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Pioneer: James W. Strickland, MD
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In this month’s column, we feature James W. Strickland, MD, an international leader and pioneer in hand surgery. Strickland founded the Indiana Hand Center in 1971. He was also president of the American Society for Surgery of the Hand from 1990 to 1991 and the president of the American Academy of Orthopaedic Surgeons from 1995 to 1996.
How did you decide on a career in orthopedics?
James W. Strickland, MD: As a freshman at Indiana University in 1954, my only motivation was to pursue a business career and, most probably, to work for and succeed my father as an automobile dealer in Indianapolis. I played high school basketball in Indianapolis — a career most notable for having defended the great Oscar Robertson several times. As a walk-on on the freshman basketball team in an era when freshman could not be on the varsity team and played separate games, I completely avulsed my left tibial tubercle after long-standing Osgood-Schlatter’s apophysitis, while playing my first and only college game against Vanderbilt University.
James W.
Strickland
The surgery that followed my injury changed my life. I was so impressed with Thomas Brady, MD, the orthopedic surgeon who performed surgery on my left knee, that I changed my entire academic motivation, career objectives and college curriculum to become a physician with a specific desire to become an orthopedic surgeon. Unfortunately, I had not prepared myself well for the science course demands of pre-medicine and had to load my next few semesters with catch-up courses that most other pre-med students had taken in high school. Basketball was forever over; replaced by a massive adjustment in my previous cavalier attitude toward academic effort. Luckily, it all worked out and I have never looked back at the career change that resulted from an athletic injury.
Who have been your most important mentors and what were the most valuable lessons you learned from them?
Strickland: My medical development, first as a physician, then as an orthopedic surgeon, and finally as a hand surgeon, was greatly influenced by many wonderful mentors, the most important of whom were George J. Garceau, MD, and William B. Stromberg Jr., MD.
Dr. Garceau headed the Department of Orthopedic Surgery at Indiana University for nearly 20 years and served as president of the Clinical Orthopedic Society in 1948, vice president of the American Academy of Orthopedic Surgeons (AAOS) in 1960, and president of the American Board of Orthopedic Surgery in 1957. He was a consummate teacher whose manner was unpretentious but authoritative. He was a gentle and compassionate man who left a lasting impression on everyone he touched because of his common sense and respect for what was best for patients. I can clearly remember the Sunday morning poliomyelitis conferences in which he softly corrected aspects of the muscle examinations reported by the orthopedic residents. He would seek the treatment opinions of the orthopedic staff without ever embarrassing the residents, and, when he concluded the discussion of a polio patient, Dr. Garceau would succinctly tender his opinion which was immediately judged as the “right answer” by all in the room regardless of their previous recommendations. Such was the respect which he commanded with great modesty. He was not only my most influential orthopedic teacher, but he was also my practice partner when I had the great privilege of practicing with Dr. Garceau and George Rapp, MD, for the 2 years before I elected to confine my practice to surgery of the hand.
I was also strongly influenced by Dr. Stromberg under whom, with John Bell, MD, were my mentors for surgery of the hand when I was a fellow at Passavant Hospital on the Northwestern University Medical School campus in Chicago in 1969. Dr. Stromberg practiced and taught hand surgery at Northwestern University from 1958 until his retirement in 1986 and did volunteer surgery for years at the Shriners Hospital for Crippled Children in Chicago. His teachings were simple and practical and he was a superb surgeon who emphasized the use of sharp dissection. “Strommy” taught me much more than hand surgery. He taught me to be compassionate, to honor my patients, and to practice ethics and values that have stood the test of time. With his great sense of humor, he also taught me to laugh and enjoy the professional interaction with patients, colleagues and medical staff to the fullest. In short, he taught me how to be a real physician. After my fellowship, Dr. Stromberg and I remained good friends until his death in 1991.
Together, Drs. Garceau and Stromberg taught me to consider each case with respect for the patient’s personal situation and individual needs.
What has been your most important contribution to orthopedic surgery?
Strickland: I guess some would consider the privileged opportunity I had to serve as president of the American Society for Surgery of the Hand and the AAOS as my most important contributions in the field of orthopedic surgery. Or, perhaps my scientific papers and lectures should rise to a high level of importance. Indeed, those years of leadership and scientific endeavor are important, but when I sit back and think about what was most important about what I have left behind, I realize the answer is easily the more than 150 young men and women I have had the opportunity to help train and the wonderful care they have provided patients around the world. Many have become teachers themselves in their practice settings, in orthopedic and hand surgery literature, and at national educational meetings. Others have become leaders in their communities and medical organizations. I am incredibly proud of them. I have found that staying in touch with the students I trained helped me realize I have had, in some small way, a place in their development as caring and skilled physicians, has provided an inestimable personal satisfaction and feeling of accomplishment. In truth, those I trained probably taught me more than I taught them.
How do you envision the future of orthopedic surgery in the next decade?
Strickland: I have no great concern about the advancement of orthopedic surgery with the exciting development of new and better methods for the treatment of the formidable spectrum of surgically manageable musculoskeletal disorders. Well-trained and dedicated orthopedic surgeons will continue to improve current techniques and develop innovative alternative methods to restore mobility and extremity function and treat spine afflictions. These advances, using evidence-based documentation and algorithms of care, will continue to improve the quality of life for patients with orthopedic conditions including a rapidly increasing aging population.
I do, however, have concern about the socioeconomic and business changes that will create new and practice modifying pressures on orthopedic surgeons and their ability to continue to provide high-quality services for their patients. We are confronted with the likelihood that 16 million new patients will soon be covered by low-paying health care policies and that, currently, about 50% of specialist physicians accept those patients. The future will test our commitment to provide good orthopedic care without being unduly influenced by the business side of practices and personal income.
Those who know me know I have been on my “soapbox” for a long time about the emphasis on increased patient and procedure volumes that have resulted from the decline in reimbursement for orthopedic services. No one can question that spending too little time with patients to truly understand their particular problems and individual needs and practicing with personal surgery quotas inevitably begins to bend ethical behavior and is undeniably detrimental to the quality of the services orthopedic surgeons provide. Furthermore, volume-driven practicioners will almost always compromise the true joy of delivering orthopedic patient care. While much about the ACA confuses or bothers me, I hope the new systems for health care delivery will reward quality over quantity as has been repeatedly articulated by those who foster the system. I am skeptical about the true commitment and methodology for achieving that transition, as beneficial as I believe it would be for patient care.
What advice do you have for the next generation of orthopedic surgeons?
Strickland: You must set about to become part of a practice or institution that emphasizes the quality of patient care over fiscal considerations that require short patient encounters or high procedural numbers. Quality supersedes quantity in patient care and outcomes.
Try to reduce or eliminate the business side of practicing medicine by forming fair and practical relationships with health care institutions that share a commitment to the best possible, cost-effective patient care and stay engaged with the institution on refining effective, efficient and integrated systems for the management of orthopedic conditions.
Take time to get to know your patients. Sit with them, look them in the eye, listen to them, touch them, understand not only their musculoskeletal problem but the effect that it is having on their function and life in general. Spend a few moments to help them understand their disorder and the best options to make them better. Let patients participate in the decision making. And please, do not sit before patients with a computer on your lap, typing into the electronic medical record program when you should be eye-to-eye interviewing, examining and demonstrating genuine concern.
Always remember that orthopedic surgeons are caregivers not businessmen and women. Being able to practice the art and science of medicine and orthopedic surgery is what matters most. Paramount in everything you do must always be the wonderful link between your hearts, your hands and the patients you serve. Nothing matters more.
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Disclosure: Strickland has no relevant financial disclosures.