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Letters to the Editor to:

Scientific Articles:
Joseph A. Janicki, Unni G. Narayanan, Barbara J. Harvey, Anvesh Roy, Shannon Weir, and James G. Wright
Comparison of Surgeon and Physiotherapist-Directed Ponseti Treatment of Idiopathic Clubfoot
J Bone Joint Surg Am 2009; 91: 1101-1108 [Abstract] [Full text] [PDF]
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[Read Letter to the Editor] Are we really that busy?
Lewis E. Zionts, MD   (16 June 2009)

Are we really that busy? 16 June 2009
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Lewis E. Zionts, MD,
Physician
Orthopaedic Hospital, Geffen School of Medicine at UCLA, Los Angeles, California

Send letter to journal:
Re: Are we really that busy?

LZionts{at}laoh.ucla.edu Lewis E. Zionts, MD

To the Editor:

I read with great interest the article by Dr. Janicki and colleagues entitled,"Comparison of Surgeon and Physiotherapist-Directed Ponseti Treatment of Idiopathic Clubfoot" (1). Although I was not surprised by their conclusion, that infants with idiopathic clubfoot can be managed by ancillary personnel without “compromising the quality of care”, I found myself wondering, who would want to forgo one of those activities that embodies the very essence of our profession?

In my experience, one of the most meaningful activities in which I have engaged as a physician over the years has been the treatment of an infant’s clubfoot. What makes this endeavor particularly satisfying is that it is one of the few activities that involve extended, personal, hands-on contact with the patient. I believe that most parents genuinely appreciate the fact that the treatment is being rendered to their child by the person who they view as the most knowledgeable and well-trained member of the health care team – the physician. There are few conditions I treat for which the gratitude of parents, grandparents, and other family members is more profoundly expressed. We do have skilled ancillary personnel in our clinic who can help the parents deal in depth, if necessary, with educational, cast, and orthotic issues that may arise. These individuals enable us to take care of our patients without unduly compromising our schedules.

I realize from my interaction with our residents that our profession has become increasingly technically oriented. I also acknowledge that there are certain cost concerns in the practice of medicine. However, I would hope that, before we turn over as rewarding an activity as the treatment of idiopathic clubfoot to our nurses and physical therapists, we reflect on the reasons we originally chose to become physicians. More importantly, we should take into account the comfort the family derives when the physician personally attends to the care of their child.

The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of his immediate family, is affiliated or associated.

Reference

1. Janicki JA, Narayanan UG, Harvey BJ, Roy A, Weir S, Wright JG. Comparison of surgeon and physiotherapist-directed Ponseti treatment of idiopathic clubfoot. J Bone Joint Surg Am. 2009;91:1101-8.