Luis Rafael Ramos Pascua is the president of the Spanish Society of Orthopedic Surgery and Traumatology and Head of the Orthopedic Surgery and Traumatology Service of the Hospital Universitario 12 de Octubre.
What personal abilities do you think a good orthopedic surgeon and trauma surgeon should have?
In the first place, the same that a person and, in particular, a doctor should have, which can be summed up in two words: empathy and humanity. The ability to put yourself in the shoes of the other and understand him, while maintaining “social distance”. This is, without forgetting that one is the patient and the other, the doctor, the professional who tries to solve a health problem. From here on, a good traumatologist must be very studious, prudent in his decisions and, of course, skillful manually. This cocktail distinguishes the excellent from the less excellent and breaks with the stereotype of the “traumatologist-carpenter”.
Generally, what are the most frequent pathologies?
It depends on whether we are referring to trauma or orthopedic pathologies. Among the first, without a doubt, the fractures. Among these, the most frequent are those related to osteoporosis, among which the vertebral, wrist, hip and shoulder fractures stand out, increasingly frequent due to the aging and longevity of the population. Among non-osteoporotic fractures, perhaps those of the clavicle and all those related to traffic accidents.
The most frequent orthopedic pathologies are those that can be called “degenerative” or that are related to aging, in a broad sense, with osteoarthritis and degenerative tendinopathies to the head. Among osteoarthritis, the most frequent and disabling are those of the hip and knee. And a pathology that occupies us more and more time, as well as demanding: the complications derived from prostheses that have been previously implanted.
How has the treatment of this type of pathology progressed?
In general, a lot and in all fields, as in any other medical discipline. Diagnostic imaging techniques have improved, facilitating diagnoses and therapeutic planning; implant materials and designs; and even surgical techniques, hand in hand with advances in biology and technology. Progress has also been made in the treatment of soft tissues, until now perhaps more neglected, and in less tangible and recognized aspects that are very important in achieving a good surgical result: there is a greater awareness of teamwork and decisions “Collegiate”, and an equally more comprehensive perioperative management.
In this sense, what type of surgery is the most innovative and the one that is most often used?
The most innovative, although it may seem surprising, is the one that is well indicated and executed, which does not serve more interest than the benefit of the patient. The one that is carried out under strict aseptic and antiseptic conditions, quickly and according to a previous planning, and that does not end until after the last point to the skin. Despite robotics, 3D printing, “new realities”, bone substitutes and, in this field, tissue engineering (on many occasions all of this oversized, especially at the media level), the key to good treatment today is still in the human factor.
The new coronavirus pandemic has affected practically all areas of healthcare. How has it influenced your specialty?
It has undoubtedly affected us a lot because in the most critical months it forced us to suspend most of the consultations and scheduled surgical interventions, as well as to further individualize the therapeutic indications so as not to expose patients to unnecessary risks and optimize available resources. Overnight, many traumatologists found themselves reconverted into makeshift internists, when not “unoccupied”, and we had to reorganize the activity of the services to adapt to the new situation.
As a consequence of all this and based on the memory of colleagues who fell ill, some of whom died, although not all health areas or hospitals have been stressed in the same way, surgical waiting lists and for a first consultation have increased . However, taking into account the characteristics of our Specialty, compared to others such as Oncology or Cardiology, the damage for our patients has not been so much in the quantity as in the quality of life lost. Except for specific cases of delays in the diagnosis of musculoskeletal cancer, which surely have also occurred, most of the really urgent pathologies have been treated.
And I do not want to miss the occasion to refer to another very important consequence of the pandemic: the “stop” and the subsequent and slow “reinvention” of training, which is the fundamental pillar of present and future healthcare activity. Suddenly it was necessary to suspend the teaching activities for the students, the training activities for the residents and the continuing training activities for the rest of the professionals.
How has the Spanish Society of Orthopedic Surgery and Traumatology adapted to this new situation?
In principle, complying with the general public health instructions in an emergency situation such as this one. Regarding our specific responsibilities, taking into account that we are a medical-scientific association that owes itself to its associates and society in the promotion of musculoskeletal health, we lead the confusing and absent initial specific information with communications that deserved recognition. international. With the help of Dr. Jesús Gómez Vallejo, member of Social Affairs and Cooperation of the SECOT, we prepared up to 8 documents of our own production with proposals that at that time were pioneers in relation, for example, to telephone assistance in external consultations or surgical activity. We also organized a multidisciplinary webinar followed by 450 attendees from 12 countries, which the Argentine Association of Orthopedics and Traumatology repeated, and we answered dozens of questions from patients in a space that we set up on our website for that purpose.
Simultaneously, we had to accelerate the process of virtualization of training that we had started in previous years, I would almost say premonitory, and we were one of the first scientific societies that announced and held its national online congress at the end of September, with a great success of assistance and criticism. A merit of the entire Society that had the previous Board of Directors as the main protagonist, for their great effort and good work.
The Society has several scientific lines, could you tell us a little about them?
Of course. The scientific fronts and projects of our Society are many and diverse. Apart from maintaining an exemplary training program for residents and activities for all our associates, as well as projects related to our presence on social networks and specific professional practice (updating of the Nomenclator, informed consent documents, etc.), we encourage research in general through our Research Agency and the SECOT Foundation and, currently, we are developing online courses on tumors, infections and Child Orthopedics, we are updating the thromboprophylaxis guide, etc.
Focusing on the specialty, what is your situation in Spain? What barriers or complications do they encounter?
Currently, Spanish Orthopedic Surgery and Traumatology is in very good health and has a lot of prestige from a technical point of view, as evidenced by our presence in many international forums. However, it is highly commendable that this is the case, taking into account the difficulties we encountered in the implementation of new technologies due to the budgetary limitations of the services and the difficulties in obtaining financing for training. In relation to this, we are very concerned about a document drafted as a Non-Law Proposition in which the prohibition of financing the continuing education of medical professionals by private companies is suggested, knowing that the state is incapable of sustaining it in the terms current. In this sense, we are fully aligned with the objectives of the Federation of Spanish Scientific-Medical Associations (FACME).
And another great topic of debate and concern is the draft Royal Decree that regulates transversal training in health sciences specialties, in which the opinion of specialists seems to count for little.
How would you solve them?
Although it sounds demagogic, leaving its management in the hands of professionals or, at least, listening to them in a “proactive” way, without political interference and, less, ideological. Trusting scientific societies, with the requirement of transparency and compliance with their ethical codes and good practices.