While there may be a silver lining in difficult situations, the 17-year-old John Tongue probably wasn’t thinking about that when his car flipped over repeatedly one rainy night, sending him on a long rehabilitation journey. “I am alive today because I was wearing a safety belt, ” says Dr. Tongue, Second Vice President of the American Academy of Orthopaedic Surgeons (AAOS).
Years later, the silver lining emerged, and today there are innumerable Oregonians who are alive because of Dr. Tongue. For his work in passing the Oregon Safety Belt Law, Dr. Tongue was honored with both the AAOS Humanitarian Award and the National Highway Traffic Safety Association Public Service Award.
John Tongue’s connection to—and interest in—public service began early. “I was born and raised in Portland, Oregon, where my brothers and I gleaned inspiration and education from our father, an attorney, and our mother, a wise woman who handled three sons with grace. My father was a scholar, and a ‘lawyer’s lawyer, ’ who donated a great deal of time in volunteer public service in our state. He finished his career as an Oregon Supreme Court Justice. He was a model of integrity and taught us the importance of citizenship. So, I grew up with respect for our institutions of government and appreciate what a marvel the democratic process is. I felt connected to this process, and at a young age felt a responsibility for it.”
But the bar exam/a life as a lawyer was not in the cards. Why? Because the four-year-old John Tongue had already declared his major, so to speak. “When I was four I was enchanted with a children’s book about people helping others. I told my parents that I would become a doctor…and I never wavered.”
Dr. Tongue, now a proud community orthopedic surgeon, did have a change of heart with regard to his medical interest. “I was a surgical extern in Bern, Switzerland, and had my sights set on pediatrics. But I couldn’t get around the fact that communicating with the mothers was difficult for me. One day I was walking past an OR where the surgeons were pinning a hip. When I saw the fluoroscopy image of the pin crossing the hip fracture a switch flipped in my head. I immediately decided that I wanted to do that.”
Not only did John Tongue craft a career in hand, wrist, hip, knee, and shoulder, he mastered—and then taught—those communication skills that had plagued him with “the moms.” “One of my proudest accomplishments is my involvement in the AAOS Communication Skills Mentoring Program, an effort through which over 40 orthopedists have taught these skills to more than 5, 000 of our peers. As part of this program, we conducted an eye-opening study in which we asked fellows how they ranked in terms of interpersonal skills. While they rated themselves as ‘excellent, ’ they were far less charitable when it came to rating their colleagues. At the same time, we surveyed the public, and they agreed with our views of our colleagues: that orthopedic surgeons’ communication skills were quite lacking. Our greatest deficiency is the ability to express empathy…we tend to feel uncomfortable with this. While physicians are concerned that it takes more time to show compassion, research shows that it really doesn’t, and that patients do better clinically—and report higher satisfaction rates. Fortunately, when we repeated the survey ten years later things had improved significantly.”
If John Tongue didn’t know how to communicate, he couldn’t have lasted. “I have worked and lived in the same community for over 30 years; patients come in with tremendous trust, something that motivates me to live up to their expectations. I think some younger orthopedists greatly underestimate the value of creating a ‘deep well of goodwill’ just by being a good listener and demonstrating empathy for your patients. Now we are seeing that electronic medical records can be a barrier to patient-physician communication, because physicians’ attention is divided.”
The goodwill and trust exists not only between Dr. Tongue and his patients, but between the good doctor and his on-call partners. “I have been blessed to work in a hospital with other small group and solo colleagues, and that has given me a substantial amount of flexibility. While I take ER call and weekend call, I also have seven on-call partners to exchange practice coverage with me, allowing me to travel for volunteer Academy work. All of this is done on a handshake.”
Without such support, says Dr. Tongue, he would not have been able to give time to the volunteer work on traffic safety issues that has resulted in lives saved and grateful families. “In 1981 I read an article about Mothers Against Drunk Driving in Time magazine, and, recalling my car crash experience, I decided to join the Governor’s Advisory Committee on Driving Under the Influence of Intoxicants. We got 14 new laws passed. In studying the data about traffic deaths and injuries I was shocked to learn that most Oregonians were not wearing seat belts.”
I spent six intense years working on this, and led an Oregon safety belt use initiative petition drive to get 80, 000 signatures to get it on the ballot. Then we won! We are the only state to pass a safety belt law by public vote—now 97% of my fellow Oregonians wear seat belts, the highest use rate in the nation.
The lessons Dr. Tongue learned during this process will serve him well when he takes the helm at AAOS next year. Dr. Tongue elaborates: “One day I was debating a law professor on the seat belt issue; I had ample data and was brimming with confidence. I was surprised to later read the evaluations and find that he had destroyed me with personal freedom arguments. That taught me that I had to improve my ‘pitch.’ I learned to mix statistics with compelling stories that people respond to.”
“While orthopedic surgeons tend to be fair and open to ideas, when change is necessary sometimes our first reaction is often ‘no.’ The key thing is to not put someone in a position where he or she can’t ‘move down the bench’ and change their minds.”
“Be respectful, listen with openness, and when you disagree, continue to look for common ground. If you have a good idea and are invested in it then you just need to keep plugging away, improving your knowledge and talking points until others can join you and help resolve the issue.”
Dr. Tongue, who will be the first AAOS President from the Northwest, and the first modern day solo practitioner to head the organization, says, “One of my leadership philosophies is that there is an ebb and flow to progress when you’re trying to do meaningful work. All of us will fail at some point…we must accept that. To this day I follow the advice of my medical school professor who said that I would learn much more from studying complications than from studying successes.”
“The reasons that I am interested in teaching interpersonal communication skills are so that there will be less misunderstanding between surgeons and patients, higher satisfaction for both, as well as a lower liability exposure for surgeons. When I teach residents I tell them that they must be aware of a tipping point where they are working too fast. Their personal satisfaction decreases because they are making errors and not enjoying valuable interactions with their patients and staff. At that point, liability exposure explodes. It can be very seductive to be too busy because you feel important and make more money. But then your home life also becomes compromised.”
Yes, he talks…but, says Dr. Tongue, the most important thing he wants to be remembered for at AAOS is listening.
The most common failure in communication is to assume that it has already occurred. This can be counteracted by careful listening, and by saying what we mean and meaning what we say.
“Also, when we have patient care issues that don’t involve surgery, then we often don’t fully value the importance of clear, meaningful communication. Related to this is the fact that we don’t pay enough attention to matching the treatment to the lifestyle of the patient. There are several non-operative possibilities for those with knee pain, for example, but it takes time to explain these things to the patients, many of whom may think that surgery is the only answer.”
Dr. Tongue is concerned about recent media reports that are critical of orthopedic surgery. “I think it is important to talk to the public about the value of orthopedics…about how our field helps people walk again, get back to work, return to sport, or relieve chronic pain. One of my goals is to undertake a research project on the human and economic value of orthopedics.”
While conducting this study, Dr. Tongue will likely consult the history books for details. The fact is, he himself derives strength and courage from reading history. “I recently sat with a group of young orthopedists and discussed their futures, and the future of the field. I told them about the strength I derive from reading history, in particular the founding fathers, whose hard work, ethics and perseverance provide superb lessons for how to conduct one’s life. My hero is President Lincoln because he brought the country through extraordinarily difficult times with genuine humility. If I were able to meet him, I would simply say, ‘Thank you.’”
These and other profundities stream through the brain of Dr. Tongue all week long. Then, he hits the river. “If I have an evening off I head to the Deschutes River and go fly fishing. It is true ‘re-creation, ’ and when I wake up it feels as if someone has scrubbed my brain clean. For more active enjoyment I enjoy skiing on Mount Hood, or hiking along the beautiful Oregon coast. My wonderful wife of 34 years and I are blessed to have raised three healthy, employed children!”
Dr. John Tongue…creating community and, through his traffic safety work, ensuring that communities will survive.
