ORTHOPOD EDITOR
Jeffrey P. Beckenbaugh, DO

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In This Edition

Abstract:
Peri-operative Dexamethasone for Control of Pain After Total Knee Arthroplasty

Indirect reduction and fixation of a Lateral Plateau depression fracture utilizing balloon tibioplasty in a cachectic, malnourished patient: A Case Report

Please Join Us at the Postgraduate Seminar

2012 Annual Meeting Recap

Changes Coming to the 2013 Annual Meeting

AOA Develops New Platform for Posting CME Credits for 2013-2015 Cycle

New FDA Ruling Prompts Added CME Option for Providers

Physician Payment Sunshine Act: Final Rule

Good Samaritan Regional Medical Center Orthopedic Surgery Residency Program in its Third Year

We Need More Doctors in Government - How About You?

SAOAO Report:
Student AOAO - A Glance at the Past and a Spotlight on the Future

RAOAO Report

Member Spotlight: Steven J. Heithoff, DO, FAOAO


Thank you to our preliminary exhibitors and supporters

Gold Level
DePuy Orthopaedics

Silver Level
Auxilium Pharmaceuticals
DJO GLOBAL
Innomed, Inc.
Smith & Nephew

Bronze Level
Biomet Orthopaedics

Exhibitors
American Osteopathic Board of Orthopedic Surgery
Auxilium Pharmaceuticals
BioMarin Pharmaceutical Inc.
Biomet Orthopaedics
BioPro, Inc
Bioventus
CeramTec
ConforMIS, Inc.
DePuy Orthopaedics
DJO GLOBAL
Elsevier USA
Exactech
Innomed, Inc.
Lippincott, Williams & Wilkins
Skeletal Dynamics
Smith & Nephew
The Progressive Orthopaedic Company
TranS1
Viztek
Wright Medical Technology, Inc.

Commercial Support
AOAO would like to thank the following companies for providing an educational grant:

DePuy Synthes USA

For the up-to-date list of exhibitors and products descriptions, click here.

We Need More Doctors in Government- How About You?

By Keith J. Frederick, DO, FAOAO


Dr. Frederick has been a member of the Academy since 1986. His son, Ben Frederick is a resident in Radiology in Columbia, Missouri (he is an MD). His daughter, Catherine Benbow is an DO (ATSU) and is a second year resident in family medicine in Springfield, Missouri, and her husband Andrew will graduate from ATSU this spring. His youngest daughter, Dorothy, just graduated from Missouri State University and is serving on an 11 month long mission trip to 11 countries.


I am a practicing osteopathic orthopedic surgeon and was elected in 2010 to the Missouri House of Representatives as the only physician in that body of 163 individuals.  My wife Marilyn and I recently went out to dinner with a couple of dentists and their wives who practice in my town.  One of them complained about something the state legislature had done in the dental field last year.  He complained that a new law would allow a dental school to employ a dentist to teach dentistry in our state even if his or her dental degree was not from the U.S.  I am now used to people ‘busting my chops’ over their pet issue, but I am also often prepared to fight back with the facts.

Dr. Frederick

Dr. Frederick and his wife, Marilyn

I recalled the hearing that took place in one of the Committees that I sit on, the Committee on Professional Registration and Licensure.  I quickly pointed out to him that dental schools in the state, the dental board, and the dental association had all testified in favor of the bill and that I did not recall anyone testifying in opposition to it. I told him that if he was dissatisfied with the way the legislature is treating his profession and patients, he should get involved in state government, become active in state politics, and even consider a run for the legislature.  When his wife heard my proposal to her husband, she put her fingers in both of her ears.  I have a feeling there won’t be any more dinners out with them till he has pledged not to run for so much as dog catcher!  

By the way, Marilyn and I discussed the idea of running for office a great deal before we decided to throw our hat in the ring.  Yes it is our hat, not your hat, when you decide to run.  Your spouse needs to be "all in" or it is a non-starter. Marilyn is a very capable and motivated person and without her help I really could not serve effectively in the Missouri House and have an active orthopedic practice.

Running a practice and being a member of the House of Representatives is not for the faint of heart, but then again neither is climbing the mountain of educational challenges necessary to become an orthopedic surgeon and to practice medicine these days.  My fellow orthopedic surgeons reading this, you are probably type A personalities or you wouldn’t be where you are now.  Each of you has what it takes to hold public office, except perhaps the will to do so, which is understandable.  I would like to convince some of you to consider running for public office.

First, I would like to shine a light on the many valid reasons not to run, some of which are listed below:

You will get some negative feedback.  I remember last year reading my email one Sunday morning and calling out to my wife this question,  “Honey, do you think I am a gutless coward?”  Thankfully this accusation did not originate from a disgruntled constituent, but rather was a mass email originating from out of state and send to legislators all over the country.  This person was upset about Obamacare. 

Parade

Dr. Frederick’s family and friends during a campaign parade

So why run for office?  Why not stay in your comfort zone, practice orthopedics, make your full salary, and have free time to pursue your interests?  I have a presentation that I give to physician groups entitled “Your House is On Fire” and the subtitle is “Your Patients’ Houses Are On Fire”.  In case you haven’t noticed, the practice of medicine is under siege.  Perhaps you have heard the joke that there are two ways to practice medicine, one is to go to medical school and the other is to get elected to the state legislature.  Simply put, if you don’t have a seat at the table, it is likely you will be on the menu.

Our profession is a grand and noble profession.  It has been established and nurtured through the dedication and selfless caregiving of generations of physicians.  The total immersion in the educational process, the length and difficulty of it, and the delayed gratification and personal sacrifices necessary to become a physician are unequaled by any other profession.  Yet, the profession of medicine is being torn down, and in a decade, it could be unrecognizable. If the physicians who make up this profession do nothing but acquiesce and comply with ever more onerous usurpation of the physicians and patients rights to have a patient-physician relationship, that historic and unique relationship will be destroyed.  My reputation used to be a result of how I took care of patients, but in the future it will be based on how closely I follow the algorithms of treatment established by government agencies, the Independent Payment Advisory Board and the Patient Centered Outcomes Research Institute.  Who decided it should be so and on what basis?  Was it evidence-based research that led to this wholesale change in the basics of practicing medicine?

A survey published last year by Medscape, and a landmark analysis by the Rand Corporation released this January, reveal that the promise that EHR’s would save billions of dollars and result in greatly improved care has not been realized due largely to systems being “neither interconnected nor easy to use”.  What a surprise!  We physicians knew this was the case, but until these results were published our voices were not heard.  There was no effort to assure that electronic health records would have proper user interfaces but rather, decisions were made that favored the bean counters to the detriment of the physicians and their patients. The doubling of mortality for patients at the Children’s Hospital of Pittsburg as early as 2002 after initiating a CPOE (computerized physician order entry) system was a red flag alerting us to the dangers of interposing software between physicians and their patients without sufficient thought.  Software companies brought to market EHR products that were years away from being ready.  Government money was responsible for this widespread and hasty adoption of EHR’s (including CPOE), and there was insufficient evidence base to support those launches. Programs were launched that failed to meet a host of the standards established by Human Factors Engineers for the development of information software, standards recognized as critical to success by fields requiring  high reliability  such as aviation and the military.  Those EHR’s were launched, though not ready, because companies wanted to capture a share of the available dollars awash in the system, compliments of the government.  If there were as many doctors involved in government as there are attorneys maybe that would not have happened.

The physician brings knowledge, experience and empathy to the patient/physician relationship. The patient brings specific needs, concerns and priorities, along with family concerns and together they develop a consensus of how to proceed. This most personal and individualized process takes place between the patient, including family, and the physician, including consulting physicians, when necessary.  That process and that relationship are being eroded.  The attacks on the patient/physician relationship are dismembering the culture of a profession that is a prominent part of the overall American culture.  We as defenders of the individual patient, and as members of the profession who have endured the crucible of medical training, yielding up a decade or two of the prime years of our lives to become physicians, cannot allow those who only know medicine by the numbers to redefine what the doctor/patient relationship is.  That, my friends and colleagues is big reason, though not the only reason, that I chose to enter politics.  As I told my friend the dentist, in Missouri the medical community may fail to prevail on any particular issue, but that will not happen because the medical profession was asleep at the switch.  We will not see a course plotted for medical care in our state without the input of physicians.  If our view as physicians is not adopted on a particular issue after we have made the case the best we can, then so be it.  I for one, however, know that our patients are depending on us to protect their relationship with us.   We cannot sit by and allow central planners to pull the levers and manipulate marionette strings that drive a wedge between patients and their physicians. 

Aside from the need for involvement due to concerns about medical practice, there is a case to be made that physicians should be involved with their government as any other citizen should be.  Informed, educated and dedicated people are needed to serve in government at all levels. There are plenty of attorneys in most state legislatures, but not many doctors.  Naturally, I have been outspoken on health related issues such as Medicaid reform, the roles of physician extenders and midwives, insurance exchanges, insurance mandates, prompt credentialing of physicians,  non physician roles in pain clinics, hospital licensure and inspections, medical liability, tanning bed restrictions, changes to the board of healing arts, and a host of others.  However, I am involved in and weigh in on issues as varied as elementary and secondary education, higher education, workplace liability, economic development, tort reform, abortion, the constitution, including second amendment rights and states’ rights, and many other issues of the day. Why should physicians fail to be involved in these decisions?

Dr. Ben Carson, a pediatric neurosurgeon who sprang on the national political scene last month, was asked why he thought he knew anything about politics and why he didn’t just stick to doctoring.  He asked how hard it could be, “I mean, it’s not brain surgery.” 

Why should you run for political office?

If you would like to know more about running for office, contact me at Keith.Frederick@House.Mo.Gov.   I also recommend a book entitled “How to Win a Local Election”, by Judge Lawrence Grey. 

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