Relations with Industry and Hospitals Acceptable standards of professionalism practicing orthopedic surgeons may accept tuition, travel, and modest hospitality (including meals and receptions) to attend an industry sponsored non-CME course given at a local convention center industry relationships must be disclosed to patients, colleagues, and institution gifts must have a market value under $100 no direct kick-backs can be given to a physician or hospital systems from an industry physicians cannot refer patients to centers in which they have a financial interest (Stark II laws) Patient Satisfaction & Complaints Patient complaints formal written patient complaints regarding quality of care require letters of response to patients from the surgeon Communication leading cause of medical litigation on average, most doctors interrupt patients during an interview within 23 seconds orthopedic surgeons are described by patients and colleagues as "high tech but low touch" orthopedic surgeons are described as having poor communication skills and empathy for patients translation services can be provided by employees fluent in the language, commercially available telephonic services, professional interpreters, and volunteer translators inappropriate for family members to act as translators unless patients offer/agree Medical Innovation Royalties surgeons receiving royalties for implants used in surgery must be disclosed to patients Research must disclose any financial conflicts of interest and should ethically remove any possible bias from funded studies Patient Transfer The Emergency Medical Treatment and Active Labor Act (EMTALA) all patients must be appropriately screened and stabilized in the original emergency room/hospital risk of patient transfer must be less than the risk of keeping patient accepting hospital/center must know of and accept patient Physician Advertising Physician advertising is becoming more common AMA and AAOS cannot prevent physicians from advertising services FTC, AAOS, state medical boards can sanction for false advertising things to avoid using terms such as "cure" if no cure truly exists using terms such as "painless" or "bloodless" to describe surgery overstating credentials such as "board certified in joint replacement" if no such qualification exists using terms such as "world renowned" Diversity Understanding cultural differences leads to enhanced patient-physician relationships minimized disparities in health care optimized access to orthopaedic care Implicit biases present when unconscious prejudices or stereotypes influence care delivered to patients determinant of health disparities Access to Healthcare Type of health insurance has been shown to be a determinant of healthcare access in the pediatric population Physician burnout Consist of loss of enthusiasm for work, feelings of cynicism, and diminished feelings of personal accomplishment Affects 45-55% of all US physicians