Ponseti Broke the Iron Triangle

We need more disruptive innovation (and it need not be high-tech, as Dr Ponseti has shown)

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Comments by Stuart L. Weinstein and Thomas Parker Vail

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A Goldwater Rule for Sports Medicine

Obviously, physicians should not diagnose patients they’ve never met (but some commentary and analysis from afar can be kosher)

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Comments by Benjamin G. DombXavier A. Duralde, and Duncan C. MacCourt

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Bhandari’s Paradox

Fragility fractures of the femoral neck should be treated with total hip arthroplasty in many cases (but only rarely is this treatment chosen)

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Comments by Joseph M. Lane and Kyle J. Jeray

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Why Did You Apply in Orthopaedic Surgery?

Yes, orthopaedics is a wonderful field for those eager to fix things (but might the high pay contribute to its appeal?)

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Comments by Maureen T. Connelly and Scott E. Porter

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Want to Match in an Orthopaedic Surgery Residency? Send a Rose to the Program Director

Market congestion for residency positions may make students yearn for the old days of typewriter-on-paper applications (unless they borrow a trick from the online dating world)

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Comments by Alvin E. RothTerrance D. PeabodyKenneth A. Egol

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Viscosupplementation, Opioid Overuse, and the Excesses of Empathy

The opioid epidemic has been perpetuated by the action of some bad actors (but some well-intentioned actors have contributed as well, perhaps)

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Comments by Samuel Shem and Anna Lembke

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Rethinking the Resident Research Requirement

Asking a good question (even without answering it)  is better than finding gee-whiz results

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Comments by Mellick J. ChehadeStephen Pinney, and Kevin P. Black

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JoeCare: Free Health Insurance Coverage for All

Health insurance is not health care (and for that matter, health care is not health)

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Comments by Thomas C. BarberDavid GrandeLaura N. Medford-Davis, and Brian G. Smith

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Unnecessary Surgery Can Never Be Done Well

Those who purport to measure the quality of care without being able to measure appropriateness of care are full of it, or worse. (No parenthetical walk-back here)  

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Comments by Paul E. LevinKhaled J. Saleh, and Zain Sayeed

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Safety Alert: One in 200 Knee Replacement Patients Die Within 90 Days of Surgery

And one is 700 or so with need an amputation (Why isn’t this known by every patient contemplating elective knee replacement?)

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Comments by David Ring and Leonid (Ari) Kandel

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Ending The Residency Application Arms Race—Starting with the USMLE

If a lottery prize is worth $100, don’t be surprised to find rational players willing to spend almost $100 to win it (with much more than $100 wasted in total)

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Comments by Joseph ZuckermanS. Elizabeth Ames, and William C. McGaghie

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Two Patients, Two Operating Rooms, One Surgeon—Does The Math Add Up?

Spoiler alert: it doesn’t (but the problem can be fixed, maybe….)

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Comments by Alexander Langerman and Michelle M. Mello

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Learned Helplessness and Medicare’s Bungled Bundled Payment Program

Government policy with good intention,  fumbled implementation (have you ever seen that before?)

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Comments by Robert E. Mechanic and Vincent D. Pellegrini

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Inigo Montoya and Statistical Significance

This essay has very little do with Inigo Montoya –I was just name-dropping for attention–but if you read it, please reward yourself by watching this video clip

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Comments by Andrew GelmanDavid Trafimow, and Alex Reinhart

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Morbidity and Mortality Conference: Theater of Education

M&M is perhaps the worst formal method to teach medical error prevention (except for all of the other ways that have been tried from time to time)

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Comments by Charles L. Bosk and Christina L. Cifra

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Fibromyalgia is Real

Of course the disease is real for the suffering is real (the question is whether it is a musculoskeletal condition)

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Comments by Nortin M. HadlerDaniel J. Clauw, and M. Clement Hall

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Arthrostasis

It would be nice if all of our treatments were homeostatic (but some of our best ones are not)

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Comments by Scott F. DyeJaimo Ahn, and José Cordero-Ampuero

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Choosing Wisely

Professional courtesy these days is not about waiving co-pays, for that’s not allowed. (Real courtesy is being told what’s worth paying for)

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Comments by Sohail K. MirzaAugusto Sarmiento, and James Rickert

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Codman Was Right—Spread The Word

It’s not only for his eponymous Triangle or Shoulder Fracture Classification did Codman gain immortality: he also was the father of Outcomes Studies. (Though as Woody Allen observed, it may be preferable to gain immortality by not actually dying.)

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Comments by David C. RingNicholas H. Osborne, and Randale C. Sechrest

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Geriatric Hip Fracture Centers: The Time Has Come

We know a lot about how to care for geriatric hip fractures (but not every facility can implement these best practices)

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Comments by Stephen L. Kates and Kenneth A. Egol

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Specialization and its Discontents

“The man whose whole life is spent in performing a few simple operations…generally becomes as stupid and ignorant as it is possible for a human creature to become.”–Adam Smith

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Comments by Pierre J. HoffmeyerAugusto Sarmiento, and K. Daniel Riew

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Orthopaedic surgery is lucrative (but evidently not lucrative enough)

“Who is rich? One who is satisfied with his lot.”–Pirkei Avot 4:1 

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Comments by Elizabeth W. DunnMichael I. Norton, and Daniel Scott Horwitz

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The Myths of Femoroacetabular Impingement

We can agree that some people have “hip impingement anatomy”; some people have hip pain needing treatment now; and some people without pain will develop hip arthritis. (The problem: these are not necessarily the same people.)

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Comments by David A. RubinChristopher M. Larson, and Marc J. Philippon

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The ACGME Core Competencies are Overrated

The ACGME competencies are not everything (but as I learned from commentators, they are something)

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Comments by Mellick J. ChehadeStephen Pinney, and Kevin P. Black

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Defending Waste, Fraud, and Abuse

The definition of  waste, fraud and abuse is in the eye of the beholder (and when the beholder is a federal prosecutor, that can be a scary prospect)

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Comments by Carrie Valiant and Peter Cram

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Demerit Scholarships: A Method for Weeding Out the Marginally Bad Resident

We will pay dearly to attract the worthy (but not enough to repel the unworthy)

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Comments by William N. Levine and James E. Carpenter

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Not By Bread Alone: Shortcomings of the Pay-For-Performance Approach

Good performance may deserve a financial bonus (but if that’s all you say it deserves, Shaw knows what we are)

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Comments by Kevin J. BozicDavid S. Jevsevar, and David J. Shulkin

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Harvard Beats Yale and Other Fallacies

Small sample size can lead to misleading conclusions (though Harvard still is better)

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Comments by Saam Morshed and  Howard Wainer

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Free for Service: The Inadequate Incentives for Quality Peer Review

You can certainly attract reviewers for no rewards (but you will get reviews worth every penny you spent)

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Comments by Elizabeth WagerJames D. Heckman, and John L. Zeller

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Everyone (Else) is Conflicted 

Conflict of interest declarations are not necessarily helpful  (Actually, they may even be harmful)

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Comments by Mohit Bhandari and Don A. Moore

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Male Practice: Gender Inequality in Orthopaedic Surgery

We have come a long way from the days when the hospital sign on the men’s locker room door said “DOCTORS” (but not far enough)

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Comments by Laura Forese and Dawn LaPorte

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The Folly of Forecasting

A rough extrapolation may be the best guess we can offer (yet for some predictions, extrapolation alone [ignoring fat tails] is not only silly, but dangerous)

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Comments by Richard IorioSteven Kurtz, Kevin Ong, and Edmund Lau

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Orthopaedic Residency: How Do You Know When the “Cake is Done?”

It’s wonderful to promote residents early when their competency allows it (but what do we do when “never” is the right time?)

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Comments by Douglas DirschlGary E. Friedlaender,  and Robert S. Sterling

Getting the last word 

 

Other columns [Before the Last Word]

A Tribute to Fred Kaplan

In the Beginning was the Word

Lessons of the Prisoner’s Dilemma

Miranda Health Care Rights.

Physician Surplus and its Remedies

Consequences of Price Controls

Health Care Rationing

Fine wigns

Animal Rights v Animal Research: A Modest Proposal