For the last two months I worked in Orthopaedics and therefore spent a lot of time in the company of Orthopods themselves. In honor of completing my orthopaedic rotation I decided to write a blog post about what I learnt about this particular species of doctor. You’re probably thinking that the point of my internship is to learn more about the actual disciplines themselves, rather than the people practicing them. And this is particularly true when it comes to Orthopaedics since I recently consented a patient for a “ORIF of 1st metatarsal of left hand” …. For those who aren’t medically trained just Google that phrase and you’ll find that Google will respond with “did you mean left foot”. Yes, Google is smarter than me, but the sooner I accept that the easier my life (and career) will be. Despite the fact that Google knows more about medicine than I do, I still spend my time learning more about my colleagues, than medicine itself. So, here is my far-from-comprehensive guide to the Orthopedic Surgeon.
Please note that the following information is massively stereotypical and should be taken with a pinch of salt, and is actually written with a great deal affection.
Apparently a guy called Nicholas Andy coined the word “orthopedics” when he published “Orthopaedia: The Art of Correcting and Preventing Deformities in Children”. That is just a random and interesting fact and more evidence that Google is smarter than me. What I didn’t have to Google is that “Ortho” means to make straight. So basically Orthopods are the “make-straight” doctors, and they specifically deal with bones, or the musculoskeletal system, which also includes tendons and ligaments. But this is getting way to complicated, and orthopods themselves will tell you that they don’t do complicated.
Classically, Orthopods are portrayed as the “jocks” of medicine. All braun, and very little brain. Many would describe them as the doctor with the blank look on his face who is dressed as if he is ready to go to the gym, with a hammer in his hand (with emphasis on ‘his’). From my experience however, I found that Orthopods are actually very good at blending in and can range from jock, to hipster, to female. The only true way to identify an orthopod is to look at his (for the sake of stereotypes we are going to stick with the masculine nouns) shoes and you will see the trademark plaster of paris stains. (Stains is actually the wrong word to use. Plaster of paris comes out very easily, so please don’t freak out the next time a doctor gets a little bit on your clothes – its really not the end of the world).
The Orthopod has three main natural habitat – Fracture clinic, Theatre and the Theatre Tea Room. Most frequently the Orthopod can be found in the Theatre Tea Room, debating how to get their theatre list past the Anaethetist over a cup of coffee. However, when not in the Tea Room, they will either be found in Theatre itself or in the fracture clinic. If the Orthopod has a choice, he will be in theatre fixing the fractures, rather than in fracture clinic diagnosing them. You see, an Orthopod’s passion lies in fixing and “making straight” rather than diagnosing. This is what other species of doctors don’t understand. Just because it doesn’t take 3 weeks, 27 blood tests and a third opinion to diagnose an Orthopaedic patient with a broken bone doesn’t mean Orthopedics is easy. The challenge lies in the making straight, hence the Orthopod will choose Theatre over Fracture Clinic every time. But the Theatre Tea Room will always be their number one.
Heirarchy and behavior
As in every department there is a Heirarchy: Head of Department, Consultant, Senior Medical Officer, Junior Medical Officer, Sisters, Nurses, Intern. Orthopods generally also follow this rule. However, there is a way to move up in the ranks, something other species lack. The secret lies in the ability to put on a perfect plaster of paris cast. Those who put on a attractive, but also effective, plaster cast are admired greatly by the Orthopod and will be treated with respect. Orthopods usually move in packs between fracture clinic and the Theatre Tea Room, however they can be found alone or in pairs when in Theatre itself. Orthopods are a very social species, and outside of the hospital they can often be found enjoying a good steak.
Natural enemy and threats
The Orthopod has only two natural enemies – the Elderly Neck of Femur Fracture and the Anaethetist, and they usually go hand in hand. Let’s explore the latter first. The Anaethetist. As I previously mentioned, the Orthopod thrives on “making straight” and the majority of the time this requires an Anaethetist. The Orthopod needs the Anaethetist to keep their patient (read fracture) still. In the majority of cases, the Anaethetist and the Orthopod can co-exist without incident, but conflict arises when the Elderly Neck of Femur Fracture enters the picture. Most of the Orthopod’s patients are young and the only comorbidity they have is stupidity (hence their broken bone). However in the case of the Elderly Neck of Femur Fracture, the picture is different. This particular patient is probably hypertensive, diabetic, has had three previous strokes, some vague history of chest pain and is now delirious. This scenario makes the Anaethetist very unhappy, and when the Anaethetist is unhappy then it usually means the Orthopod cannot make straight – and this makes him unhappy too. And this particular breed of patient is usually a Panda and this makes the Intern unhappy. So all in all, everyone is unhappy. But – there is always a but – the Orthopod has a secret weapon, which brings me to my next topic.
Means of survival
Every species has a means of survival. Otherwise they would be extinct – survival of the fittest and all that. The Orthopod’s secret weapon is the one liter bag of normal saline. Let me present a typical scenario in order to demonstrate.
Orthopod: Book this patient on the list for a total hip replacement.
Intern: This patient has a neck of femur fracture. But she also has a BP of 186/120, a sugar of 30, is delirious and has ST depression on her ECG.
Orthopod: Okay, give her a liter of normal saline and then book her on the list.
The Orthopod believes that the bag of normal saline will solve all problems and make The Anaethetist happy again. Usually they are correct, but in some cases the Physician has to step in and resolve the conflict.
All in all the Orthopod is a fairly pleasant species to work with, and despite the fact that I still can’t tell the difference between fingers and toes, I did learn a lot during my rotation with them. I enjoyed being apart of their ranks for two months, though I am most likely to become one of their moral enemies in the future (The Anaethetist, not the Elderly Neck of Femur Fracture, although both are possibilities).