What's with the stereotypes about ortho?

[drivesmecraazee]

Why do so many people say orthopods are dumb and that they don't know much about medicine? I've heard this a million times, mostly those comments come from IM and IM subspecialists, probably they say it because a lot of things seen in ortho are mannaged surgically and the surgeries are kinda brutal (cool ), but still, even if orthopods don't use medication much, there are different options for treatment and diagnosis in ortho isn't that simple, at least that's the way I see it.
Is there any truth in those jokes about orthopods? Some simplicity in ortho? I don't think so, but still, I would like to hear the opinions of those with more experience than me.
Thanks for your opinions.

Excuse me, english isn't my first language...

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[basupran]

Whenever I tell a medicine attending that i am going into ortho, they tell me that I am wasting my brain. This is because when they were medical students, the ones in the back of the class who couldn't match anything else went into ortho..hence, the stereotype.
No worries, things have changed.

 

[Buckeye(OH)]

Whenever I tell a medicine attending that i am going into ortho, they tell me that I am wasting my brain. This is because when they were medical students, the ones in the back of the class who couldn't match anything else went into ortho..hence, the stereotype.
No worries, things have changed.

So, was that a 2JZ?

Used to have a VG30DETT - Im sure you know what that is.

 

[dragonfly99]

don't worry, when you rotate on ortho the ortho docs will tell you that internists "Don't do anything" (i.e. sit around drinking coffee all day), that their jobs are going to be taken over by nurse practitioners (i.e. primary care will be taken over by nurses) and that internists "Can't make decisions" (i.e. indecisive). Unfortunately this is the way doctors (and I guess, people in general) are sometimes. They like to talk bad about other people because it makes them feel bigger. Also, some of these stereotypes (i.e. ortho who doesn't seem to remember anything about diabetes or hypertension, even the basics, although he was at the top of his med school class, the internist who can't seem to make a firm decision because he gets bogged down in thinking and thinking about all the details over and over) have SOME basis in truth, which is how the stereotypes got started.

A medicine fellow.

 

[basupran]

So, was that a 2JZ?

Used to have a VG30DETT - Im sure you know what that is.

300ZX

I am running an MR2 right now. Bought her non-turbo and did a rear clip turbo engine + LSD swap on her...upgraded 46 trim turbo with exhaust clipped and all the supporting mods. Can't wait to finish up med school and get me a ridiculous car.

 

[radslooking]

the stereotypes generally fit pretty well. orthos seem to be learning less and less medicine and caring less and less. This just seems to be how medicine is changing in general. The surgeons are trying to do more surgeries and less patient care. This is most pronounced with the orthos. You can debate whether this is good or bad, it just is what it is. I love the ortho guys I know. they aren't bad or dumb, it's just the way it is changing.

 

[coastal]

I think there is probably little appreciation for the depth of knowledge one has to acquire during an orthopedic residency. It is this depth which prompts one to prophylactically circumscribe one's breadth of knowledge; with limited time, one must prioritize and, thus, much general medical knowledge gets left by the wayside. Most of us abhor the neolithic, nay, paleolithic monsters we are destined to become yet, somehow, we lack the courage to say "No, I DO care about your medical issues, sirrah, we can handle this ourselves. Let Medicine's coffee break continue."

As our residencies progress we change. As our muscles hypertrophy our brains atrophy (Arnold's 2nd law). Offense is taken easily and retaliation for said offense is swift. On call this past weekend we cluster &*cked a group of little medicine residents who had the audacity not to flatten themselves against the walls in abject terror as we passed. One of them had some spirit, I think he was a medicine athlete, synchro swimming or rhythimic gymnastics or something. Our chief couldn't really believe this guy was going to get up and told him as much. Being the junior on call, my job was to translate his grunts and feral howls into local dialect. I've promised my wife that I'll try to stay bilingual even during my final years of residency. I guess she doesn't believe me because she bought a caveman dictionary the other day....

I feel happen already. Just start but now so dumb. Help me. Patient with hyperbloodpressure and sugarblood. Medicine only hope. Grunt.


As an aside, by the end of my residency I won't know much about medicine because I'm not interested in it and I don't really care. I've got lots of shizzat to learn (again, probably far beyond what the general medical community appreciates) and not a tonne of free time to learn it in. I will be able to fix stuff though.

 

[radslooking]

I think there is probably little appreciation for the depth of knowledge one has to acquire during an orthopedic residency. It is this depth which prompts one to prophylactically circumscribe one's breadth of knowledge; with limited time, one must prioritize and, thus, much general medical knowledge gets left by the wayside. Most of us abhor the neolithic, nay, paleolithic monsters we are destined to become yet, somehow, we lack the courage to say "No, I DO care about your medical issues, sirrah, we can handle this ourselves. Let Medicine's coffee break continue."

As our residencies progress we change. As our muscles hypertrophy our brains atrophy (Arnold's 2nd law). Offense is taken easily and retaliation for said offense is swift. On call this past weekend we cluster &*cked a group of little medicine residents who had the audacity not to flatten themselves against the walls in abject terror as we passed. One of them had some spirit, I think he was a medicine athlete, synchro swimming or rhythimic gymnastics or something. Our chief couldn't really believe this guy was going to get up and told him as much. Being the junior on call, my job was to translate his grunts and feral howls into local dialect. I've promised my wife that I'll try to stay bilingual even during my final years of residency. I guess she doesn't believe me because she bought a caveman dictionary the other day....

I feel happen already. Just start but now so dumb. Help me. Patient with hyperbloodpressure and sugarblood. Medicine only hope. Grunt.


As an aside, by the end of my residency I won't know much about medicine because I'm not interested in it and I don't really care. I've got lots of shizzat to learn (again, probably far beyond what the general medical community appreciates) and not a tonne of free time to learn it in. I will be able to fix stuff though.

ah, the dreaded sugarblood. i feel now too.

 

[tkim]

Is there any truth in those jokes about orthopods? Some simplicity in ortho? I don't think so, but still, I would like to hear the opinions of those with more experience than me.
Thanks for your opinions.

Excuse me, english isn't my first language...

You mean like this?

 

[mm3781]

Also, it seems to work somewhat differently in the private world vs. the academic world. In the private hospitals I have rotated through, the internists are more than happy to do medical management on orthopaedic patients. Obviously, there is a monetary incentive not present in the academic world. Personally, I think medical problems are best managed by the medicine docs. I don't plan on staying up on all the new medicine literature, and so I feel it would be a disservice to the patient for me to manage complex medical issues. Likewise, if an internist is uncomfortable with orthopaedic injuries, then I would more than happy to see a patient to see if they need surgery or not.


Another VG30DETT here as well. Unfortunately, I am selling her to pay for a new car since my jeep is about to die and the trade-in value is like $1.50 with gas prices the way they are right now.

 

[ddmo]

The stereotype is basically just based on ignorance. You see, orthopaedics is not taught in medical school, so most non-orthopaedists don't have the slightest clue the volume of information an orthopaedic surgeon must know. These are the same people that look at a hip fracture and think the solution is simple, you just fix it. They don't even appreciate the different treatment options or their indications, let alone the technical aspects of performing each of them. Not to mention the thousands of other procedures an orthopaedic surgeon must be proficient in. For some reason they find it acceptable to mock me for the fact that I would prefer that they manage a patients a. fib, htn, etc; when I consider that in the patient's best interest. That is what they do day in and day out, they are the masters of it, they study the guidelines. Meanwhile, I don't balk when they consult me for something as simple as a pubic ramus fracture in an elderly patient; because while this may be simple to me, it's not really their job to need to know how to manage that. At the end of the day, while they are studying guidelines of what anti-coagulation is needed for drug eluting stents, I'm deeply engrossed in the benefits of using fixed angle locking plates compared to standard compression plates. When push comes to shove, just remember, we were the best of the best in medical school and to speak softly and carry a big mallet.

 

[Tired]

When push comes to shove, just remember, we were the best of the best in medical school and to speak softly and carry a big mallet.

Alternatively, next time you get a consult for a hip fracture from Medicine, tape a DHS to the chart and write a note that says, "Recommend insertion of included implant. Thank you for this interesting consult. Call for any questions."

 

[pagemmapants]

Alternatively, next time you get a consult for a hip fracture from Medicine, tape a DHS to the chart and write a note that says, "Recommend insertion of included implant. Thank you for this interesting consult. Call for any questions."

Would pay to see this happen.

 

[VincentAdultman]

Alternatively, next time you get a consult for a hip fracture from Medicine, tape a DHS to the chart and write a note that says, "Recommend insertion of included implant. Thank you for this interesting consult. Call for any questions."

Do you think ortho should medically manage its pts?

 

[Illuminatus]

Do you think ortho should medically manage its pts?

I think ortho should know how to medically manage their patients (and know it better than medicine)...but medically managing a dynamic trauma list of 25-40 patients as PGY2 would require over 200-300 hours of work a week..it's just not realistic.

 

[VincentAdultman]

I think ortho should know how to medically manage their patients (and know it better than medicine)...but medically managing a dynamic trauma list of 25-40 patients as PGY2 would require over 200-300 hours of work a week..it's just not realistic.

No probably not, I was referring more to the idea of consulting medicine for patients with well-controlled DM or HTN.

 

[Dedikated2liftn]

No probably not, I was referring more to the idea of consulting medicine for patients with well-controlled DM or HTN.

Nothing to do with the ongoing conversation, but love the avatar.

 

[VincentAdultman]

Nothing to do with the ongoing conversation, but love the avatar.

 

[Tired]

Do you think ortho should medically manage its pts?

We suffer from a lack of precision in this conversation. "Medically manage" is a loaded term, and highly dependant on the person throwing it around. I've heard it used for everything from uncomplicated type II diabetes to unstable afib in the setting of severe pneumonia.

In my mind, the litmus test is pretty simple: Picture a day when we're in the OR for 12hrs straight (which is most days). Are the patient's "medical issues" of such severity that our unavailability during this time places them at serious risk?

I think we can manage non-brittle diabetes. I think we can manage Stage I/II hypertension. I think that we can handle most previously-controlled chronic problems. Anything new-onset needs Medicine to own them. Anything unstable or requiring frequent assessment and bedside attention also needs to go to Medicine. I don't think we should ever be the Primary team on an ICU patient.

 

[VincentAdultman]

We suffer from a lack of precision in this conversation. "Medically manage" is a loaded term, and highly dependant on the person throwing it around. I've heard it used for everything from uncomplicated type II diabetes to unstable afib in the setting of severe pneumonia.

In my mind, the litmus test is pretty simple: Picture a day when we're in the OR for 12hrs straight (which is most days). Are the patient's "medical issues" of such severity that our unavailability during this time places them at serious risk?

I think we can manage non-brittle diabetes. I think we can manage Stage I/II hypertension. I think that we can handle most previously-controlled chronic problems. Anything new-onset needs Medicine to own them. Anything unstable or requiring frequent assessment and bedside attention also needs to go to Medicine. I don't think we should ever be the Primary team on an ICU patient.

Awesome. We're on the same page.

 

[Tired]

Awesome. We're on the same page.

It's pretty embarrassing being a service where you have to call a consult for an asymptomatic 150/90.

On the other hand, it's stupid to have to argue about getting Medicine on board for chest pain with a normal EKG.

 

[2oRadio]

Alternatively, next time you get a consult for a hip fracture from Medicine, tape a DHS to the chart and write a note that says, "Recommend insertion of included implant. Thank you for this interesting consult. Call for any questions."

Awesome. Just awesome.

 

[PeepshowJohnny]

We suffer from a lack of precision in this conversation. "Medically manage" is a loaded term, and highly dependant on the person throwing it around. I've heard it used for everything from uncomplicated type II diabetes to unstable afib in the setting of severe pneumonia.

In my mind, the litmus test is pretty simple: Picture a day when we're in the OR for 12hrs straight (which is most days). Are the patient's "medical issues" of such severity that our unavailability during this time places them at serious risk?

I think we can manage non-brittle diabetes. I think we can manage Stage I/II hypertension. I think that we can handle most previously-controlled chronic problems. Anything new-onset needs Medicine to own them. Anything unstable or requiring frequent assessment and bedside attention also needs to go to Medicine. I don't think we should ever be the Primary team on an ICU patient.

I think that's pretty much perfect.

 

[DrDre311]

When push comes to shove, just remember, we were the best of the best in medical school.

Ironic that fantastic medical knowledge is what allowed me to go into a specialty that let me flush all that crap out of my head and learn a bunch of stuff most docs have never heard of. I might only know 5-6 antibiotics (4 of which I'll forget when I'm done with GS) but I can fix your hand and your face like nobody's business, and make the rest of you look pretty, too.

 

[ddmo]

You mean they make an antibiotic other than Keflex?

 

[Tired]

You mean they make an antibiotic other than Keflex?

I usually just write "IMC" (Internal Medicine Consult) and next thing I know my patients are on the appropriate drug.

It's like magic.

 

[dragonfly99]

Just remember we (different specialties) all need to respect each other for what we do. Don't expect an fp to have the in depth knowledge of different areas that others/specialists would have. Don't think the IM resident is dumb because they can't precisely and exactly describe the location of every fracture in every bone over the phone to you (i.e. slightly comminuted, closed fracture of the distal radius is probably as much as they will know...). IM folks shouldn't c/o "dumb consult" for a genuine medical issue.

I think some of the conflict between IM and ortho comes about when ortho wants IM to admit every single ortho patient (almost) to IM just b/c diabetes or HTN is in the chart. If the person has DM and takes one oral med, no insulin and the glucose is 135, he probably doesn't need to be on the IM service. In the private world, yes, the hospitalist doesn't give a crap b/c he's getting paid for the admission, but in the academic world the medicine intern and residents are busy with their various other medical admissions (unstable angina, Crohn's dz, little old ladies with pneumonia) and understandably may not be happy campers to throw on extra admissions with little or no teaching/learning value for them. It's the reason why large academic hospitals really need to have a functional nonteaching service to take some of these types of admissions, if the surgical services aren't staffed well enough to take their own admissions (and ortho is NOT the only one that does this).

 

[Tired]

Just remember we (different specialties) all need to respect each other for what we do.

If I were a mod, I would ban you from this forum for writing this.

Reasonableness is not welcome here.

This is the Ortho forum, and your failure to mention weightlifting, MMA, or a hot chick should at least warrant probation.

 

[dragonfly99]

Oh well tired,
this will probably be my only foray into the ortho forum, LOL.
No chance of me mentioning "hot chicks" as I'm a straight woman. I might mention that "Alex" of Gray's anatomy has hotness >> "McDreamy" and >>>"Mcsteamy". Unfortunately I found out he's married with 4 or 5 kids, so have to figure out a way to break up his marriage... LOL!

p.s. what's MMA?

 

[Nic Dawson]

MMA = Mixed Martial Arts = future customers for Ortho

 

[pagemmapants]

I think if I go into private practice I'm going to give away free Rollerblades to the kiddoes on a biannual basis...

Job security. =)

 

[Tired]

I think if I go into private practice I'm going to give away free Rollerblades to the kiddoes on a biannual basis...

Job security. =)

I already invest in Jungle Gyms.

 

[ddmo]

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