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GUEST EDITORIAL
Year : 2022  |  Volume : 37  |  Issue : 1  |  Page : 1-2

Medical jousting in orthopedics


Department of Orthopedics, Apex Trauma Centre, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

Date of Submission29-Mar-2022
Date of Acceptance12-Apr-2022
Date of Web Publication13-May-2022

Correspondence Address:
Kumar Keshav
Department of Orthopedics, Apex Trauma Centre, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Flat- B-506, Arsha Sumangalam, GH-13C, Sector-14, Vrindavan Yojna, Lucknow 226029, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jbjd.jbjd_6_22

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How to cite this article:
Keshav K. Medical jousting in orthopedics. J Bone Joint Dis 2022;37:1-2

How to cite this URL:
Keshav K. Medical jousting in orthopedics. J Bone Joint Dis [serial online] 2022 [cited 2022 Aug 15];37:1-2. Available from: http://www.jbjd.in/text.asp?2022/37/1/1/345168



“Medical Jousting” is not new in medical parlance. It is the act of making derogatory remarks by a doctor or any healthcare professional about a coworker or colleague in an effort to show oneself superior and thereby create a better impression in the mind of the patients who have been treated earlier elsewhere.[1] It has become quite rampant these days in orthopedic specialty. It has existed for years, but has gained more relevance in today’s world of cut-throat competition.[2],[3] In this editorial, I will discuss some of the common scenarios in our orthopedic specialty, the problems it poses, the reasons behind it, and the possible remedial measures.

I will narrate to you a few scenarios, which most of us can correlate with. Dr. Vinod (name changed), having more than a decade of experience in the field of orthopedics, did open reduction and internal fixation by a long “PHILOS plate” on a spiral fracture of proximal one-third humeral shaft in one of his patients. Unfortunately, in the postoperative period, the patient had neuropraxia of the radial nerve. The patient was explained about the scenario in the postoperative period and was told that it will most likely recover and if it did not recover within 6 weeks to 3 months, it would require exploration. The patient was discharged on the third day of surgery. After about 3 weeks, he went to some other orthopedic surgeon who not only criticized the surgery of the former on account of postoperative radial nerve palsy but asked him to get re-operated immediately. The patient got reoperated and the following week, he sued the former surgeon. Now, the matter is in the court, which is leading to anxiety, tension, loss of practice, and wastage of precious time of both the surgeons. Let’s take up another case. A patient of Ankylosing Spondylitis with both the hips ankylosed and fixed in flexion was operated on one side in the form of Total Hip Replacement. Unfortunately, he got his prosthetic femoral head dislocated out of the acetabulum two days after discharge from the hospital. The patient’s relatives went to a different surgeon who not only criticized the operating surgeon but even started questioning his eligibility and competency. The relatives went to the operating surgeon’s hospital and created ruckus and did a lot of damage to the hospital property. The above incidences are few of the many examples which we often come across. The various words of wisdom (pun intended) like “This operation is a disaster,” “Who the hell has operated you? He/ She has done a complete mess,” “Had I operated you, this would not have happened,” “How come he is being allowed to practice orthopedics?,” and “Did he explain you about the complications that could have happened?” has become quite commonplace in today’s world, especially in our country.[1],[2],[3],[4]

There are certain factors due to which orthopedic surgery as a specialty faces more such incidences. Radiological investigations like X-rays are quite cheap and one of the mainstays of our diagnostic modalities. The patient can roam about from one doctor to another with the X-ray in his hand and everybody is free to comment upon that. Nobody cares to know the scenario or the kind of set-up or the financial condition of the patient due to which a particular kind of surgery was done. Many times, several doctors comment upon just the X-ray or MRI without even physically examining the patient, which may create confusion in the mind of the patient. The immediate complications of surgery like infection, neurovascular compromise, dislocation of hip prosthesis; and delayed ones like non-union, and malunion are much more clinically apparent and appear more dramatic than similar ones in other specialties. In cases like post-operative chronic osteomyelitis with implant in situ, it is now a rule rather than an exception for the patient to hear some derogatory remarks.[3],[4],[5]

All these remarks are just a way adopted by a doctor to downgrade his peer(s) whom he considers as a competitor, so that he may prove himself superior in the eyes of the patients. For a surgeon resorting to jousting, it may be beneficial for the time being but has far-fetching negative consequences for medical fraternity as a whole. First, it creates mistrust amongst the patients.[3] We must be aware of the fact that if we are bad-mouthing somebody, we may ourselves be bad-mouthed by someone else. Patients get confused and may go on for doctor-shopping spree. More often, they eventually start labeling the whole medical profession as bad. Second, this has increased the number of medicolegal cases in the country against the doctors.[4] If someone resorts to jousting without adequate reason, he may himself be at the receiving end of a defamation claim by the first surgeon. Third, it may incite the patient party to such an extent that they may resort to beating up the treating doctor and damaging his hospital or personal properties.[5] Though punishable, such episodes are on the rise and medical jousting has got a significant role to play in it. Finally, it is leading to loss of unity amongst the medical fraternity.[6]

Although I believe that not indulging in any medical jousting is an individual call, based on one’s own moral and ethical standards, there are certain steps that we can take to stop this dangerous evil. All medical specialties have some forms of societies and so do we orthopedic surgeons. Those who resort to jousting should be ostracized by the peers and should not be allowed active involvement in their societies. The seniors should impart their younger colleagues not only the surgical skills but also the moral values and things like interpersonal relations, teamwork, and doctor-patient communication during their residency. In fact, these should be a part of their curriculum. Even if the operating surgeon is wrong, there is a way to tell that to the patient in a way that he/she does not feel as if some gross negligence has been done. Explaining to the patients the possible complications and outcomes of a particular surgery must be done properly and written down in the consent form. This will help one to protect oneself from legal hassles that may crop up in the future, even if someone else badmouths the operating surgeon.[3],[4],[5],[6],[7]

It is high time we stand for our brethren so that someday someone else will take a stand on our behalf. Nobody is perfect. We all make mistakes at various stages of our career, either small or big. A person who claims that he has not done any mistake in his life has either not done enough or is God himself. All of us, the lesser mortals, should promise ourselves not to resort to jousting and protect our fellow brothers and sisters. I would reiterate the Sanskrit hymn that was taught to me during my school days, “Sarve Bhavantu Sukhinah, Sarve Santu Niraamayaah, Sarve Bhadraanni Pashyantu, Maa Kashcid-Duhkha-Bhaag-Bhavet” which implies “May all be happy, may all be free from illness, may all see good in others, may no one suffer.”[8]

Financial support and sponsorship

Not applicable.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Subrahmanyam BV, Reddy GVN, Phanindra SV, Rao KSVKS. Medical jousting: Ethical and legal implications. Narayana Med J 2017;6:68-70.  Back to cited text no. 1
    
2.
Agrawal A, Thawani V. Medical jousting: Think well before speaking. J Mahatma Gandhi Inst Med Sci 2020;25:50-1.  Back to cited text no. 2
  [Full text]  
3.
Ashok DS. Medical Jousting: The no-win conundrum for everyone. J Educ Res Med Teacher 2017;5:30-2.  Back to cited text no. 3
    
4.
McDaniel SH, Morse DS, Reis S, Edwardsen EA, Gurnsey MG, Taupin A, et al. Physicians criticizing physicians to patients. J Gen Intern Med 2013;28:1405-9.  Back to cited text no. 4
    
5.
SnyderL.American College of Physicians Ethics, Professionalism, and Human Rights Committee. American College of Physicians Ethics Manual: sixth edition. Ann Intern Med 2012;156:73-104.  Back to cited text no. 5
    
6.
Kessels RP. Patients’ memory for medical information. J R Soc Med 2003;96:219-22.  Back to cited text no. 6
    
7.
Leape LL, Shore MF, Dienstag JL, Mayer RJ, Edgman-Levitan S, Meyer GS, et al. Perspective: A culture of respect, part 2: Creating a culture of respect. Acad Med 2012;87:853-8.  Back to cited text no. 7
    
8.
Sarve Bhavantu Shukhinah. Available from: https://shlokam.org/sarvebhavantusukhinah/. [Last accessed on 2022 Mar 28].  Back to cited text no. 8
    




 

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