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To the editor:
My fracture team thinks Dr. Cannon was on-point in “Orthopedists express concern about 7-day full coverage mandate in United Kingdom,” when he said that U.K. orthopaedists provide coverage 7 days a week and the problem is a lack of support services. From 3 p.m. Friday to 8 a.m. Monday, we experience skeleton crews, unavailable studies and a lack of providers in physical therapy, laboratory and consulting services. Insurers create another barrier when phone-in services for preauthorization are unavailable. Case in point: we cannot get cardiac ultrasound done and interpreted, and thus the patient with the hip fracture waits days for surgery.
However, the solution is not to throw more money at a dysfunctional system as the article in Orthopaedics Today Europe seems to suggest. The thrust should be to use resources better. Both the 48-hour rule for house staff and the concept of overtime pay for weekend service may be confounding the real issue as is the idea that mentoring of junior doctors will be reduced by a 7-day mandate.
If four cases can be done in a block on Wednesday morning, why only two cases in the same amount of time on a Saturday? Have you ever had a senior administrator in the hospital mid-day Sunday to see that everything was functioning well? Cannot consultants/attendings work and teach their teams on a weekend, as well as on a weekday rotation? The goal should be to improve the value of every hour that is allocated for patient care. If the patient must spend extra days because therapy is unavailable on weekends, then hospital days are not being used to full advantage.
Our principal job as orthopaedists is to care for broken bones. The British tradition of bone setting going forward from Hugh Owen Thomas and Ernest William Hey Groves is a great one. It is alarming then to have baked into our pudding the ingredient of general practice. There is no sense in seeing a general practitioner for a hip fracture, least of all on a weekend. We should have pride in the care and service provided by the orthopaedic profession to patients who are hurt and not allow our care to be diminished by other issues, even if these issues seem politically correct. Colleagues in allied specialties who facilitate the care of the injured are always welcome. Specialists who are unavailable and place barriers to effective treatment by leaving their machines idle on the weekend are burning the pudding.
To be clear — 7-day care is what I want if I break my hip. What I do not need is a lot of sympathy, caring, pain medication or team care. Just give me swift, accurate orthopaedic surgery, please.
David Seligson, MD
Louisville, Ky., USA
Disclosure: Seligson reports no relevant financial disclosures.