Why should orthopedic surgeons go back to school?

Hi folks

So, i havent written a rant for long time, so i thought why not today-so here it is, please call me if i have not insulted the group you have belong to or have fun and enjoy   

  As my esoteric audience know I am a great believer in EBM. One of the many things EBM teaches you is just because you have grey hair in your head and naughty regions does not mean you have "truer" knowledge. Please note you do accumulate knowledge as you grow but it is never true as it will always be mixed with biases. no! no! this is not about another rant about biases.

Unlike traditional medicine, EBM needs effort and some real courage (as Dr. Kelso says- balls and girl balls). Courage in medicine is difficult to find. We have only followers of rituals, sycophants, money grabber and much more,but never followers of truth. Prakash keeps on pointing out there are many people who talk about EBM nowadays and may be also implementing it, that is times are changing.

One group of doctors who I see, who have no understanding of biology (school level), patients preference (well most of them don't talk to the patient, so..) or understanding of high school probability, so no idea what the duck is evidence. They are very competent in biological carpentry- because they do "fix"  every poor chap who is wheeled into the consultation room. I am talking about ortho surgeons. 

As noted non of the white coat carpenters- never give the patients the options of surgical and non- surgical treatment ( sometimes if you are a family member and extremely lucky they may). It is because of 2 reasons- one well they are a hammer and they only see nails. ( For that reason I think we need MD in ortho) and 2, I am pretty sure most of them have never seen a SR, or RCT. So they don't have a clue many of the surgeries are as good as conservative management. Well like any good doctor in India I don't have any data for these- but I have confidence so you can assume it is all true-remember like the professionals who came on TV and blabbered during covid without data (so that's that)

  Pray why are you worried about those people. Beyond low level treatment they suggest to the patient and fail to recommend some simple high value treatment- well I have a selfish motive. They ruin physiotherapist in turn ruin patients.  

In health care in India the hierarchy is like this : 

 

so those are the 2 levels of health care in India

So what happens is many of the PTs have to follow the surgeons diktat rather than any science. I dont know when this started- but it started in the late 90s where exercise became a no no in most of cold ortho conditions even though that was the time the evidence started emerging for the value of it. Then came some absolutely criminal advice- dont sit on the ground, dont travel in a bike (I always ask my patient did you ask the doctor will he prescribe the car or he will buy it) dont bend, dont walk, dont climb stairs, this way to the surgical table (if the poor sap had some referred pain in the legs).

I think some of the ortho specialty hospital is buying a huge x-ray machine to keep in the entrance. So everyone who steps in will get a whole body x-ray, which i think can save some time and increase the surgical rate. If you go for consult in a nice shoes and formal shirt or a expensive jewelry - well you sure will get a beautiful selfy of your spine with wonderful pixels you can even see whats wrong with your RNA and DNA. 

I know we all bend ethics, we all take our food from other peoples plate, we are as a country used to being unethical, but this is just sad. Just sad. As i said these advice is parroted by therapist also. If i say something people think i am less educated so i don't know. I did read less than anyone who has gone to medical school, but i read and once in a while use my brain to think. 

I seriously think to change this situation these are my recommendations:

1.   A 4 weeks course on ageing, healing and repair

2. A 4 weeks course on listening to patient

3. 1 year program on cold orthopedics

4. 1 years course on why surgery is not always the answer

5. 10 years course on making them understand patients are humans and PTs do go to college 

6. A 30 days jail term for useless x-rays and other imaging

7. For every back surgery for back pain (without serious neurological symptoms) 10 years

for all the PTs in the GH who after 40 years cant do anything else other than IFT- well nothing you cant grow balls, you are beyond useless. 

Love

K. Hariohm