The American Journal of Orthopedics

Practicing sports medicine in a large Southern city has a number of pros and cons on an everyday basis. One of the many upsides is the trusting respect that patients have for their caregivers, doctors included. As an orthopedic resident in a large Northern city, I was often amazed at the distrust and skepticism that many patients showed toward the same professionals. I still believe—14 years later—that many of the surgeons I trained with are among the finest in the country, and they continue to lead the orthopedic world in many ways.

The trust that seems inherent in the population that I interact with on a daily basis can easily be taken for granted and/or misplaced. One manifestation of this misplaced trust occurs when a physician fails to educate a patient about their condition and treatment plan, and the patient is left wondering if the doctor is truly acting in their best interest, or if there are better options. On a daily basis, many patients who have come from every walk of life and every level of education simply want to better understand their condition and what their options are, in order to make an informed decision about what is best for them.

It is customary at this point in sports medicine practice to advise active people who suffer a torn anterior cruciate ligament (ACL) to undergo surgical reconstruction. Although the timing of surgery, surgical technique, postoperative rehabilitation, and return-to-activity criteria may differ from one surgeon to the next, the plan of care would generally be the same. The sports medicine literature would certainly support that there is more than one path to successful outcomes in ACL surgery, and it would also support there are some paths which are less likely to lead to success in some patient populations.

When encountering a patient whose surgeon did not explain the reasoning behind their specific treatment plan, what I find the most striking is that they had no idea that there was more than one way to achieve a successful outcome; they appreciate the education that we provide to help them decide which path to choose. In the case of ACL treatment, I believe that the treating physician should be well-versed in the available literature and offer considerable education to the patient about his or her options, and why the surgeon chose to recommend a specific treatment plan. I do not believe that simply saying that surgery is required, with no further discussion of the process and the inherent variables within it, is sufficient. With accessibility of information via any number of online sites, the dogmatic one-path-fits-them-all ACL surgeon may find that patients increasingly seek other opinions. The single-technique ACL surgeon may find happiness through years of successful outcomes—by his or her standards—but may ultimately find that savvy patients become aware of their other options.

I have sat through many national meetings and listened to respected surgeons talk about their techniques and innovation, along with their outcomes. Too many times I have heard that one technique, or one device, is better than another. I have also heard surgeons say with absolute certainty that a specific device or technique cannot lead to success. There is more than one way to drill a femoral tunnel for ACL reconstruction, and the ACL surgeon should be able to accomplish the goal of proper tunnel placement regardless of the technique he or she chooses. More than one graft option may lead to successful outcomes, and ACL surgeons should be skilled in the use of the various graft options. ACL surgeons should be versatile, not dogmatic and one-dimensional, allowing for a better understanding of the spectrum of injury. In saying this, I am certain that there is more than one path to successful outcomes in many of the injuries we treat as sports medicine physicians, and that thoughtful and considerate education of the patient regarding the reasoning behind our recommendations is of paramount importance.

Perhaps the patients I encountered in my training were not trusting right off the bat. I learned to watch and listen to my mentors as they communicated their knowledge to their patients. I fully recognize that clinicians who are reading this editorial likely are the ones most interested in education of both themselves and their patients. However, patients are increasingly aware that there is often more than one path to success, and I find it interesting that the medically uninformed patients seem to be more willing to accept this fact than many of the medically knowledgeable physicians.

Dr. Dugas is Editorial Board Member of this journal; and Fellowship Director, American Sports Medicine Institute, Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama.

Author’s Disclosure Statement: The author reports no actual or potential conflict of interest in relation to this article.

Am J Orthop. 2013;42(6):261. Copyright Frontline Medical Communications Inc. 2013. All rights reserved.

Practicing sports medicine in a large Southern city has a number of pros and cons on an everyday basis. One of the many upsides is the trusting respect that patients have for their caregivers, doctors included. As an orthopedic resident in a large Northern city, I was often amazed at the distrust and skepticism that many patients showed toward the same professionals. I still believe—14 years later—that many of the surgeons I trained with are among the finest in the country, and they continue to lead the orthopedic world in many ways.

The trust that seems inherent in the population that I interact with on a daily basis can easily be taken for granted and/or misplaced. One manifestation of this misplaced trust occurs when a physician fails to educate a patient about their condition and treatment plan, and the patient is left wondering if the doctor is truly acting in their best interest, or if there are better options. On a daily basis, many patients who have come from every walk of life and every level of education simply want to better understand their condition and what their options are, in order to make an informed decision about what is best for them.

It is customary at this point in sports medicine practice to advise active people who suffer a torn anterior cruciate ligament (ACL) to undergo surgical reconstruction. Although the timing of surgery, surgical technique, postoperative rehabilitation, and return-to-activity criteria may differ from one surgeon to the next, the plan of care would generally be the same. The sports medicine literature would certainly support that there is more than one path to successful outcomes in ACL surgery, and it would also support there are some paths which are less likely to lead to success in some patient populations.

When encountering a patient whose surgeon did not explain the reasoning behind their specific treatment plan, what I find the most striking is that they had no idea that there was more than one way to achieve a successful outcome; they appreciate the education that we provide to help them decide which path to choose. In the case of ACL treatment, I believe that the treating physician should be well-versed in the available literature and offer considerable education to the patient about his or her options, and why the surgeon chose to recommend a specific treatment plan. I do not believe that simply saying that surgery is required, with no further discussion of the process and the inherent variables within it, is sufficient. With accessibility of information via any number of online sites, the dogmatic one-path-fits-them-all ACL surgeon may find that patients increasingly seek other opinions. The single-technique ACL surgeon may find happiness through years of successful outcomes—by his or her standards—but may ultimately find that savvy patients become aware of their other options.

I have sat through many national meetings and listened to respected surgeons talk about their techniques and innovation, along with their outcomes. Too many times I have heard that one technique, or one device, is better than another. I have also heard surgeons say with absolute certainty that a specific device or technique cannot lead to success. There is more than one way to drill a femoral tunnel for ACL reconstruction, and the ACL surgeon should be able to accomplish the goal of proper tunnel placement regardless of the technique he or she chooses. More than one graft option may lead to successful outcomes, and ACL surgeons should be skilled in the use of the various graft options. ACL surgeons should be versatile, not dogmatic and one-dimensional, allowing for a better understanding of the spectrum of injury. In saying this, I am certain that there is more than one path to successful outcomes in many of the injuries we treat as sports medicine physicians, and that thoughtful and considerate education of the patient regarding the reasoning behind our recommendations is of paramount importance.

Perhaps the patients I encountered in my training were not trusting right off the bat. I learned to watch and listen to my mentors as they communicated their knowledge to their patients. I fully recognize that clinicians who are reading this editorial likely are the ones most interested in education of both themselves and their patients. However, patients are increasingly aware that there is often more than one path to success, and I find it interesting that the medically uninformed patients seem to be more willing to accept this fact than many of the medically knowledgeable physicians.

Dr. Dugas is Editorial Board Member of this journal; and Fellowship Director, American Sports Medicine Institute, Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama.

Author’s Disclosure Statement: The author reports no actual or potential conflict of interest in relation to this article.

Am J Orthop. 2013;42(6):261. Copyright Frontline Medical Communications Inc. 2013. All rights reserved.

Practicing sports medicine in a large Southern city has a number of pros and cons on an everyday basis. One of the many upsides is the trusting respect that patients have for their caregivers, doctors included. As an orthopedic resident in a large Northern city, I was often amazed at the distrust and skepticism that many patients showed toward the same professionals. I still believe—14 years later—that many of the surgeons I trained with are among the finest in the country, and they continue to lead the orthopedic world in many ways.

The trust that seems inherent in the population that I interact with on a daily basis can easily be taken for granted and/or misplaced. One manifestation of this misplaced trust occurs when a physician fails to educate a patient about their condition and treatment plan, and the patient is left wondering if the doctor is truly acting in their best interest, or if there are better options. On a daily basis, many patients who have come from every walk of life and every level of education simply want to better understand their condition and what their options are, in order to make an informed decision about what is best for them.

It is customary at this point in sports medicine practice to advise active people who suffer a torn anterior cruciate ligament (ACL) to undergo surgical reconstruction. Although the timing of surgery, surgical technique, postoperative rehabilitation, and return-to-activity criteria may differ from one surgeon to the next, the plan of care would generally be the same. The sports medicine literature would certainly support that there is more than one path to successful outcomes in ACL surgery, and it would also support there are some paths which are less likely to lead to success in some patient populations.

When encountering a patient whose surgeon did not explain the reasoning behind their specific treatment plan, what I find the most striking is that they had no idea that there was more than one way to achieve a successful outcome; they appreciate the education that we provide to help them decide which path to choose. In the case of ACL treatment, I believe that the treating physician should be well-versed in the available literature and offer considerable education to the patient about his or her options, and why the surgeon chose to recommend a specific treatment plan. I do not believe that simply saying that surgery is required, with no further discussion of the process and the inherent variables within it, is sufficient. With accessibility of information via any number of online sites, the dogmatic one-path-fits-them-all ACL surgeon may find that patients increasingly seek other opinions. The single-technique ACL surgeon may find happiness through years of successful outcomes—by his or her standards—but may ultimately find that savvy patients become aware of their other options.

I have sat through many national meetings and listened to respected surgeons talk about their techniques and innovation, along with their outcomes. Too many times I have heard that one technique, or one device, is better than another. I have also heard surgeons say with absolute certainty that a specific device or technique cannot lead to success. There is more than one way to drill a femoral tunnel for ACL reconstruction, and the ACL surgeon should be able to accomplish the goal of proper tunnel placement regardless of the technique he or she chooses. More than one graft option may lead to successful outcomes, and ACL surgeons should be skilled in the use of the various graft options. ACL surgeons should be versatile, not dogmatic and one-dimensional, allowing for a better understanding of the spectrum of injury. In saying this, I am certain that there is more than one path to successful outcomes in many of the injuries we treat as sports medicine physicians, and that thoughtful and considerate education of the patient regarding the reasoning behind our recommendations is of paramount importance.

Perhaps the patients I encountered in my training were not trusting right off the bat. I learned to watch and listen to my mentors as they communicated their knowledge to their patients. I fully recognize that clinicians who are reading this editorial likely are the ones most interested in education of both themselves and their patients. However, patients are increasingly aware that there is often more than one path to success, and I find it interesting that the medically uninformed patients seem to be more willing to accept this fact than many of the medically knowledgeable physicians.

Dr. Dugas is Editorial Board Member of this journal; and Fellowship Director, American Sports Medicine Institute, Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama.

Author’s Disclosure Statement: The author reports no actual or potential conflict of interest in relation to this article.

Am J Orthop. 2013;42(6):261. Copyright Frontline Medical Communications Inc. 2013. All rights reserved.

On behalf of the California Podiatric Medical Association, we wholeheartedly agree with Dr. Pfeffer’s opinion¹ that “The title of physician and surgeon is earned, and should be based on an educational standard established by a recognized accreditation agency, in this case the [Liaison Committee on Medical Education (LCME)], and not legislative fiat.”

We in podiatric medicine seek to achieve recognition of equivalency by objective proof—not by legislative sleight of hand. Esse quam videri—to be rather than to seem.

Since the initial announcement of the Joint California Podiatric Medical Association, California Medical Association, California Orthopaedic Association (CPMA-CMA-COA) Task Force, which was subsequently joined by Osteopathic Physicians and Surgeons of California (OPSC), the focus has been on objective evaluation of the education and training of podiatric physicians by qualified and unbiased representatives. The addition of an LCME consultant to the Joint Task Force provides greater assurance that an educational standard comparable to that established by LCME is being utilized.

We are sincere in our efforts to prove our equivalency to this Joint Task Force. We do not claim to be identical, just as current holders of the Physicians and Surgeons Certificate are not identical, having trained at differing types of institutions both in the United States and abroad. Rather, we want to show our equivalency in meeting the requirements of the Physician and Surgeon Certificate in California.

We do differ with Dr. Pfeffer’s understanding of the training of podiatric physicians and surgeons in that broadbased medical education not only is, but has been, an
integral part of the podiatric medical education and training since at least the early 1980s. An independent report—the Medio-Nelson Report—prepared for the Medical Board of California and dated October 17, 1993 bears out this fact. Much of this broad-based training is obtained alongside allopathic and osteopathic medical students and residents. As Dr. Pfeffer noted, “Podiatric medical school education
continues to improve in California.” All podiatric medical graduates in California now attend three-year medical and surgical residencies, following four years of podiatric medical school. Some, in addition, go on to attend fellowships in advanced specialties. The limited license that podiatrists obtain reflects the specialty we have chosen and not a limited education.

We are in full agreement with the medical community that all physicians and surgeons, though they may have unrestricted licenses, should practice to their education, training, and experience, which often involves a specialty.

Any significant differences identified by the Joint Task Force will be addressed so that we may take our certified place alongside our allopathic and osteopathic colleagues, as we have on a practical basis for many years and in a myriad of settings, including hospitals, surgical centers, and medical groups across the country.

We are proud to stand together with our allopathic and osteopathic colleagues in creation of the Joint Task Force, and look forward to the culmination of its efforts and realization of its goals.

Karen L. Wrubel, DPM, FACFAS

Dr. Wrubel is President, California Podiatric Medical Association, Hawthorne, California.

Am J Orthop. 2013;42(6):255. Copyright Frontline Medical Communications
Inc. 2013. All rights reserved.

1. Pfeffer GB. Podiatric “Physicians and Surgeons.” Am J Orthop. 2013;42(3):112.

The journal welcomes Letters to the Editor. Letters are not peer reviewed. Opinions expressed in letters published here do not necessarily reflect those of the editorial board or the publishing company and its employees.

On behalf of the California Podiatric Medical Association, we wholeheartedly agree with Dr. Pfeffer’s opinion¹ that “The title of physician and surgeon is earned, and should be based on an educational standard established by a recognized accreditation agency, in this case the [Liaison Committee on Medical Education (LCME)], and not legislative fiat.”

We in podiatric medicine seek to achieve recognition of equivalency by objective proof—not by legislative sleight of hand. Esse quam videri—to be rather than to seem.

Since the initial announcement of the Joint California Podiatric Medical Association, California Medical Association, California Orthopaedic Association (CPMA-CMA-COA) Task Force, which was subsequently joined by Osteopathic Physicians and Surgeons of California (OPSC), the focus has been on objective evaluation of the education and training of podiatric physicians by qualified and unbiased representatives. The addition of an LCME consultant to the Joint Task Force provides greater assurance that an educational standard comparable to that established by LCME is being utilized.

We are sincere in our efforts to prove our equivalency to this Joint Task Force. We do not claim to be identical, just as current holders of the Physicians and Surgeons Certificate are not identical, having trained at differing types of institutions both in the United States and abroad. Rather, we want to show our equivalency in meeting the requirements of the Physician and Surgeon Certificate in California.

We do differ with Dr. Pfeffer’s understanding of the training of podiatric physicians and surgeons in that broadbased medical education not only is, but has been, an
integral part of the podiatric medical education and training since at least the early 1980s. An independent report—the Medio-Nelson Report—prepared for the Medical Board of California and dated October 17, 1993 bears out this fact. Much of this broad-based training is obtained alongside allopathic and osteopathic medical students and residents. As Dr. Pfeffer noted, “Podiatric medical school education
continues to improve in California.” All podiatric medical graduates in California now attend three-year medical and surgical residencies, following four years of podiatric medical school. Some, in addition, go on to attend fellowships in advanced specialties. The limited license that podiatrists obtain reflects the specialty we have chosen and not a limited education.

We are in full agreement with the medical community that all physicians and surgeons, though they may have unrestricted licenses, should practice to their education, training, and experience, which often involves a specialty.

Any significant differences identified by the Joint Task Force will be addressed so that we may take our certified place alongside our allopathic and osteopathic colleagues, as we have on a practical basis for many years and in a myriad of settings, including hospitals, surgical centers, and medical groups across the country.

We are proud to stand together with our allopathic and osteopathic colleagues in creation of the Joint Task Force, and look forward to the culmination of its efforts and realization of its goals.

Karen L. Wrubel, DPM, FACFAS

Dr. Wrubel is President, California Podiatric Medical Association, Hawthorne, California.

Am J Orthop. 2013;42(6):255. Copyright Frontline Medical Communications
Inc. 2013. All rights reserved.

1. Pfeffer GB. Podiatric “Physicians and Surgeons.” Am J Orthop. 2013;42(3):112.

The journal welcomes Letters to the Editor. Letters are not peer reviewed. Opinions expressed in letters published here do not necessarily reflect those of the editorial board or the publishing company and its employees.

On behalf of the California Podiatric Medical Association, we wholeheartedly agree with Dr. Pfeffer’s opinion¹ that “The title of physician and surgeon is earned, and should be based on an educational standard established by a recognized accreditation agency, in this case the [Liaison Committee on Medical Education (LCME)], and not legislative fiat.”

We in podiatric medicine seek to achieve recognition of equivalency by objective proof—not by legislative sleight of hand. Esse quam videri—to be rather than to seem.

Since the initial announcement of the Joint California Podiatric Medical Association, California Medical Association, California Orthopaedic Association (CPMA-CMA-COA) Task Force, which was subsequently joined by Osteopathic Physicians and Surgeons of California (OPSC), the focus has been on objective evaluation of the education and training of podiatric physicians by qualified and unbiased representatives. The addition of an LCME consultant to the Joint Task Force provides greater assurance that an educational standard comparable to that established by LCME is being utilized.

We are sincere in our efforts to prove our equivalency to this Joint Task Force. We do not claim to be identical, just as current holders of the Physicians and Surgeons Certificate are not identical, having trained at differing types of institutions both in the United States and abroad. Rather, we want to show our equivalency in meeting the requirements of the Physician and Surgeon Certificate in California.

We do differ with Dr. Pfeffer’s understanding of the training of podiatric physicians and surgeons in that broadbased medical education not only is, but has been, an
integral part of the podiatric medical education and training since at least the early 1980s. An independent report—the Medio-Nelson Report—prepared for the Medical Board of California and dated October 17, 1993 bears out this fact. Much of this broad-based training is obtained alongside allopathic and osteopathic medical students and residents. As Dr. Pfeffer noted, “Podiatric medical school education
continues to improve in California.” All podiatric medical graduates in California now attend three-year medical and surgical residencies, following four years of podiatric medical school. Some, in addition, go on to attend fellowships in advanced specialties. The limited license that podiatrists obtain reflects the specialty we have chosen and not a limited education.

We are in full agreement with the medical community that all physicians and surgeons, though they may have unrestricted licenses, should practice to their education, training, and experience, which often involves a specialty.

Any significant differences identified by the Joint Task Force will be addressed so that we may take our certified place alongside our allopathic and osteopathic colleagues, as we have on a practical basis for many years and in a myriad of settings, including hospitals, surgical centers, and medical groups across the country.

We are proud to stand together with our allopathic and osteopathic colleagues in creation of the Joint Task Force, and look forward to the culmination of its efforts and realization of its goals.

Karen L. Wrubel, DPM, FACFAS

Dr. Wrubel is President, California Podiatric Medical Association, Hawthorne, California.

Am J Orthop. 2013;42(6):255. Copyright Frontline Medical Communications
Inc. 2013. All rights reserved.

1. Pfeffer GB. Podiatric “Physicians and Surgeons.” Am J Orthop. 2013;42(3):112.

The journal welcomes Letters to the Editor. Letters are not peer reviewed. Opinions expressed in letters published here do not necessarily reflect those of the editorial board or the publishing company and its employees.