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Orthopods, how about showing us some interprofessional respect?

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Surgeons are good at cutting things out. It’s what they do.

So it should be no great surprise that the British Orthopaedic Association and the British Association for Surgery of the Knee performed a very rapid insultectomy on a joint statement they released today.

The statement was in response to the recent research, and ensuing media reports, suggesting that all those knee arthroscopies they’re performing in the middle aged or older may be doing more harm than good.

And who’s to blame? Why, us GPs, of course. We’re ordering too many knee MRIs and thereby referring too many patients. The poor orthopod is just the poor innocent wielding an arthroscope, and doing what he’s told, at the end of this process.

Given this level of insight, it’s perhaps surprising that they realised including the phrase, ‘…if GPs are doing their job properly’ might not go down too well with their primary care colleagues. So within a few hours, that was given the chop.

They needn’t have bothered. The statement manages to piss us off regardless, with gems such as, ‘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.’

So let me make some statements to the BOA/BASK on our behalf.

1 Many of us don’t faff around with scans – indeed, we don’t have access to them when they really would be useful.

2 The individual who can order MRIs, and seems to delight in exploiting this, is the ‘Lower limb specialist practitioner,’ or whatever title the Noctor delights in down your way, which is who the patient inevitably sees when we really wanted them to consult an orthopaedic specialist.

3 We don’t refer patients for surgery, we refer them for an opinion. It’s your call – if they really don’t need an operation, feel free to tell them. Even if their expectations have been raised, you’re big enough and, let’s face it, ugly enough, to say ‘No’.

The teensy grain of relevance in your statement is that we GPs need to be careful what we wish for – if we want access to MRIs then we need to be sure we can contextualise and interpret the results. A fair, but very small, nut which, like most orthopods, you’ve used a sledgehammer to crack.

In the meantime, you knuckle-headed, ignorant, reactionary, petty, blame-shirking, quasi-carpenter tossers, how about showing some interprofessional respect?

Update: Hot off the press, I hear the BOA has apologised. Which is what any group of medical professionals doing their job properly should do…

Dr Tony Copperfield is a GP in Essex. You can follow him on Twitter @DocCopperfield.

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Readers' comments (12)

  • It's a shame that a bunch of professional would have written such a response to a research article.
    I am still wondering how as a GP, I can compel the orthopaedic surgeon to do arthroscopy!

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  • There has been no apology.A line has been added to say that their statement was not intended as a criticism or to cause offence

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  • funny in Canada some of the spinal and other orthopods wont accept referrals uuntil an MRI as been done. Does this make the UK backward or Canada over investigative wno knows.

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  • Spot on as always.

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  • In Nottingham City we GPs have direct access to MRI.Secondary care (or it's central triage service) will not accept referrals until one has been done.Perhaps that policy will need to change

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  • Vinci Ho

    We are really Jedi Knights !
    Because accordingly , we can use our Force to compel and hypnotise these orthopods to do things they don't really want to do !!!
    Wow! What a hideous way of giving us the compliment , thank you.
    May the force be with us , folks, the force is awakening indeed (don't miss the film coming in December , mates)

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  • Replicate this point of view across a whole swathe of secondary care and you get a rough idea of the kind of ignorance that exists out there isn't just orthopaedic surgeons is it...if only that it was the case

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  • Im(nvh)o, GPs (the good one) are the only doctors that rely on clinical skills and not whizzy gizmos to make a diagnosis. What else are a pair of ears and a pair of hands for? Once you get to hospital it's all expense and mostly futility..... Ears and hands are superfluous in secondary care - they have MRIs instead!

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  • I do not understand this at all. Not like E=MC2 [ ie speed of light is a maximum, if you push a photon it does not go faster, ergo the energy must become mass, so reasoned Einstein].
    Now, we have orthopods who do ALL the knee operations. There are, apparently, too many operations according to them.
    So, we GPs are to blame for all the extra operations, even though the orthos do them. Ergo, we must have a gun to their head or it must be some quantum phenomena like entanglement ie if orthos do the operation, it is the fault of the GPs who referred the knees for an opinion.
    I think the poor sods are mixing up opinions for operations.
    Simple mistake for orthos really. They cannot all be Einsteins.

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  • Worse is to follow. Since all the extra and unnecessary operations are the fault of the GPs who referred them, we GPs will also be responsible for all the complications, mistakes and be liable.
    MDU, better watch out.

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From: Copperfield

Dr Tony Copperfield is a jobbing GP in Essex with more than a few chips on his shoulder