Orthopedic physicians at UT Medicine San Antonio reflect on their long history of publication and the connection between research, teaching and clinical practice.
“That’s why I came here,” says Robert Quinn, MD, Professor and Chair of the Department of Orthopaedics at the UT School of Medicine, pointing to a picture of a physician standing beside an elbow-high pile of textbooks.
“I’ve only been here a year and a half,” continues Dr. Quinn, who is also Residency Program Director and The John J. Hinchey, MD, and Kathryn Hinchey Chair in Orthopaedic Surgery and Orthopaedic Oncology. “I was attracted to this program because we do write the book when it comes to orthopedics.”
Michael Wirth, MD, Professor and The Charles A. Rockwood Jr., MD, Chair in Orthopaedics, shares a similar story.
“During my third year at medical school, I fell in love with orthopedics,” he says. “I asked my advisor where I should go, and he said, ‘You should study at San Antonio. There are several specialists there who wrote all these books.’”
Dr. Robert Quinn, Chair, Department of Orthopaedics
“There are legacy programs in medicine, programs that arose 30 years ago based on people and activities at certain institutions,” Dr. Quinn explains. “Here, our legacy stems from the work of Charles Rockwood Jr., MD, the first department chair. He’s the one you see in the picture with all these books. Our books — and the personalities behind them — made this program what it is today.”
Dr. Rockwood ranks among the nation’s premier orthopedic surgery teachers. From the development of artificial shoulder joints to the authorship of numerous textbooks, including many that are still standard reference volumes for orthopedic surgeons and emergency medical providers, Dr. Rockwood has shaped the way orthopedic surgery and trauma care are practiced in the United States.
“When I got started, ambulances transported dead bodies,” Dr. Rockwood says. “The poor guy with the broken bone would have to sit there and wait for the next ambulance. We recognized early on that emergency personnel on the scene should be trained to stabilize and transport patients. The federal government awarded us funding to develop such a program.”
Author and UT Medicine orthopedic surgeon Michael Wirth, MD
Out of that program arose Emergency Care and Transportation of the Sick and Injured, the original “orange book” for emergency medical technicians. Dr. Rockwood established a pattern by collecting experts in pediatrics, poison control, snakebite care and other trauma-related fields to contribute chapters. Further book offers followed.
“A publisher at Lippincott realized there was no current textbook on the management of fractures,” Dr. Rockwood says. “He asked different orthopedic organizations who should write the book, and he kept hearing, ‘Go see this doctor in San Antonio; he just wrote a book on emergency medical care.’”
Working with David Green, MD, Dr. Rockwood produced the first edition of Fractures in Adults and Children in 1975. As with his first book, he asked colleagues — experts in their subspecialties — to write the various chapters. Whereas previous textbooks had frequently been the work of single experts, Dr. Rockwood was at the forefront of a tradition in academic medicine in which textbooks became collaborative efforts of the best minds in their respective fields. Like Emergency Care and Transportation, Fractures in Adults and Children is still in print, with the 8th edition due to be published in 2015.
For his next major textbook, Dr. Rockwood invited his colleague Kaye Wilkins, MD, DVM, Professor of Pediatric Orthopaedics, to join him.
Author and Professor of Orthopaedics Kaye Wilkins, MD, DVM
“I was attracted to the innovative work Drs. Rockwood and Green were doing,” says Dr. Wilkins, who just received his 40-year pin from UT Medicine. “Pediatric orthopedics was a new subspecialty, and I was probably the first fellowship-trained orthopedic surgeon in pediatric orthopedics. I wanted to be in on the development of the field. The textbook — still in print as Rockwood and Wilkins’ Fractures in Children — opened a lot of doors, nationally and internationally.”
Like Dr. Rockwood, Dr. Wilkins is still actively teaching and creating instructional materials. His work has taken him across the United States and to countries as diverse as Bangladesh, Haiti, India, Mexico and Vietnam. Now experiencing health concerns, Dr. Wilkins has limited his travel schedule to weeklong visits to Haiti, where he teaches techniques for treating children’s fractures to physicians in areas where surgery may not be an option. He also continues to teach international colleagues through Internet seminars.
Soon after Dr. Wilkins came to the School of Medicine, Fred Corley, MD, Professor of Orthopaedic Surgery, joined the faculty. Focusing on hand surgery, he has become one of the region’s icons of orthopedic surgery.
Hand specialist and Professor of Orthopaedics Fred G. Corley, MD
“I was practicing medicine in town,” says Dr. Corley, who had studied medicine in San Antonio. “At the invitation of Dr. Rockwood, I came to work at the medical school. I have enjoyed the challenges of interesting patients and the chance to work with medical students and residents.”
Gladly Learning, Gladly Teaching
In The Canterbury Tales, Chaucer sums up one character by saying “Gladly would he learn, and gladly teach.” The physicians at UT Medicine embody both halves of that description, working with colleagues, students and patients to learn as much as they can and then spread that knowledge widely.
“You need to stay active in education and teaching to keep your mind stimulated,” Dr. Wilkins says. “My young trainees are full of new ideas. The day I haven’t learned something from a resident isn’t a full day for me. That is what I am trying to do in other countries — help them develop their own orthopedic educational systems.”
Learning and Leadership
It may be counterintuitive to assert that academic modesty leads to strong leadership, but at the School of Medicine, a combination of curiosity and reverence for colleagues’ learning seem to be hallmarks of an enduring leadership style, one that has influenced everything from the ongoing strength of the program to new avenues in textbook publication.
“No one is so smart he can be the expert on everything,” says Dr. Rockwood, describing why he canvassed colleagues to write chapters for his books.
Similarly, Dr. Wilkins also attributes the program’s strong leadership tradition to the zeal for knowledge shared by Dr. Rockwood and the physician-scholars at UT Medicine.
“Dr. Rockwood identifies talents in different people and then delegates and supports them,” Dr. Wilkins says. “He doesn’t micromanage. He does a lot of behind-the-scenes work to open doors for his colleagues.”
That culture of leadership has spread. Nationally, physicians from UT Medicine have served as presidents of the American Academy of Orthopaedic Surgeons, the American Society for Surgery of the Hand, the Pediatric Orthopaedic Society of North America and the Texas Orthopaedic Association.
From Education to Outreach
Dr. Wirth instructing orthopedic fellows Kevin Paisley, MD, and Scott Stevens, MD
The physicians of UT Medicine’s Department of Orthopaedics are eager to share what they know with colleagues, trainee physicians and patients.
Dr. Quinn is continuing the legacy of the program with a textbook of his own, a work on orthopedic oncology. A teacher as well as a practitioner of medicine, he finds instruction hones his patient care skills.
“We excel at communicating with our patients because we have both medical expertise and a high comfort level with explaining what we do,” he says. “You cannot be a good teacher if you are not a good communicator.”
Physicians have also worked closely with the military and civilian organizations to share their knowledge about orthopedics and trauma medicine. For instance, Dr. Quinn works in the areas of search and rescue, wilderness medicine and military medicine. Many of the experts at UT Orthopaedic Surgery hold active or past military commissions.
The physicians have also established fellowships to share advanced learning with new students.
“Around the end of my fourth year, I established a shoulder fellowship,” Dr. Wirth says. “I was blessed to be invited to stay here as a faculty member. William Ward said, ‘Good teachers explain, superior teachers demonstrate, and great teachers inspire.’ If I have kindled even the smallest flame or inspiration in a medical student or fellow, it will have been a grand adventure for me.”
For Patients, a Broad Range of Care Offered by Experts
These providers and many more offer patients the opportunity to benefit from well over a century of accumulated experience. The Orthopaedics Department at UT Medicine includes expertise in subspecialties such as general orthopedics, hand surgery, joint replacement, orthopedic oncology, pediatric orthopedics, podiatry, shoulder surgery, spine surgery, sports medicine and trauma medicine.
The academic program offers substantiated benefits in patient outcomes as well as breadth of coverage. Dr. Wirth points to the Johns Hopkins study that found joint-replacement patients at high-volume surgical centers experienced only half the complication rate of those who had their surgeries performed at low-volume centers.
The reason, says Bernard Morrey, MD, Clinical Professor and Emeritus Chairman of Orthopaedics at the Mayo Clinic, and Professor of Orthopaedics at the School of Medicine, is the diversity of cases witnessed by high-volume academic surgeons.
“It is in the patient’s best interest to have somebody experienced in their condition caring for them,” Dr. Morrey says. “Sometimes that experience is not available to the first contact physician. Working in a known referral center in a university setting, we are in a position to see these patients who need extra attention and extra experience.”
“An academic environment tends to hone us to practice the best medicine we can and to implement advances that might not be available in the community,” Dr. Corley says. “We have a lot of excellent, competent, caring physicians here who enjoy working with patients and each other. We’ve spent a long time building a department that is very well known, not only in this country but around the world.”
“One reason we publish so widely is we want to share our experience with our colleagues,” adds Dr. Morrey, whose career began concurrently with the development of joint arthroplasty and who has played a key role in developing that field. “Another reason is we make it known to practicing orthopedic surgeons where the expertise resides, so if they or encounter a complex problem, they know they can send their patient to us.”
Those textbooks don’t get dusty. Dr. Rockwood points to a copy of the first edition of Fractures in Adults and Children, much battered, with a hole running all the way through the thick pages.
“We kept that book in the emergency room,” he recalls. “It was so popular people kept running off with it. Finally, one of the emergency physicians drilled a hole in it, added a brass ring and chained it to a desk. It has been worn and worn and worn. We’ve written a lot of books here, and they all have one purpose: to promote better care for patients.”
With 34 orthopedic providers, 4 podiatrists and many physical therapists on staff at multiple locations, including the medical center and downtown, UT Medicine is now in a position to handle all referrals — from a simple sprain or backache to complex spine surgeries and joint replacement. The clinic at the Medical Arts & Research Center in the medical center now offers extended hours, from 10 a.m. to 7 p.m., Monday through Friday, assuring patients plenty of time to be seen after normal work hours and after school hours for sports medicine cases.
For more information, visit www.utmortho.com. To refer a patient, call 210-450-9300.