Having worked with the poor in Africa, Dr. Jeffrey Anglen, Professor and Chairman of Orthopaedics at the Indiana University (IU) School of Medicine, has seen things that fall outside the scope of normal orthopedics practice in the United States. His work abroad has changed his outlook on life and the field.
Born in Kansas City, Missouri, Jeff Anglen was the eldest of three boys. “My mom was a grade school teacher and my dad was an insurance agent. Being the big brother made me a Type A personality…I dissected frogs because I just had to get a look inside…I tinkered with my chemistry set so much that our ceiling was stained with my experiments. I was always pushing myself.”
In college, Jeff Anglen traveled the worlds of Faulkner and Hemingway, but also made time for the sciences. “As an undergraduate I was in the Honors College at the University of Missouri and studied Biological Sciences and American literature. Although I found a great deal of intellectual stimulation in the pages of literature, my interest was piqued by the challenge of becoming a physician and a surgeon.”
Then he learned that nothing much focuses the mind like a target…even if it is made of clay. “I began Johns Hopkins University School of Medicine in 1980 and remained there for residency. During that time, I had the luck to serve under Chairman Lee Riley, Jr. Dr. Riley occasionally took me along with him when we would play hooky from the hospital to shoot clay pigeons and hunt geese on Maryland’s Eastern Shore, something which taught me the importance of life outside the hospital. That was hard to remember in those days, particularly at Hopkins, where surgical training was an endeavor that demanded total commitment. Dr. Riley was dedicated to the comprehensive well-being of everyone under his training—each of us became like a part of his family. Another influence was Dr. Ken Krackow, a knee specialist, who was an outstanding surgical mentor and very precise, i.e., ‘make this cut at 15.5 degrees.’”
Rotating at the famed R Adams Cowley Shock Trauma Center, the young Dr. Anglen got a little shock of his own one day. “I was working alongside some ‘greats’ of trauma, including Drs. Andy Burgess, Attila Poka, and Bobby Brumback. On one occasion, I challenged Dr. Brumback on the position of some screws in an acetabulum. Well, he tossed me out of the operating room and ‘fired’ me. Fortunately, that was short lived, probably due to Dr. Riley’s support.”
Patients, surgeons…Everyone’s emotions run high in trauma. And yet, Dr. Anglen still had an intellectual decision to make. “I was leaning toward trauma because I could see how stimulating it would be to treat different parts of the body. It was also clear that you could be creative with fracture treatment. Yet when I finished at Johns Hopkins in 1988 I still had not committed to trauma.”
Early in his career Dr. Anglen would run into a bit of unscrupulousness. “I went to a multispecialty group in Kansas City where a neurologist was head of the practice and was engaged in some, shall we say, unethical financial practices. My first paycheck was $35; I discovered that I had gotten myself into a position where I had actually had to borrow money to live on from this ne’er-do-well. I soon left that practice.”
Dr. Jeff Anglen (center) working in KenyaWanting to experience what was real and fundamental about medicine, Dr. Anglen signed on with Orthopaedics Overseas. “I spent six weeks in South Africa, an area where there were 3.5 million people and one orthopedic surgeon. The conditions we handled were totally new to me, such as tuberculosis of the spine and a four-week-old machete wound to the hand. Perhaps most memorable was a 13-year-old girl who had such bad contractures of the hips that she walked on all fours. She had a successful surgery, however, and was then able to walk upright for the first time in her life.”
He wasn’t in Kansas anymore…but then he was. Or close anyway…Missouri. “I returned to Kansas City after my time abroad and joined a single specialty orthopedic group (Midwest Orthopaedics), doing general orthopedics. I did total joints, scopes, discs, some hand cases and fractures, but I always enjoyed the fracture cases most. One day a woman with acetabular and calcaneous fractures came into the hospital when I was on call and while I fixed both of them, I was dissatisfied with the quality of my work. I decided that if I was going to do that sort of case, I should learn to do it right. So I called Dr. Marc Swiontkowski at Harborview Medical Center in Seattle and asked to come to their high volume trauma hospital.”
Seasoned, but not fully ready to be unleashed upon the general public, Dr. Anglen sought out another one of the greats of trauma. “In 1991 I left Seattle and went to Tampa General Hospital. Initially my plan had been to work with Dr. David Helfet, who I had known in Baltimore. However, by the time I had arranged to go there he had left. The new trauma guru, Dr. Roy Sanders, graciously accepted me, and I did another six-month fellowship there.”
Traumatologists rescue patients…this one may have rescued a program.
Dr. Bill Allen, the Chair at the University of Missouri, phoned me and said, ‘We have no one who knows orthopedic trauma. Would you consider coming here?’ I jumped at the chance because not only was it a level one trauma center, but it was also my hometown. I was the busiest surgeon in the hospital for the next 10 years.
Dr. Anglen: “In 2005 I got a call from an acquaintance at Indiana University who said, ‘We have just had a departmental review by two outsiders and we need a new chair pronto. Are you interested?’”
He was…and they drew up the contract. Dr Anglen states, “I found out that the role of a leader and administrator takes a totally different set of skills than that of surgeon, researcher or educator. It is not as immediately rewarding, and you have to have patience and a long-term perspective, but it can be enormously rewarding when you adjust your expectations.”
What is obvious to Dr. Anglen, however, is that patient care is just downright more fun.
You are fixing patients after what is likely the worst day of their lives…because of this, you become like part of the family. Patients still send me pictures from their weddings and graduations—even though I treated them 15 years ago.
Something else that energizes Dr. Anglen? The lab. “The process of finding new knowledge is stimulating, whether it’s coming up with a new way of looking at problems or figuring out how to set up the study so that you have answers to something meaningful. There is little worse than going through a study only to find that you didn’t ask the right questions. On a broader level the issue is that technology and techniques change so quickly that by the time you reach the end of the study your answers may not make a difference anymore.”
Dr. Anglen is involved in one current project that could very well change worldwide orthopedic practice. “I am lucky to have been asked to be on the steering committee of FLOW (Fluid Lavage of Open Wounds), a prospective randomized controlled study of soap versus antibiotic lavage. A preliminary prospective study showed no difference between the use of antibiotic irrigation (the standard of care) and soap in terms of wound infection—and a slight difference in favor of soap as far as wound healing. This is revolutionary in that soap is inexpensive, low tech and can be applied worldwide.”
“I have also recently been involved with a retrospective study on the safety of implantable electrical bone stimulators. Despite the methodological limitations, our review managed to show that there were no significant complications of use. At present, we at IU are working with a rabbit model looking at the healing of segmental defects and the role of the Masquelet membrane. We have done a series of implantation of different spacers and are looking at the composition of the membrane that forms around these spacers and to what extent they have osteogenic potential to help stimulate bone growth.”
As for what Dr. Anglen thinks about when he’s driving to work or walking to the lab, he notes, “I am heartened that orthopedic treatments can make such dramatic improvements in people’s lives. Total joint replacement, internal fixation, and many other treatments are now widely available around the globe. What gives me pause, however, is the rapid proliferation of new techniques and technologies that are very expensive, yet don’t have strong evidence that they improve people’s lives or outcomes. There are so many forces acting upon orthopedic surgeons today which push them toward more surgery, higher tech devices and trendy techniques, including the demands of patients, hospitals, partners, and competitive interests. This is why the American Academy of Orthopaedic Surgeons’ (AAOS) efforts in Treatment Guidelines, Technology Assessment and appropriateness criteria, being led by Dr. Kristy Weber and others, are so important.”
Dr. Anglen also serves as a Director of the American Board of Orthopaedic Surgery, sits on the Board of AAOS as chair-elect of the Board of Specialty Societies, on the Committee on Trauma for the ACS, and just recently stepped down from the Board of the Orthopaedic Trauma Association. “The ones left to be understanding about all of my work commitments are my wife Diane and our four children, aged 7-14. Our weekends are filled with volleyball, baseball, basketball, and an endless procession of elementary school social activities. The fall is reserved for Mizzou football and the summers include a treasured week at our retreat on the Lake of the Ozarks. If I ever again have any free time, I plan to pursue my interests in anthropology, literature, Tai Chi Chu’an, hiking and camping, bicycling, and bass fishing. I have scrupulously avoided developing an interest in golf, and hope to continue to do so.”
Dr. Jeff Anglen…bringing global perspective, a passion for patient care and a healthy dose of skepticism to the field.
