The five-item AAOS contribution to the Choosing Wisely list of medical procedures that patients and physicians should question has been criticized from several quarters (see OrthoBuzz post “Do ‘Choosing Wisely’ Lists Protect Physician Income?”).
The latest scrutiny comes from Indiana orthopaedist James Rickert, MD, who founded the Society for Patient Centered Orthopaedic Surgery. Speaking at the recent Lown Institute Annual Conference (dubbed “The Road to RightCare”), Dr. Rickert said that among physicians who succumb to financial interests in recommending and performing procedures of dubious merit, orthopaedists are “one of the worst offenders.” He said it’s especially hard for those who own related businesses that benefit from high surgical volume (such as device distributorships or imaging centers) to set aside financial interests during clinical practice.
Here are five procedures Dr. Rickert thinks should be on the orthopaedic Choosing Wisely list:
- Rotator cuff repairs in asymptomatic/elderly patients
- Clavicle fracture plating in adolescents
- ACL repair in low-risk individuals
- Surgical removal of part of a torn meniscus
In citing the potential risks to patients who receive these procedures, Dr. Rickert admits to getting emails and other “grouchy comments” from fellow orthopaedists who don’t like his self-described “moral persuasion” campaign. What do you think of this list?
2 thoughts on “Dr. James Rickert’s Personal ‘Choosing Wisely’ List”
I agree with Dr. Rickert that our Fellowship can do a better job in joining the contemporary efforts by endorsing those things that enhance our patients’ lives, while being honest with our patients and ourselves about real indications and transparent about outcomes and incentives.
Nearly 3 months ago, I fell on a metal surface, crashing down and sliding several feet on my bent, right leg. There was little blood, but a 50-cent sized divot was cut out just at the top of the tibia. An x-ray at a local ER showed no breaks, but the pain was terrific. After icing and taking advil for 3 weeks, I went again for help. A second X-ray revealed no breaks, but an MRI was ordered. I was given an ace-bandage to wear. The MRI showed an incomplete fracture of the proximal tibia. I was told to rest and ice it–that healing would take months. I was set up with an orthopedist to continue treatment. I have been twice and each time the visit starts with an x-ray! So with 4 x-ray’s into the treatment now, I am very suspicious. The physician didn’t even look at my leg during my second appointment. He stood by the door and told me there was nothing he could do for me–“You don need a brace, but “you can wear your bandage if it makes you feel better. It won’t heal any faster.” I’d just have to be patient and come back to see him in another month. I’m not going back. The pain has lessened, but I still need aleve or advil each day. I still ice it. How much longer will this go on? I know I don’t need another x-ray; the cost of MRI’s is outrageous. Thank you Dr. Rickert for your caring messages here. REM