“There is room for words on subjects other than last words.”
― Robert Nozick, Anarchy, State, and Utopia

Shubik Dollar Auctions and the Infinite Cost of Residency Applications

It may be crazy to spend without limits on a quest for a residency position (but it’s not illogical, once you start).

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Comments by Douglas R. Dirschl MD, and Amiethab Aiyer, MD

Restrictive Covenants Can be Liberating

With a restrictive covenant in place, you may be stuck in your job (but without one, you may not have gotten the job in the first place.)

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Comments by Matthew L. Ramsey MD, and William F. Sherman MD, MBA

The Academic Inflation Reduction Act

These days, resumes of residency applicants are longer than ever (but not necessarily better)

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Comments by Alan H. Daniels MD, and Matthew L. Webb MD, MHS

Like Father, Like Daughter

If female medical students don’t frequently apply to orthopaedic residencies, something may be missing in their experience (but that “something” may be identified in daughters of surgeons who do)

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Comments by Sarah Powell MD, and The Boden Sisters: Lauren M. Boden MD, Stephanie A. Boden MD, Allison L. Boden MD and Susanne H. Boden, MD

When Physicians Compete, Patients Can Win

If two different specialties treat the same problem differently, both can’t be right (but rivalry creates natural experiments in efficacy)

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Comments by Charles Schnee, MD and Nichole Zelenski

I Have Seen the Moment of My Greatness Flicker

As we age, it’s tempting to rage against the dying of the light (but it would be wiser to prepare)

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Comments by Lydia Dugdale MD, MAR and Charles Cornell MD

Are Medical School Loans Mortgages Without Houses?

It’s fair to demand that future doctors fund their education (but they also deserve a fair path to exit if their plains do not work out)

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Comments by Foster Chen MD, John Patrick Hunt JD, MFE and Saqib Rehman MD, MBA

Climate Change Comes to Orthopaedics

Climate science is important (but not [yet] suitable for medical school curricula)

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Comments by Jason R. Saleh MD, FAAOS, Jeffrey A. Mann MD and Eric M. Bluman MD, PhD

Why do Residents Want to Join Unions?

Residents in the past would quietly endure temporary hardships (but maybe their present hardships are not so temporary)

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Comments by Paul J. Dougherty MD, members of the Organizing Committee for the Stanford Housestaff Union and Julie Balch Samora, MD

When Opinions Are Fervid but Evidence is Lacking, a Misinformation Consensus is Ripe for Backtracking

Outlawing medical speech is wrong (but especially wrong when a Nonsensus Consensus is the arbiter of truth)

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Comments by Jason Koh MD, MBA and João Marecos LLM

ChatGPT Can’t Perform Orthopaedic Surgery

ChatGPT can do almost everything but operate (but that may be enough to save our jobs)

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Comments by Andrew Milby, M.D., Daniel A. Donoho MD and Chat GPT Itself

Primum Non Nocere Is Harmful. Primum Noce Apte May Help

Hippocrates should not be blamed for “Do No Harm” (but that is only because he did not compose this bad advice)

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Comments by Li Felländer-Tsai, M.D., Ph.D and Charles D. Rosen MD

My Flexner Retort

Flexner’s report may have produced racially disparate outcomes (but that does not mean we should memory-hole the document)

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Comments by Kris Radcliff MD and Stanley Goldfarb MD

Seeing Ourselves as Doctors See Us

Patients these days can read their medical notes (but may not like everything they see)

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Comments by Charlotte Blease PhD and Maria Hagglund PhD

My Perfectly Reliable, and Perfectly Worthless, Fracture Classification System

Reliability is necessary (but hardly sufficient)

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Comments by Mark S. Vrahas MD and Stuart A. Green MD

Planck’s Principle and the Case for Pseudonymous Publication

There are many arguments for pseudonymity (but I am reluctant to make some of them in a signed column)

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Comments by Mininder S. Kocher MD, MPH and Leonid A. Kandel, MD

Informed Consent, Omakase Style

Society wants patients to be fully informed (but patients themselves, not so much)

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Comments by Hassan M. K. Ghomrawi PhD, MPH and David Ring MD

Defund the Medical Schools! Cancel Tuition!

Defunding Medical Schools is neither sensible nor feasible (but cancelling tuition, as NYU has shown, may be possible)

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Comments by Steven Abramson MD and Nicholas A. Pulos MD

500 Words of Solitude

An Electronic Medical Record might be better than a lost or illegible paper chart (but has become incomprehensible nonetheless)

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Comments by James S. Shaha MD and Shepard Hurwitz MD

Masks and the Veil of Ignorance

The debate over masks to limit COVID-19 is clouded by a priori biases (but these biases can actually advance science)

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Comments by Eugene J. Carragee MD and James L. Carey, MD

In Praise of Ankle Sprain Surgery

Any new surgical procedure can be praised if outcomes data justify it (but complete outcomes data are rarely collected)

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Comments by Nader Hebela MD and Robert Ostrum, MD

Predicting Chaos in the Residency Match

Virtual interviews this year can wreak havoc on the process (but also do damage in years to come)

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Comments by John C. Hagedorn II MD, Helen K. Morgan MD, C. W. David Chang MD and Margaret (Meg) Wolff MD, MHPE

Thought for Food

The orthopaedic curriculum should include nutrition education (but not only to help surgeons give advice about diet)

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Comments by Yoshi Rothman, MD and Jennifer Crowley PhD

Paying Surgeons More Might Cost Less

Higher fees would seem to lead to higher spending (but if income-targeting surgeons do fewer cases, the savings on ancillary costs might more than offset it)

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Comments by Robert A. Burton, MD and Joseph Zuckerman, MD

Surprise Medical Bills are Hardly Charitable

Maybe some hospitals have an excuse for surprise bills (but certainly not those which claim Not-For-Profit status)

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Comments by David A. Hyman MD, JD, Benedict Ippolito PhD and Charles Silver JD; James Rickert MD; and Mihir S. Dekhne MS and Karan R. Chhabra MD, MSc

How Necessary COVID-19 Lockdowns Can Go Too Far

Starting a harsh lockdown may have been wise (but continuing it may not be)

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Comments by William N. Levine, John L. Zeller, Anita Ho and Kamiar Khajavi

Carpal Tunnel Syndrome is Work-related–Because I Said So

The medical case for causality is far from conclusive (but defining a work injury is not entirely a medical question)

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Comments by Judith Green-McKenzie and Charles Goldfarb

Remember the Sabbath Day to Keep it Social

It’s nice that residents have a day off (but unless that day is on the weekend, residents may remain socially isolated)

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Comments by Colleen M. Farrell, Mohammad Diab and Judith Shulevitz

Medicare for All is Not Enough

Health care might be needed for health (but it is not enough–so look elsewhere for reform)

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Comments by Joseph A. Bosco III and Gregory J. Della Rocca

Roll Them Bones: Selecting Orthopaedic Surgery Residents by Lottery

Ecclesiastes correctly noted that time and chance happen to us all (but “meritocracy” tends to overlook that)

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Comments by Cato T. Laurencin and Andrew R. Spector

High-value Health Care and the Assassination of George Washington

Washington’s doctors delivered high value health care, circa 1790 (but killed him in the process nonetheless)

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Comments by Robert H. Quinn and Antonia F. Chen

Prizes for Cures

Research grants have promoted scientific advances (but maybe not the breakthroughs we need)

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Comments by James C. Iatridis and Martha Murray

(and a letter from Regis J. O’Keefe and my reply [Download PDF])

Why Can’t I Set Fractures in Vermont?

Actually, I can set fractures in Vermont (but only if I pay for a local license–which is inefficient, if not silly)

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Comments by Alexander R. Vaccaro and Shirley Svorny

Pre-arthritis Syndrome

Your joints are silently deteriorating (but that does not mean that you have a disease)

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Comments by Shannon Brownlee, Nortin Hadler and David Rier

Big Data Will Make You Confront Big Ethical Questions—Here’s Why

Machine learning can yield important insights (but distinguishing them from spurious correlations is hard)

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Comments by Drake G. LeBrun, Charles Carroll IV and Seth Haberman

Agonizing Appropriately Over the Residency Match Rank List

The differences between most programs are small enough that sorting them precisely is futile (but the effort may have its benefits nonetheless)

The Time to Fix ABOS Recertification Has Arrived

Recertification has become unduly burdensome (as if “duly burdensome” were not enough)

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Comments by Judith Baumhauer and David F Martin

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

Getting the last word

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. Domb, Xavier A. Duralde, and Duncan C. MacCourt

Getting the last word

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

Getting the last word

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

Getting the last word

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. Roth, Terrance D. Peabody, Kenneth A. Egol

Getting the last word

Viscosupplementation, Opioid Overuse, and the Excesses of Empathy

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

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Comments by Samuel Shem and Anna Lembke

Getting the last word

Rethinking the Resident Research Requirement

Asking a good question, even without answering it, is better than finding gee-whiz results (but we don’t reward that enough)

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Comments by Mellick J. Chehade, Stephen Pinney, and Kevin P. Black

Getting the last word

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. Barber, David Grande, Laura N. Medford-Davis, and Brian G. Smith

Getting the last word

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. (No parenthetical walk-back here)

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Comments by Paul E. Levin, Khaled J. Saleh, and Zain Sayeed

Getting the last word

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

And one is 700 or so with need an amputation (Though this is apparently not known by every patient contemplating elective knee replacement)

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Comments by David Ring and Leonid (Ari) Kandel

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 (yet much more than $100 will be wasted in total)

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Comments by Joseph Zuckerman, S. Elizabeth Ames, and William C. McGaghie

Getting the last word

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

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

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Comments by Alexander Langerman and Michelle M. Mello

Getting the last word

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

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 Gelman, David Trafimow, and Alex Reinhart

Getting the last word

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

Getting the last word

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. Hadler, Daniel J. Clauw, and M. Clement Hall

Getting the last word

Arthrostasis

As Dr. Dye has shown, it would be best if our treatments were homeostatic (but some of our best ones are not)

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

Getting the last word

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. Mirza, Augusto Sarmiento, and James Rickert

Getting the last word

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. Ring, Nicholas H. Osborne, and Randale C. Sechrest

Getting the last word

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

Getting the last word

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 (He did not have surgical operations in mind, but he might as well have)

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Comments by Pierre J. Hoffmeyer, Augusto Sarmiento, and K. Daniel Riew

Getting the last word

Orthopaedic surgery is lucrative (but evidently not lucrative enough)

“Who is rich? One who is satisfied with his lot.”–Pirkei Avot 4:1 (This is not the first time the Talmud was ignored)

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

Getting the last word

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 (but these are not necessarily the same people).

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

Getting the last word

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. Chehade, Stephen Pinney, and Kevin P. Black

Getting the last word

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

Getting the last word

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

Getting the last word

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. Bozic, David S. Jevsevar, and David J. Shulkin

Getting the last word

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

Getting the last word

Free for Service: The Inadequate Incentives for Quality Peer Review

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

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Comments by Elizabeth Wager, James D. Heckman, and John L. Zeller

Getting the last word

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

Getting the last word

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

Getting the last word

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)