Observership: Orthopaedic Clinic

I participated in some incredible observserhips (observership = shadowing a doctor) last week, which I’ve yet to blog about! Here’s the first of a few reports.

On Tuesday I was permitted to spend the day in an Orthopaedic Clinic. The types of patients seen here include post-operative follow-ups (e.g. knee or hip replacement), people wanting to know whether they would benefit from an orthopaedic surgery, and referrals from Family Doctors for orthopaedic problems which they are unsure about.

The doctor running the clinic was great about encouraging my participation. He frequently let me assess the patients (sometimes alone!), and we spent a great deal of time reviewing x-rays for positive findings.

An orthopaedic clinic has a neat set-up. They have their own x-ray unit at the end of the hall, and physiotherapists and occupational therapists working on-site.  There was also a fracture clinic on the same floor, but I didn’t observe any of the operations there.

There are some great things about orthopaedic practice:

• For most patients, you can have a tremendously positive influence on their health! I found the clinic to be a generally happy place, as most follow-ups were delighted with the results of their surgeries. It was remarkable to hear an older man describe how two days after his hip replacement he was experiencing less pain than ever before, and shortly thereafter had regained his mobility and could resume activities he had stopped before the surgery because of his arthritis.
• You get to read x-rays! In most specialities, official x-ray reports are made by radiologists. In orthopaedics, the surgeons are equally (if not more) qualified to read x-rays and are generally better at picking up musculoskeletal abnormalities on the image. If you like x-ray reading, this is a great plus!
• Almost all orthopaedic surgery is elective. Choosing whether to have your ankle bones fused, or your knee replaced, must necessarily be a balance between the benefits and risks of the surgery. It’s ultimately up to the patient to decide whether the pain and disability they are experiencing is sufficient to warrant the risks of surgery. In many cases, people will decide that it isn’t. There are often many lifestyle alternatives to surgery: reducing body weight can significantly reduce arthritic pain. 
• To quote our fearless Orthopaedics instructor: “It’s not rocket science!” In this speciality, first principles and a good physical exam go a long way to discovering the diagnosis.
• Lots of patients, and always increasing. As people live longer and our Canadian population is aging, the prevalence of osteoarthritis and other orthopaedic diseases is increasing. The amount of OR time dedicated to orthopaedics has only been increasing.

Here’s some not-so great things about orthopaedic practice (in my limited opinion):

• Short patient visits. As a specialist, you don’t truly get to know your patients and are often concerned with little more than their specific orthopaedic complaint. There is little time afforded to the person behind the arthritic knee. 
• Long, hard, gruelling residency. But then, that’s true of most surgical specialities.