A satirical letter to radiologists from a jilted orthopedic surgeon [PODCAST]

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“We orthopedic surgeons are disappointed with the growing lack of enthusiasm in your reports. When I began in practice almost 15 years ago, it wasn’t unusual to see a report of a post-reduction or post-surgical X-ray that read, ‘alignment is now anatomic’ or, at a minimum, ‘near anatomic.’

What happened? What did we do to deserve reports like, ‘Overlying cast obscures fine bony detail. Alignment is improved from pre-reduction imaging,’ after we closed reduced a mangled looking extremity and got it back anatomically? Or better yet, ’54 seconds of fluoroscopic time was provided for ORIF of femur. Correlate with operative report,’ when we ORIF’d the hell out of it.”

Samara Friedman is a pediatric orthopedic surgeon.

She shares her story and discusses her KevinMD article, “An open letter to radiologists from a jilted orthopedic surgeon.”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today in the show, we have Samara Friedman. She is a pediatric orthopedic surgeon, and she wrote the KevinMD article “An open letter to radiologists from a jilted orthopedic surgeon.” Samara, welcome to the show.

Samara Friedman: Thank you so much for having me.

Kevin Pho: We’ll get into your article in a little bit, but first off, can you share your story and journey to where you are today?

Samara Friedman: From the time, I think, I was a toddler, my first words were that I wanted to be a doctor, and like so many other people, I did end up following through on that. Around when I was 17, I think, I made the decision to go into orthopedic surgery, which is not the most typical decision for a woman. We’re about 6 percent of orthopedists. But I was at a summer program at Cornell University where we had a biology seminar, and there was a surgeon who came in and showed a video of a cholecystectomy, and I was absolutely hooked. I knew I didn’t want to do anything with bowel or anything in the abdomen, but as soon as I saw that, I knew I needed to be a surgeon. I was always very much into sports and athletics, and it was just a natural meeting of different things during that summer that led me to orthopedic surgery as my specialty. So from 17 on, that’s where I was heading.

Kevin Pho: You mentioned about 6 percent of orthopedic surgeons are women. What are some of the challenges women face in the field?

Samara Friedman: I think we have challenges from both our colleagues, in part, as well as from patients. I think our colleagues overall are getting much better and much more accepting of women in the field, and they celebrate the improvement in diversity of the field, both from a race standpoint and a gender standpoint. Orthopedics has lagged behind, and we’re making improvements in both. But there was definitely a lot of discrimination that I faced during my career. Particularly, becoming pregnant as a resident was very challenging. I think since that time, which was 16 years ago, there have been a lot of strides, but there’s also a lot more that needs to be done to get to the point where women are treated equally in the field.

And then I also think, from patients, I notice some people ask for second opinions when it seems to be from one of my female colleagues versus one of my male colleagues. They tend to be a little bit more trusting of the men’s opinion. But every once in a while, I’ll get someone on the flip side who specifically wants a female doctor, particularly for their female adolescent athlete. So it does work both ways, certainly not equally yet, but again, at least we’re making strides in the right direction.

Kevin Pho: Now, for those women in medical school who may be considering orthopedic surgery as a career choice, what kind of advice do you have for them?

Samara Friedman: I would say, if it is what you love, absolutely go for it. It is such a rewarding field, and the more women, the more diversity in the field, the easier it is for everybody else. So I would very much encourage any women who are thinking about it but are worried about lifestyle issues, dealing with the issues of being a woman in a surgical subspecialty. Those things are going to change by more women joining in, and it is, like I said, a truly rewarding specialty. So I would highly recommend, if you’re considering it, explore it, and if you love it, go for it.

Kevin Pho: So tell me, what is, to you, the most rewarding aspect of pediatric orthopedic surgery?

Samara Friedman: Oh, it’s absolutely just being able to fix a very defined, discrete problem with my own two hands. I love reducing fractures in the ER just as much as I love doing surgery, just as much as I love seeing the patient at the end of the road, seeing them back into the playground, into sports, whatever it is. It’s just so satisfying to see that improvement and know that you played a large role in that with your own two hands, and just getting that feedback from your patients that it meant something to them, and now they’re able to do things that they weren’t able to do because of an injury or because of another orthopedic issue that you’ve helped to correct for them.

Kevin Pho: All right, let’s transition into KevinMD and the article that you wrote. It’s a satirical article titled “An open letter to radiologists from a jilted orthopedic surgeon.” Now, for those who didn’t get a chance to read your article, can you just walk my audience through it and share the story of why you decided to write it?

Samara Friedman: So I decided to write it after, just recently, I had a distal radius fracture that was very displaced and particularly unstable, and the reduction turned out anatomic, and of course, I was thrilled with that. I was a little too busy, being on a call weekend, to document the consult at that time. Then when I went back into the chart to document it, I saw the report from the radiologist, which, not unusually, said basically, “Alignment is improved.” So it’s almost like you’ve hit a home run, and the announcers are saying, “Yeah, they make good contact.” It takes the wind out of your sails a little bit.

And yes, I don’t put too much emphasis on my ego based on what a radiologist writes, but there’s just some irony in that, a little humor in that, to me, to see you put so much effort in, and the radiologist is like, “Eh, not bad.” And so, again, I used to write for GomerBlog, until they kind of went into hibernation mode. So I like to put pen to paper with my tongue firmly planted in my cheek. That’s how I write best. And so that’s how the article came to fruition from there.

Kevin Pho: Now, what are some typical radiology descriptions that you get as an orthopedic surgeon? Is what you wrote satirically out of the ordinary?

Samara Friedman: No, that’s pretty typical, pretty typical. Obviously not your MRI reports or CT reports, but your post-op reports and your post-reduction reports, that’s what they would typically look like: very sort of cut-and-dry, matter-of-fact, no embellishment, no “Yay, good job there, ortho.” Not that I would obviously expect that, but it used to be that they would write, “Alignment is anatomic.” But now I think, in part, they’re also overwhelmed with volume from their perspective. There’s probably a shortage of radiologists. They’re expected to do the work of probably one and a half radiologists. They get a tremendous amount of reports their way, and the ones that don’t really require attention, they probably just do what they need to do as fast as possible and then move on to the next one.

Kevin Pho: So I want to talk about the place of humor and satire in medicine. You mentioned that you used to write for GomerBlog. Tell me about that experience and how you got into that.

Samara Friedman: So I tend to be a sarcastic person by nature, and I never really thought about submitting my work initially, but I had a few ideas in mind of some articles that I wanted to write, and then I kind of realized that GomerBlog would be the place for it. I wrote under the pseudonym LadyBro. I had started writing for them, I think, right before COVID started, in like February of 2020, and I had put out about five articles before they kind of shut down their presses. But I really enjoyed having that outlet to kind of highlight sort of the lighter sides, the more ironic sides of life as an orthopedic surgeon, mostly. I mean, not all of it was about orthopedics, but a number of the articles were.

Kevin Pho: And why are humor and satire so important? Because on KevinMD, on my blog, and on this podcast, we talk about very serious articles. We talk about physician suicide, physician burnout. We talk about so many serious articles, and that’s why it was such a breath of fresh air to receive your contribution, this satirical contribution. But in general, why should we accept more humor and satire in medicine? Why is that important to you?

Samara Friedman: I think, in part, sometimes you have to laugh so you don’t cry. Not that medicine is such a black cloud. Like I said, I’m very satisfied with my work and what I’m able to do, and I have no regrets at all going into the field that I selected. But satire always contains some element of truth to it, and I think it’s important to kind of look at it from the perspective of irony, the perspective of humor, because that still does open the same conversations. But again, it allows you to look at it with less doom and gloom, as you said, which are many of the contributions there. It allows you to look at things with maybe a little bit more of an open mind and kind of laugh about some of the things that are more challenging, and just take a look at it from a different perspective.

Kevin Pho: Now, in general, what kind of responses did you get to your satirical pieces on GomerBlog?

Samara Friedman: Overall, they were very positive responses. I think my first article was basically about recruiting women into orthopedics with the promise of no line for the bathroom, which is always a running joke in orthopedics. We have so few women, but at our conferences, it’s great, because women never have to wait in line for the bathroom. So it was things that I think a lot of people kind of already joke about and keep in the back of their minds as sort of the humorous parts of what we do. And then I just like to put that pen to paper and put it out there in black and white for people to enjoy. And so overall, the feedback that I received from my work on that was overwhelmingly pretty positive.

Kevin Pho: Was there any pushback or anything negative?

Samara Friedman: Not that I recall. I mean, most of it, if you look at the GomerBlog site, there’s not that much commentary that’s put on their actual website. I think on their Facebook page, people write comments, and there are always people who are going to put negative things as well. But overall, I think people go to GomerBlog because they look to it for humor and to enjoy it, and it’s a real loss that it’s no longer up and running.

Kevin Pho: We’re talking to Samara Friedman. She’s a pediatric orthopedic surgeon, and she wrote the KevinMD article “An open letter to radiologists from a jilted orthopedic surgeon.” Samara, what are some of your take-home messages that you want to leave with the KevinMD audience?

Samara Friedman: I think in medicine, we are always being self-critical, and that’s a necessary part, because you use that to improve your outcomes, improve your work, your ability. And we do M&Ms, of course, to see what can be done differently, what went wrong. But how often do we celebrate our successes? I think that’s important too, for people are always pointing fingers at each other. You recently had a podcast where a pediatrician was talking about how doctors were being vilified. Well, when the public vilifies doctors, I think people tend to point fingers at each other, to try to take the blame off of them. It’s important to remember that we’re all on the same team. We’re all in the same boat, and we should be celebrating everybody’s successes in medicine and not just looking at the failures. Again, there’s importance in doing that, absolutely, but also importance in bringing out what makes the job worthwhile and what we really reap satisfaction from doing.

Kevin Pho: Samara, thank you so much for sharing your time and insight, and thanks again for being on the show.

Samara Friedman: Thank you so much.

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