The case for orthopaedic medicine in Israel

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• 作者：Aharon S Finestone (1) (2) (3) (4)
  Simon Vulfsons (3) (5)
  Charles Milgrom (6)
  Amnon Lahad (7)
  Shlomo Moshe (8)
  Gabriel Agar (1) (2)
  Dan Greenberg (4)
  
• 关键词：Orthopaedic medicine ; Musculoskeletal pain ; Pain management
• 刊名：Israel Journal of Health Policy Research
• 出版年：2013
• 出版时间：December 2013
• 年：2013
• 卷：2
• 期：1
• 全文大小：388 KB
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• 作者单位：Aharon S Finestone (1) (2) (3) (4)
  Simon Vulfsons (3) (5)
  Charles Milgrom (6)
  Amnon Lahad (7)
  Shlomo Moshe (8)
  Gabriel Agar (1) (2)
  Dan Greenberg (4)
  
  1. Department of Orthopaedics, Assaf Harofeh Medical Center, Zerifin, Israel
  2. Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
  3. Israel Society of Musculoskeletal Medicine, Israel Medical Association, Ramat Gan, Israel
  4. Department of Health Systems Management, Ben-Gurion University of the Negev, Beer Sheba, Israel
  5. Institute of Pain Medicine, Rambam Health Care Campus and Rappaport School of Medicine, Technion, Haifa, Israel
  6. Department of Orthopaedics, Hadassah University Hospital, Jerusalem, Israel
  7. Department of Family Medicine, Hebrew University of Jerusalem Medical School, Jerusalem, Israel
  8. Occupational Medicine Department, Maccabi Healthcare Services, Holon, Israel
  
• ISSN：2045-4015

文摘

Background Musculoskeletal complaints are probably the most frequent reasons for visiting a doctor. They comprise more than a quarter of the complaints to primary practitioners and are also the most common reason for referral to secondary or tertiary medicine. The clinicians most frequently consulted on musculoskeletal problems, and probably perceived to know most on the topic are orthopaedic surgeons. But in Israel, there is significant ambivalence with various aspects of the consultations provided by orthopaedic surgeons, both among the public and among various groups of clinicians, particularly family practitioners and physiotherapists. Methods In order to understand this problem we integrate new data we have collected with previously published data. New data include the rates of visits to orthopaedic surgeons per annum in one of Israel’s large non-profit HMO’s, and the domains of the visits to an orthopaedic surgeon. Results Orthopaedic surgeons are the third most frequently contracted secondary specialists in one of the Israeli HMO’s. Between 2009 and 2012 there was a 1.7% increase in visits to orthopaedists per annum (P-lt;-.0001, after correction for population growth). Almost 80% of the domains of the problems presented to an orthopaedic surgeon were in fields orthopaedic surgeons have limited formal training. Discussion While orthopaedic surgeons are clearly the authority on surgical problems of the musculoskeletal system, most musculoskeletal problems are not surgical, and the orthopaedic surgeon often lacks training in these areas which might be termed orthopaedic medicine. Furthermore, in Israel and in many other developed countries there is no accessible medical specialty that studies these problems, trains medical students in the subject and focuses on treating these problems. The neglect of this area which can be called the “Orthopaedic Medicine Lacuna-is responsible for inadequate treatment of non-surgical problems of the musculoskeletal system with immense financial implications. We present a preliminary probe into possible solutions which could be relevant to many developed countries.