Tell us about your work as a traumatologist.
I am on-call Monday through Friday during the day at St. Peter’s Hospital. For four of those days, I’m at the hospital ready to help patients who come in with traumatic injuries or infections. I also do follow-up in my clinic at the OOA Eastside Clinic on Wednesdays.
Today is a pretty typical day and my surgery lineup includes a woman who had an ankle fracture, a gentleman who fell and broke his hip, and a younger man who fell off the back of his pickup truck and broke his tibia.
How does trauma orthopaedics differ from other orthopaedic medicine?
Orthopaedic surgeons generally become subspecialized at an anatomic site. So a doctor might be a hand specialist, a spine specialist, a shoulder specialist, or a foot and ankle specialist. As a traumatologist, I’m basically the fracture specialist.
Fractures can happen all over the body, so I repair injuries—both operatively and non-operatively— all over the body starting from the shoulder girdle, including your proximal humerus, scapula, and clavicle all the way down to complex foot and ankle fractures and everything in between at all ages.
DYK? Trauma orthopaedics medicine can include surgery of the pelvis and acetabulum, foot & ankle and upper extremity, spine, post-traumatic joint reconstruction, correction of a malunion. A traumatologist’s training includes learning how to treat bone infections, manage multiply-injured patients, as well as specific programs in pediatric and geriatric orthopaedic trauma.
Tell me about your fellowship training.
I did my fellowship training at Regions Hospital in Minnesota, which is a Level 1 Academic Trauma Center. We took care of everything from multiply-injured patients to high-energy traumas, which typically lead to more complex injuries because the soft tissue is just as damaged as the bones underneath. As a physician, I have to figure out how to manage those soft tissue problems along with managing the bony problems underneath.
An example of the type of case I worked on during my fellowship would be a car accident where the patient broke both femurs and had a bad upper extremity fracture of some type. I also learned how to treat complex cases that didn’t go well. For example, if someone has an infected non-union, how do you manage those? How do you manage when someone has complex foot and ankle trauma and they need some kind of salvage surgery because their joint is arthritic several years down the road? How do you manage the complex decisions that need to be made when treating the residual effects of orthopedic trauma? Those are the kinds of challenges that I was exposed to during my fellowship.
DKY? High energy traumas can include things like a car accident at highways speed, hitting a tree while driving a snowmobile, or falling off a high ladder.
How do you build trust with patients in emergency situations?
I half-jokingly say that my job is like blind-date surgery. It’s really critical in the first 10 seconds that my patient and I trust each other and that we come to an understanding pretty quickly. It’s the reverse of a typical process where you might work with a patient for years and they eventually get to the point where they trust you enough to do their replacement. Instead, I meet patients for the first time either the night before surgery or the day of surgery. Then we get to know each other better on the other side of surgery.
How do you achieve the best outcomes for patients?
One of the biggest things that I think about is how to make the postoperative care as simple as possible. So if it’s possible, I close wounds with all stitches below the skin (a subcuticular closure) which means that there is very little incision care because it’s already sealed up with skin glue. It also means that I’m not digging staples out of an elderly woman’s hip for a hip fracture, for example. The incision can heal nicely without anyone having to mess with it.
Occasionally, people show up at St. Peter’s with multiple injuries. A patient might have had a ground-level fall and broken both their shoulders and their hip, Or perhaps they break both their distal femur and their hand. I immediately start planning: “How could it be possible for me to fix everything at one go in the operating room?” I do this so that the person isn’t going in on Tuesday for their femur, and then going back with someone else on Thursday for their hand injury. Less trips to the OR means less exposure to anesthesia and usually a quicker discharge from hospital.
You also work as a physician coach. Can you tell us what that involves?
I’m working through the process to become a certified physician coach. At this point, it’s a passionate hobby of mine. One of my goals in coaching is helping other physicians realize that there are better ways to use Electronic Medical Records (EMR) because the associated frustration can be a big driver of burnout. I usually do it by watching them get frustrated and then asking: “Hey, what’s really frustrating to you about this?” Then I help them troubleshoot a more efficient solution. A few tweaks can make a huge difference.
I’ll show them things like using a customizable order set. They go, “Oh my goodness, this is fantastic! I’ve gone from doing 80 clicks per patient to 5 clicks per patient!” There are relatively simple strategies that can make a big difference during your individual days. If I can help others with that, particularly those in my local community, I find that really rewarding.
What would you like patients to know about your approach to medicine?
I try to take a shared decision-making model with a patient. I like working with patients to reach the best decision possible. While I’m the content expert and I know about outcomes and about different ways of repairing things, I don’t have to live with the outcome. It’s the patient who has to live with the outcome, so they should really know as best as they can what that may look like and what they are prepared to tolerate. My work is not always easy, but I love coming to work and I love what I do.