B.A.S.E.-Jumping Orthopedic Surgeon!
Omer Mei-Dan, M.D. knows how to get out of trouble in the OR…and at 15, 000 feet. One of the world’s few B.A.S.E. (Building, Antenna, Span, Earth) jumpers, Dr. Mei-Dan, an associate professor of orthopedics at the University of Colorado, can peer deep inside the experiences of his patient-athletes.
When asked how an orthopedic surgeon got to be a B.A.S.E. jumper, he quickly pointed out that it was the other way around. “I was always an extreme athlete, and B.A.S.E. jumping was just one of the adventure sports that I was undertaking in my younger years. When I was still living in Israel, my extreme activities landed me on television with a sponsorship by Red Bull. I came to see that medicine, and specifically orthopedic surgery, would be the best fit for my interests. I wanted to be amongst people like myself—people who were interested in using their bodies in calculated, smart, fun, and advanced ways.”
Perhaps his most publicized jump was in 2000 from the Eiffel Tower. “It’s something in life that you never get to repeat; the man who did his dive shortly after my jump perished in the attempt. I practiced for that jump for an entire year. It was particularly complicated because you have to fly through the balcony on the first floor…and there’s not much margin for error. If you deploy too early you’re going to hit part of the structure. It all came off perfectly. The execution was 100% accurate, we purchased tickets so that we couldn’t be accused of trespassing, and, most importantly, we ensured that no one was below me when I jumped.”
Asked if B.A.S.E. jumping has made him a better doctor, Dr. Mei-Dan replied, “It is important that I understand my patients’ sports enough such that I understand the biomechanics, associated equipment, and techniques. If I operate on a rock climber and that person wants to get back to climbing, then I can help them with a safe rehab protocol that results in a quicker return to climbing. I help these patients navigate their passions in educated ways. It is easier when you treat soccer or basketball players because most health care providers know what they do. It’s not the same with people who do extreme sports; most people don’t know what that person faces as they are hauling themselves up a mountain, or free diving, or ice climbing.”
“Take a rock climber who is on crutches…someone who is accustomed to climbing twice a day. There are mental implications here, and my being able to speak their professional language and share common experiences helps establish an especially strong rapport.”
“From a clinical perspective, the fact that as an extreme sports athlete you have to think quickly and react fast and accurately, sometimes ‘out of the box’, as your life depends on it. That usually translates to my work as a physician. You’re working—fast—off the XYZ algorithm and then, in case of need, bifurcating quickly off that algorithm.”
“When descending during a jump, you decide on the visual parts that you want to mark. There is no time to look at a stopwatch, and no time to take your eyes off what is around you. You can count, but it’s not very accurate when you’re in a free fall.”
Asked about any other particularly exciting jumps, Dr. Mei-Dan notes, “I jumped into a hole in the deepest vertical cave in the world (in Mexico). I first rappelled down about 1, 500 feet to the bottom to check out the landing area. It was like a cone, starting at about 50 feet in diameter, but opening to an area the size of football field at the bottom. When I jumped I had to intentionally delay opening my chute so that I was as far as possible from the surrounding walls when I did open it.”
So will we see this orthopedic surgeon flying off the Leaning Tower of Pisa any time soon? “No, ” says Dr. Mei-Dan, “It’s too low…not so interesting.”
“What I enjoy most is the nature…climbing a mountain and then jumping off. I’m taking a hard look at the Norwegian fjords for my family summer vacation.”
Refining Levels of Evidence
When he’s not in surgery, Robert Marx, M.D., an attending orthopedic surgeon at the Hospital for Special Surgery (HSS) in New York City and professor of orthopedic surgery at Weill Cornell Medical College, is busy ensuring that orthopedic research is of the highest quality possible. Dr. Marx is associate editor for Evidence-Based Orthopaedics and deputy editor for Sports Medicine and at The Journal for Bone and Joint Surgery (JBJS). He tells OTW, “Prior to assigning levels of evidence at JBJS, for 10 years, I assigned levels of evidence for research papers appearing in Clinical Orthopaedics and Related Research. It is clear to me—and it has been validated in the literature—that the quality of orthopedic evidence has consistently improved over the last two decades. We are heading in the right direction.”
“JBJS works from the level of evidence (LOE) table published by the Centre for Evidence-Based Medicine (CEBM) in the UK. In accordance with their updates, we have made some alternations to our LOE table. We continue to divide studies by type, and the majority of the ranking criteria remain the same. We have, however, flipped the table such that the rows are now columns and the columns are now rows. This change has made the table more intuitive and user friendly; it asks what the research question is and then answers the way a reader would respond.”
“We didn’t accept everything proposed by the CEBM. For example, they made level one a meta-analysis of randomized controlled trials (RCTs) and level two only RCTs. We didn’t think it was appropriate for RCTs to be only level two because this kind of study is extremely hard to accomplish in orthopedics. Randomized trials are the highest quality of clinical investigation, and grading them as level two is not an accurate reflection of the level of evidence.”
“Looking into the future, we must encourage those in our specialty to conduct the highest quality research possible. In addition, we need to promote high quality research by offering funding to those who are doing it. I have been involved with the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine, and we have recently developed new a granting process to fund orthopedic research.”
As for the most difficult studies to assign a level of evidence, Dr. Marx noted, “Many times it is black and white. When that’s not the case, however, the new table makes some allowance for the person assigning the levels to slide one way or other based on the quality of the study, a subtle weakness subtle, or the size of the effect.”
“The fact is that you never know what reviewers are going to like. Given that reality, I recommend that my colleagues always submit their manuscripts to the highest quality journal possible. That way, if something is not accepted then it can be resubmitted elsewhere.”
Hoag Orthopedic Institute: Only L.A. Hospital Earning 5 stars From CMS
At Hoag Orthopedic Institute it’s all ortho, all the time…and it’s paying off. Hoag Orthopedic Institute (or HOI) is the sole hospital in all of Los Angeles and Orange County to earn the 5-star ranking for patient experience from the Centers for Medicare and Medicaid Services (CMS). Dereesa Reid, CEO of Hoag Orthopedic, tells OTW, “We are a real world example of the early writings of Michael Porter and Elizabeth Teisberg, authors of ‘Redefining Healthcare.’ In constructing our Irvine inpatient facility and our Orange County surgery centers, we built the entire organization around the best ways to provide care to orthopedic patients. We embraced the idea of the value equation because we knew that if we were able to drive quality to the highest level and do it at a low cost then we could meet the demands of today’s healthcare environment.”
“For example, take fracture care. These are unplanned events that require a specific protocol in addition to our elective cases. Our orthopedic team makes use of best practices in terms of ‘time from the Emergency Department to the OR, ’ etc. It also helps that we have time blocked out on our OR schedule for emergency patients.”
“Hoag Orthopedic Institute’s success goes back to the original vision of having an organization that is tightly focused on orthopedic care; because of this, we don’t have to spend time learning about or handling conditions not related to orthopedics. Our specialty, patient-centric model can be compared to major cancer centers; their outcomes are better because they are focused on providing best practice, efficient care centered around the patient.”
Asked how patient experience is integrated into the clinical care and treatment protocols, Reid noted, “Patients go through preop education, and once they have surgery and arrive on the floor we use technology to facilitate communication including the latest mobile device technology integrated into our clinical systems and EHR. Additionally, we have a novel technology that allows us to interact with patients from the TVs in their rooms. We can program questions into the TV and prompt them, for example, to let us know if the noise too high, if their pain is worsening, etc. And this information is fluid; we change it depending on how our patient satisfaction results are trending. The data is analyzed around the clock, and we can make adjustments very quickly if, say, the lights needs to be dimmed or the room isn’t sufficiently clean.”
“All of our employees, orthopedic surgeons, and also an outstanding group of anesthesiologists and hospitalists have worked very hard to attain the CMS 5 star rating. They are really top notch.”
