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Orthopaedic groups apologise after claiming that ‘GPs not doing their job properly'

The representative groups for orthopaedic surgeons has been forced to apologise after putting out a public statement claiming GPs are to blame for patients undergoing needless keyhole knee surgery.

The British Orthopaedic Association (BOA), in a joint statement with the British Association for Surgery of the Knee (BASK), said patients were being set up for failed arthroscopy because GPs were over-diagnosing patients with non-arthritic complaints and referring them on with the expectation the surgeon would ‘cure’ the problem with the keyhole procedure.

It also claimed GPs were not ‘doing their job properly’ by failing to prescribe exercise to patients before referring them for surgery.

This sparked fury from GPs, including Hampshire GP Dr Michelle Sinclair, who accused the groups of being ‘patronising, arrogant idiots’, while others pointed out that they ‘refer to get an expert opinion, not an operation’ and that the BOA/BASK response amounted to ‘unbelievable peer-bashing’.

RCGP chair Professor Maureen Baker tweeted that she was ‘outraged and saddened’ by the statement.

However, the groups quickly moved to apologise to GPs, saying it was not their intention to ‘criticise or offend’.

The original statement by the orthopaedic groups was in response to a BMJ paper - widely reported in the lay press - in which experts said arthroscopy should be phased out.

They argued it offers only very limited reductions in pain while putting patients at risk of life-threatening complications such as deep-vein thrombosis.

The team said that one reason so many patients are still undergoing the procedure - some 150,000 in the UK every year - is because surgeons were biased in their belief it worked.

BOA/BASK hit back with a statement to their members and patients asserting orthopaedic surgeons only offered arthroscopy when it was appropriate and that many patients with arthritis were wrongly being referred by GPs for the procedure.

The statement began: ‘Many GPs have direct access to MRI scanning, believing that performance of this investigation replaces the traditional medical skills of history taking and physical examination of the patient.’

It continued: ‘If MRI scanning is performed too early in the investigative pathway then over diagnosis of meniscus lesions predominates. Very often the arthritic knee has an associated and often irrelevant meniscus tear. The MRI scan result then triggers referral to an orthopaedic surgeon with the expectation by the patient that the knee problem can be “cured” by a knee arthroscopy.’

BOA/BASK also said that - contrary to the paper’s assertion that patients should be advised to take exercise instead of going ahead with surgery - GPs should already have tried this before referring a patient.

The statement read: ‘It is stated that such patients should be treated with exercise, but if GPs are doing their job properly, exercise should already have been prescribed in primary care.’

However, following Professor Baker’s intervention on Twitter, the groups issued an apology.

They said: ‘Following the response to the BOA/BASK statement regarding knee arthroscopy dated 19 June we would like to clarify that our intention was not to criticise or offend GPs. The aim was to highlight the gaps in the MSK general knowledge base and we apologise to our colleagues.’

Readers' comments (56)

  • Bob Hodges

    Hands up if you can name more than two types of antibiotic?

    I can.

    Microbiology won't let me use them though.

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  • In the Colchester area, GP's do not have access to MRI's. Even if I did, I would not be requesting it. The decision to do investigations and arthroscopy lies solely with the orthopedic surgeons, who need to take responsibility for their actions. Not try and blame others for their decision. I to do not see any sort of an apology. Pulse please change the headline to "no apology given by stuck up good for nothing useless orthopedic surgeons to GP's"

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  • Let me see if I can get this right. I stop requesting knee MRI scans. Everyone who comes whining to me about having a Bad Knee for which physiotherapy "didn't work" and wanting to get a scan like their next-door neighbour's granny's hairdresser got, and to See Someone About It, gets referred straight to orthopaedics with the advice that they mustn't let the surgeon fob them off with a keyhole operation because keyhole operations also don't work.

    The MRI scan can go on the secondary care tab. The orthopod loses the patient's confidence when, as usually happens, they advise an arthroscopy.

    Sorted.

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  • When I see a gp signature on the consent form for an arthroscopy, I will take this group more seriously. Until then, I would suggest they sort their own house out first before casting stones at others. By definition, specialists are specialists and should be leading on any new changes in management. If all they are going to do, is carry out a procedure because the patient happens to be in front of them, then I would suggest they shouldn't be practising. If the procedure isn't appropriate for the patient, don't to it. As well as potentially doing harm by carrying out a needless procedure, you re-enforce to the generalist, the gp, that the procedure is appropriate and hence the generalist keeps referring in. Once a few letters start going out from the hospital, that this type of patient doesn't need this procedure, gps will follow. To imply that gps should be leading the way in a specialist field misses the point of being a specialist!

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  • This is all a bit confusing.
    The original article semed to blame GP acess to MRIs (is this common?), GPs for not having a. ordered a weight-bearing Xray (not available when I retired), not having ordered exercise &/or physio (whether or not they had) *and* for giving patients the expectation that a. their knee pain was due to a meniscus lesion and b. that the outcome of the referral would be an arthroscopy with instant cure.
    Where did they get this impression?
    Sounds like a caricature of an Orthopaedic Surgeon having a bad day.
    Are we *sure* the BAO didn't confuse their dates and think it was 1st April?

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  • Most GPs know that arthroscopy does not help, but referral for another opinion is frequently pushed on GPs by patients who have tried numerous analgesics, NSAIDs and courses of physio. That does not mean that an Orthopaedic Surgeon is compelled to perform an arthroscopy though. I believe that in many instances Orthopods also feel pressurised by patients to do an arthroscopy

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  • Am I right in saying that if an Orthopedic surgeon does an arthroscopic procedure when they think it is not clinically necessay it is tantamount to causing grievous bodily harm with intent.

    Also if these Orthopedic surgeons were practicing in a place like Australia where they are paid per service/procedure would they adhere to the conservative management that they pretend to be advocating at the expense of their income.

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  • Who cares what they think.Patient demands referral patient gets referral.That's the world we live in.NHS lives,NHS dies,not my concern.

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  • silly stupid comment by this orthopaedic group..also unprofessional to make such a puerile statement in public so putting the whole profession into disrepute.
    quite pathetic.

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  • what s wrong every one hates us anyhow , Sheeshe we hate each other
    Its a dog eat dog world and only bu*****ters get ahead
    Take a look around and you you will see I am telling the truth
    to coin a phrase to make a man/woman sweat all organs can do what they want but its at anus that always wins
    moral of the story

    The A***Hole is always in charge

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