Egerton began by describing the obstacles that were overcome in creating this eminence-based masterpiece:
“Professor Staghorn was the obvious choice to chair the panel of orthopedic experts that developed these guidelines. However, the selection of the committee members was a daunting prospect. Fortunately, Staghorn hit upon a fool-proof way of selecting the most academically qualified and cerebrally gifted orthopedic surgeons: he only selected those whose knuckles barely scraped the ground.”
Davis IV then outlined the scope of the guidelines:
“These guidelines cover all aspects of orthopedic surgery including surgical practice, teaching, career guidance, financial advice, and even advice for other specialties that deal with orthopedic surgeons. The guidelines advocate a truly holistic approach to orthopedics. Indeed, the orthopedic surgeon should fix not only the fracture but the entire bone.”
Davis went on to detail all 143 recommendations made by the committee. UCEM have kindly allowed the publication of some of the key recommendations on LITFL:
Guidelines on the Practice of Orthopedic Surgery
- When faced with a big problem, the orthopedic surgeon should use a big hammer.
- The orthopedic surgeon should always wear a surgical hood in the operating theatre so as to reduce the risk of his head being transilluminated by the bright lights above.
- The orthopedic surgeon should always wash his hands before operating, as strict sterility is vital to modern orthopedic practice. Exactly how long the orthopod should scrub for is a common cause of consternation. These guidelines provide the following incontrovertible rules for orthopods to adhere to:
- A medical student should wash their hands 30 seconds longer than the orthopedic intern when scrubbing.
- Similarly the intern should scrub for 30 seconds longer that the resident, who in turn should scrub for 30 seconds longer than the registrar or fellow.
- The orthopedic consultant, having washed his hands many times during his career, need only scrub his hands for a few seconds.
- The exact amount of time depends of course on the rate of scrubbing, an orthopod who scrubs twice as fast as his colleague need only scrub for half the time.
Guidelines on the Non-operative aspects of Orthopedics
- If in doubt… well you’re not really an orthopedic surgeon then are you?
- Save time by remembering the orthopedic auscultation point — heart sounds, breath sounds, bowel sounds and knee crepitus can all be adequately auscultated by placement of the stethoscope bell on the xiphisternum. However, such patient contact is best left to junior staff.
- The orthopedic surgeon must protect his hands at all times. For instance, if rushing to catch an elevator the orthopedic surgeon should jam his head between the closing doors and never attempt to hold the doors open with his hands.
- The orthopedic surgeon should know only one antibiotic, otherwise he risks being called a carpenter by colleagues from other specialties. Carpenters usually know at least two or three different antibiotics.
- Orthopedic surgeons should acquire expertise in research methodologies. The best way to develop competency in the conduct of a double-blind randomised controlled trial is for an orthopedic surgeon to read an ECG with a colleague.
Guidelines on Careers and Finances for Orthopedic Surgeons
- If a candidate is considering a career as an orthopedic surgeon and has half a mind for the job, he may be over-qualified.
- A candidates is deemed to have the capacity to practice orthopedic surgery if it takes him only 2 years to complete a jigsaw puzzle labeled ‘3-5 years’.
- All orthopedic surgeons should have a savings scheme. One of the simplest way to adhere to such a scheme is the textbook method. The orthopedic surgeon should ask one of his colleagues from the Society for the Prevention of Surgery to hide his money between the pages of a textbook or medical journal. That way the there is little chance of the orthopedic surgeon ever finding and spending it.
Guidelines on the Teaching of Orthopedic Surgery
- Orthopedic surgeons should emphasize the paramount importance of physiology to their juniors. For instance, the primary function of heart — namely, to pump antibiotics to the hip replacement — must never be forgotten.
- The orthopedic surgeon should never ask a medical student to tell him a joke, unless he is looking for a bruised ego and an opportunity to fail the student.
Guidelines for other specialties dealing with an orthopedic surgeon
- Remember that the orthopod is the ‘rhinoceros of medicine’ — think-skinned, small brained and charges a lot for almost nothing.
We suggest that you obtain a copy of these new guidelines and slowly read them out loud to your favorite orthopedic surgeon at the first available opportunity.
Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of three amazing children.
On Twitter, he is @precordialthump.