by Jarrod Shapiro, DPM
Joined practice July 2006 of
John K Throckmorton, DPM
Lansing, Michigan
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As a new doctor recently out of residency, still sorting out my clinical practice pathways, I’m very malleable when it comes to using new products, and I like to try out new surgical techniques and technologies. I’ve had the opportunity to try out quite a few products in practice that for any number of reasons I didn’t try as a resident. Let’s talk a bit about the use of new medical technologies.
In the office I’ve been somewhat limited with trying new office products. I would say this is due to two primary issues. First, I’m an associate to another doctor. If he doesn’t want to have something in his practice then it won’t be used. For example, I’m currently forced to send my patients to the hospital for arterial dopplers because my boss doesn’t want to deal with this technology in the office.
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For now, I can respect his decision and live with this practice limitation. If it became too constrictive, though, I’d have to renegotiate our relationship or leave.
Second, and more importantly, these new technologies cost money. Some practices may not have the capital available to invest in new products. Take EMR programs, for example. Depending on the product EMR software can be very expensive and time consuming with the conversion from a paper-based office. Usually, though, the addition of new technologies can revitalize a practice and improve a practice’s competitiveness.
Now, when it comes to new surgical products I have more leeway, although cost remains an issue in the hospitals and ambulatory surgery centers. Although every hospital is different, requests for new products usually have to pass through a review committee. Assuming a product is not too expensive, they’ll usually approve a product assuming it is different enough from what’s already in stock. But to tell you the absolute truth, I’d say it’s really about money.
 Here’s an example. I’ve recently started using headless compression screws for some of my cases. These would be similar to the old Herbert screw that has a threaded head. I started out using Synthes’ version with which I was unsatisfied. I then requested the Wright Medical version which I’d used several times at another hospital with impressive results. This hospital, which has a contract with Synthes, then told me the only reason I was allowed to use the Wright screw was because it was cheaper. I’m now in the process of requesting the newer screw for permanent use.
Keep in mind, though, there are pitfalls to using new technologies. In the operating room this often translates to increased operative time at first. Additionally, if the surgeon is not adequately familiar with the product, this may lead to complications and possibly even a poor result. Finally, your patients may not want you to “experiment” on them. You’ll avoid these problems by doing some simple things.
- First, read thoroughly about any new technology you’re considering using, and examine it with a critical eye. Ask your local reps if they have any scientific literature on the product. If they don’t have good literature, use it with significant caution.
- Practice using the product before using it in the OR. If possible attend a course or cadaver workshop first. At the very least review the product and its instrumentation prior to implanting it in your patient.
- Discuss the use of a new product with your patients preop. Give them an honest appraisal of the product and explain to them why you want to use this particular product. You may even want to consent them for an alternative procedure. For example, when I consent a patient for an endoscopic gastrocnemius recession I’ll add “possible open” to the procedure and let them know there is a possibility of a larger incision.
- Have alternatives available in the OR in case things don’t go according to plan. For example, keep your Synthes modular foot or frag set available if you’re planning to try one of the new screws.
- Call your hospital in advance of the surgical day. Be sure they have approved use of the product, they have your alternatives available, AND your new product is there in the hospital. Remember, preparation will decrease complications.
In the short time I’ve been in practice I’m already learning what I like and what I don’t like. Until I become that stodgy old man who’s afraid to try something new I’ll keep searching for the next best thing since sliced bread. Best wishes with your search.
Jarrod Shapiro, DPM
PRESENT New Docs Editor
[email protected]
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