The Ins and Outs of Knees and Hips

When I was training as an orthopaedic surgeon, one of my old bosses was always able to finish his clinic by 5pm, irrespective of how many patients attended. When asked about this remarkable skill he replied that the explanation was quite simple. It takes 3 minutes to see an orthopaedic patient, two if you are pushed for time. There is one minute to take a history, one minute to examine the patient and one minute to write a letter to their GP. If there were a late flurry of patients then the history taking could safely be omitted. This masterful exposition of the orthopaedic art was carried out in a room with only one chair on which he sat. For those patients considered a little to unsavory for close physical contact a walking stick was employed to elicit physical signs. This gentleman fitted firmly into the category of orthopaedic surgeons known to be strong as an ox and half as bright. Mercifully they have now long retired.

The next generation of orthopaedic surgeons has been listening to patients and I would proudly count myself as one of them. Indeed I have spent 35 years listening to and resolving the problems of patients troubled by knee and hip disease. It seemed to me early on that there were only so many questions that I could be asked and if I could formulate the answers in written form, this would be a great labour saving device. It wasn’t that I wanted to avoid explaining the problem myself. It was that most of what I said went in one ear and out the other, as I had discovered by being asked the same questions by the same patient at the next visit. What started off as a few printed sheets, rattled off a photocopier, grew into a comprehensive body of literature, covering all aspects of knee surgery and primary hip replacement. The booklets have always been well received by patients and rewritten on several occasions in the light of their comments and advances in knowledge.

I have now reworked the books for a more general readership under the umbrella title “The Ins and Outs of Knees and Hips.” Essentially there are suites of booklets in electronic format, bound together to cover single topics such as arthroscopy, patellar problems, ligament injuries, hip replacement, and all the variations of knee replacement both total and partial. Several of the booklets covering the medicolegal aspects of knee surgery, infection, and various controversial topics have been made available as single items.

Although the internet is awash with clinical information, much of it has been cut and pasted so many times that it has been reduced to a liquidized diet, devoid of inspiration or informed opinion. If you are a patient, the days of simply visiting a consultant surgeon and accepting meekly what he or she offers up should be past. Access to high quality information allows you to form at least one opinion, thereby empowering you to have a meaningful discussion with your medical advisor. My advice has always been that if you are not satisfied with the answers to your questions, get another opinion.

So if you are a patient, an interested member of the public, a physiotherapist, nurse, medical student or junior doctor and you are interested in finding out more about knee and hip problems, you will find it in the booklets. I should add that these are not ordinary educational booklets. They are populated by a rich array of humorous characters both original and taken from 19th century publications. The captions are not exactly what the first author intended, but seem strangely appropriate to modern orthopaedics. Just because the topic is serious doesn’t mean to say you can’t make it amusing.

One of my other bosses of the old school had an even more effective way of coping with a heavy clinic workload. He left his juniors to do the clinics on their own. On one celebrated occasion he arrived at noon for a 9 am clinic. He was still dressed in his sailing clothes complete with boots and apologised for being late declaring that he had missed the tide. Needless to say he has now sailed off into the sunset.

Source by David Shakespeare

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