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Updated: May 3 2023

Ethics in Orthopaedic Practice

  • Relations with Industry and Hospitals
    • Acceptable standards of professionalism
      • practicing orthopedic surgeons may accept tuition, travel, and modest hospitality (including meals and receptions) to attend an industry sponsored non-CME course given at a local convention center
      • industry relationships must be disclosed to patients, colleagues, and institution
      • gifts must have a market value under $100
      • no direct kick-backs can be given to a physician or hospital systems from an industry
      • physicians cannot refer patients to centers in which they have a financial interest (Stark II laws)
  • Patient Satisfaction & Complaints
    • Patient complaints
      • formal written patient complaints regarding quality of care require letters of response to patients from the surgeon
    • Communication
      • leading cause of medical litigation
        • on average, most doctors interrupt patients during an interview within 23 seconds
        • orthopedic surgeons are described by patients and colleagues as "high tech but low touch"
        • orthopedic surgeons are described as having poor communication skills and empathy for patients
      • translation services
        • can be provided by employees fluent in the language, commercially available telephonic services, professional interpreters, and volunteer translators
        • inappropriate for family members to act as translators unless patients offer/agree
  • Medical Innovation
    • Royalties
      • surgeons receiving royalties for implants used in surgery must be disclosed to patients
    • Research
      • must disclose any financial conflicts of interest and should ethically remove any possible bias from funded studies 
  • Patient Transfer
    • The Emergency Medical Treatment and Active Labor Act (EMTALA)
      • all patients must be appropriately screened and stabilized in the original emergency room/hospital
      • risk of patient transfer must be less than the risk of keeping patient
      • accepting hospital/center must know of and accept patient
  • Physician Advertising
    • Physician advertising is becoming more common
      • AMA and AAOS cannot prevent physicians from advertising services
      • FTC, AAOS, state medical boards can sanction for false advertising
      • things to avoid
        • using terms such as "cure" if no cure truly exists
        • using terms such as "painless" or "bloodless" to describe surgery
        • overstating credentials such as "board certified in joint replacement" if no such qualification exists
        • using terms such as "world renowned"
  • Diversity
    • Understanding cultural differences leads to
      • enhanced patient-physician relationships
      • minimized disparities in health care
      • optimized access to orthopaedic care
    • Implicit biases
      • present when unconscious prejudices or stereotypes influence care delivered to patients
      • determinant of health disparities
  • Access to Healthcare
    • Type of health insurance has been shown to be a determinant of healthcare access in the pediatric population
    • Physician burnout
      • Consist of loss of enthusiasm for work, feelings of cynicism, and diminished feelings of personal accomplishment
      • Affects 45-55% of all US physicians 
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