We Live in Changing Times
Peter B. MacDonald, M.D., FRCSC,
President, Canadian Orthopaedic Association
As practicing physicians, particularly in orthopaedic surgery, we are reminded that there are changing times in health care, as well as in the world in general. With health care consuming up to 45% of the provincial budgets and trending upward each year, we are reminded that first and foremost, we must do whatever we can to make our system as efficient as possible.
A report released by the Canadian Institute for Health Information (CIHI) and Choosing Wisely Canada on April 6th, 2017 looked at selected medical tests, treatments and procedures across Canada and found that up to 30% of them were potentially unnecessary. These included CT scanning in a minor head trauma, the use of benzodiazepines in the Canadian senior population, unnecessary sleep medication in children, and MRI in low back pain, and other cases such as osteoarthritic knees.
We are reminded through Choosing Wisely that guidelines can be followed that are evidence-based and eliminate trends that tend to be historical and ingrained in our health-care system that have no benefit to our population. Recent media attention has highlighted the BMJ recommendations with regard to arthroscopy in the arthritic knee. This is not really anything new from a scientific point of view as it began with the late Sandy Kirkley and the Western University group with their randomized clinical trial published in the NEJM in 2008. However, although the trend is away from this procedure, there are still likely too many of them being done.
We also need to steward our imaging resources better. Use of unnecessary MRI’s such as in knee osteoarthritis are partly our responsibility in terms of educating primary care physicians as to the poor use of this precious resource. We all need to be more evidence-based in our practice and I look forward to our upcoming Annual Meeting’s Presidential Guest Speaker, Dr. James Wright, who questions our ability to be evidence-based in our practices on a daily basis.
It is important to be reminded of our social responsibility in orthopaedics. There are things that come through our practices that we either choose to ignore or fail to recognize including intimate partner violence (IPV) and the opioid crisis. We recommend that all orthopaedic surgeons refresh their IPV knowledge by reviewing the COA’s 2017 IPV Position Statement and Best Practice Recommendations. Our Standards Committee, chaired by Dr. Jeff Gollish, is taking a detailed look at the opioid issue and will report back to the membership shortly.
We are in final preparations for our Annual Meeting being held in Ottawa from June 15-18. Ottawa is a wonderful city to visit, especially during the nation’s 150th celebration activities, and our educational program offers quality content that is relevant to our entire orthopaedic community. This should be one of the best meetings in recent memory. Sherry and I look forward to seeing you all there!