Posted by: Tony Copperfield2 July 2015
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.