked myself how such a “good physician” and “good man” could be shamed so mercilessly, particularly since I, like Mark Chassin expressed…
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Ethics

Often Wrong, but Never in Doubt

The popular trope of the confident, arrogant and swashbuckling surgeon is usually as far from representing reality as a Norman Rockwell painting is from representing modern urban life. "Often wrong, but never in doubt" is a phrase bandied about medical schools for laughs to describe the attitudes of those who practice surgery. I am often wrong, often in doubt, and…
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Work/Life Balance

Happiness in Hand Surgery

One of the main reasons I chose the field of orthopaedics and later, hand surgery, was that my mentors along the way truly seemed to enjoy their jobs. The hand surgeons I encountered bantered with their patients in the clinic and played country music in the OR. They ran marathons and made time to attend children’s plays and sporting events.…
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Clinical

What is a p-value? The problem of hypothesis testing in observational studies

At a time when cost-effective, evidence-based care is increasingly demanded by patients, payers and our own professional organizations, research on outcomes of treatment has become more common. Over the past 10 years there has been a steady increase in the  levels of evidence reported in most of the journals read by hand surgeons. While this trend is encouraging in appearance,…
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Diversity

Where are the Women?

by Deana Mercer, MD and Robert R. Schenck, MD The number of women in orthopedic surgery continues to be a challenge for the  specialty.  Despite the percentage of women in medical school having increased from 6.9% in 1965 to 47% in 2014, the percentage of women in orthopedic surgery residency programs is less than 15%, the lowest percentage of women…
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Patient Communication

The Power of Words

A lot of our activity as providers of health care is gathering and providing information via the spoken language. I have noted through the observation of students and residents in training and critical reflection on my own experience, the power of words to create fear, anxiety, and uncertainty, or alternatively to create calm, reassurance and hope. Words, the ones chosen,…
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Clinical

Clinical Practice Guidelines – Burden or Boon?

The American Academy of Orthopedic Surgeons (AAOS) has released a new Clinical Practice Guideline on the Diagnosis and Treatment of Carpal Tunnel Syndrome. This document replaces earlier ones on diagnosis, published in 2007, and treatment, which appeared in 2008. There was a widespread perception that the recommendations made in the previous guidelines were weak and did not contribute substantively to…
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Ethics

Telling It Like It Is: Difficult Peer Conversations in the Outpatient Setting

Many of us have become leaders in our practices, ambulatory surgery centers (ASC’s) and hospitals by choice or circumstance. Leadership often means that difficult conversations with our fellow surgeons are part of our responsibility. Unfortunately, few of us are trained in the art of handling these conversations in a way that ends with the desired outcome, which is usually to…
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