The Importance of Being on the Same Page

No doctor is perfect. My guess is that orthopedic surgeons are as tired of talking about the importance of weight loss and exercise as I am to what seems to be deaf ears. Worse, it's unprofessional to complain about other specialists[1], but my last two weeks have been a bit frustrating. 

• Patient was seen two years ago with "mild arthritis" in a joint. She was told by two orthopedic specialists that she didn't need surgery. Neither of them recommended physical therapy or for that matter, any movement whatsoever. Apparently that's what she didn't do--move (or so I've been told by a friend). Now she's scheduled for a joint replacement having never been offered the option of physical therapy. I cannot help but think her inactivity accelerated her joint problem.[2]
• I encourage my patients with knee and hip pain to exercise and especially to lose weight. If I send them to an orthopedist they come back to me and deny that the orthopedist recommended weight loss. I think they just didn't hear what they don't want to hear but many times, there is nothing in the referral note indicating that they were told to lose weight. 
• Last week two patients came to me after they saw their orthopedic surgeons asking ME to send them to physical therapy. Why? Because the surgeon didn't recommend it. 

Several years ago a friend of mine was sitting in an orthopedist office. After looking around the orthopedic's waiting room, she began a diet and exercise program the next morning. She told me "Except for the athletes, every person over 50 in that office was at least 30 pounds overweight. How can you miss the message there?" At that time she was in her early forties. Now ten years later she has kept the 10 pounds she shed off and exercises at least four times weekly.

Day in and day out I understand how frustrating it is to try to motivate patients to exercise and lose weight. Many of my orthopedic colleagues DO emphasize these things and my sense is that they are improving in that regard. In a society where obesity is ever more the norm, we've all got to be on the same page to help patients make changes, especially if you are the expert in the patient's eyes.[3] 

1. http://well.blogs.nytimes.com/2013/07/11/doctors-badmouthing-other-doctors/

2. http://www.mayoclinic.com/health/arthritis/AR00009
3. http://www.news-medical.net/news/20130411/Orthopaedic-surgeons-should-recommend-weight-loss-to-patients-prior-to-joint-replacement.aspx