Tongue Reflects on his Presidency

Upon his election last winter as president of the American Association of Orthopaedic Surgeons, John R. Tongue, M.D., vowed to demonstrate the quality and value of orthopedic surgery and enhance the communication between patients and physicians. Before handing over the reigns of leadership to his successor, Joshua J. Jacobs, M.D., Tongue spoke with Orthopedic Design &Technology about the challenges and victories of his 12-month term.

ODT: Upon your election as president last year, you said you wanted to demonstrate the quality and value of orthopedic surgery. How did you fulfill that goal?
Dr. Tongue: We are continuing to work on demonstrating that. Happy to tell you that the presidential symposium Friday morning at 8 a.m. [was] devoted to explaining the social and economic value of orthopedic surgery based on research that we’ve been doing the last two years which I helped initiate. We reported on common conditions that we treat in orthopedics, connecting the direct costs, which are fairly well known, to the indirect costs and benefits that have not been studied in the past. For example, when a 55-year-old teacher has a total knee replacement in the state of Oregon, they continue to teach, they continue to pay taxes, they continue to be productive, active citizens. And that improves their general health as well as the bottom line to society because they’re not retired or on disability maintenance intentionally. So showing that these procedures that we do are not only cost effective but they also are cost saving to society is important. We have research that we explained and we think it’s very exciting to present new information.

ODT:One of your other goals as president was to enhance the communication between patients and physicians. How did you accomplish this?
Dr. Tongue: Twelve years ago, I helped initiate the communication skills mentoring program, which we’ve presented hundreds of times as interactive workshops to around 6,000 orthopedic surgeons. We continue that program to enhance communication for interviews between patients and physicians. We’re expanding that effort now with a pilot project using the education model developed by the [U.S.] Department of Defense 10 years ago called TeamSTEPPS. We are using that format now to teach interdisciplinary teams of orthopedic surgeons to work with not just patients but all of the folks involved in caring for orthopedic patients. The settings for these workshops are for those working in hospital O.R.s, surgical centers, clinics: so that we can reduce medical errors and improve quality of care of our patients by better communication through team members, since we are all working now in larger teams than we were when I started practice. We think this is going to be an important next step.

ODT: Please characterize the past year (2012) for the orthopedic industry.
Dr. Tongue: I can’t speak for the orthopedic industry but I can tell you over the last three years as a member of the presidential line I’ve had the opportunity to sit down face to face with five or six companies each year to talk to about their challenges and their opportunities. We continue to value the relationship between orthopedic surgeons and the industry in continuing the future progress in the development of procedures and technologies that will advance orthopedics all over the world. I’ve had the opportunity in international travel to witness the reputation of our field, which is very high internationally thanks to the innovative partnership between our members and members of industry in advancing our field. During my career—I’ve been in practice now for 34 years—I’ve seen the development of fracture fixation and arthroplasty, a phenomenal pace that has made orthopedic surgeons much more valuable in society and that’s one of the reasons that I’m particularly excited about this research we’ve done on the social and economic value of what we do. Many of the procedures that we do on a regular basis such as total knee replacement and rotator cuff repair are relatively expensive procedures like cardiology procedures but the return to society in terms of the value of these procedures when you look at the downstream indirect cost benefit is tremendous. Making that connection between the up-front costs, which payers see, and the downstream benefits which the payers do not see is important in maintaining access to appropriate musculoskeletal care for our patients. We need to look to adding greater value and reduce costs for what is clearly an unsustainable healthcare system. We think the orthopedic care has tremendous value across the board compared to all other forms of medical care and we want to explain that to patients, the public, payers, and regulators during this period of transformation in healthcare reform that is going to be disruptive.

ODT: What was the most difficult challenge of your presidency?
Dr. Tongue: It’s been a wonderful year, the most exciting thing has been learning the value of pooling all the different talents and resources of our large group of volunteers to accomplish difficult projects. One of the most challenging projects has been documenting and articulating evidence-based medicine in terms of clinical practice guidelines and the process we’re developing now for appropriate use criteria. The challenge is that these efforts are evidence-based on existing literature and sometimes things that we do in regular practice that we all believe are valuable are not documented in existing literature at the level we would like them to be. We have spent lot of time this year educating groups within our profession about the difference between what literature supports and what we actually do in practice, which is oftentimes clearly beneficial but not documented well in literature. Our personal experience and our personal training sometimes doesn’t match up with the highest levels of orthopedic research and literature, which challenges us to do better research and also challenges us to ask better questions about what we do. That’s caused concern and we have met that challenge by greatly increasing our communication about evidence-based medicine and we’ve done this through webinars, through written communication, through one-on-one meetings with specialty organizations, and regional and state organizations, including multiple presentations by presidential line. We’ve made good progress in explaining to folks that if we don’t make these statements others will make them who do not understand what we do. To maintain access to care for our patients we need to continue to ramp up our efforts in articulating these quality- related documents, these guidelines and these use criteria so that we establish this information

ODT: What advice would you give to your successor, incoming president Joshua J. Jacobs?
Dr. Tongue: Josh Jacobs is superbly qualified to be our next president. We have very different backgrounds; my leadership background came through advocacy and his has come through academic medicine and many leadership positions as both a department chairman and through leadership in many other organizations. He clearly knows what the job entails, he has wonderful relationships and contacts throughout the academic world that have been a real benefit in teaming up with him over the past two years. As I look back the last three years I’ve dealt with hundreds of conference calls and thousands of emails, and then there’s of course the travel, which this past year was about 100 days for me. I guess the only recommendation I have for Josh is to make sure he gets some sleep. He’s going to be a busy guy. I know he’s excited about the challenge.