Friday, June 29, 2012

Are Orthopedists Really Stronger Than an Ox?

Dear Madame L,

I'm a pre-med student who had orthopedic surgery as a child. Ever since then, when that orthopedic surgeon fixed my badly broken leg so I can now walk without a limp and even play sports, I've wanted to become an orthopedist myself.

But then some people in my lab told me this joke, that orthopedists are stronger than an ox and about twice as dumb, so now I'm wondering about this. Can you reassure me?


Pre-Med Student

Dear Doctor-To-Be,

Madame L would like to reassure you that orthopedic surgeons are among the smartest medical school graduates, in one of the most competitive areas of medicine. And that's true. Apparently it's only AFTER they get their medical degrees that they lose some of their competitive edge, at least according to their colleagues. 

Joking aside, orthopedic surgeons' mostly undeserved, Madame L is sure, reputation for being strong but not too bright is probably due to the fact that bone-setters in the past tended to be large, strong men, rather than medical practitioners.

For example, here's a quote from a medical journal article (titled...wait for it..."Are orthopaedic surgeons gorillas?"  in 1988: 

  "Before the advent of modern orthopaedics fractures and dislocations were the domain of the bonesetter. In
the absence of anaesthetics closed reductions required considerable strength to overcome muscle spasm, and thus bonesetters were often large men, traditionally blacksmiths and farmers. Hugh Owen Thomas, though small himself, came from four generations of farmer bonesetters noted for their size. In 1887 he recorded the need for "ten large and heavy men (carters) to reduce the shoulder dislocation."3 Other eminent
orthopaedic surgeons of the time were large. Abraham Colles was described as a man of above middle size4 and Robert Jones as a "bulky figure."'

Inspired, perhaps, by that article, researchers came up with this one, two years later: "Are orthopaedic surgeons really gorillas?"

They claimed to have found that orthopedists "...have larger hands than general surgeons, and we favour a work hypertrophy theory. Immunological recognition may be a factor in the selection and survival of surgical residents. Orthopaedic surgeons are slightly closer to gorillas than are general surgeons. Live gorillas' glove size is a difficult variable to measure."

Ah, the fun-loving life of a medical researcher! --- And of those who review such articles for publication --- as, for instance, those who commented on it:

 "There are, however, several areas of the statistical analysis presented that require attention. In particular, no logistic regression analysis or covariate adjustment has been made for left or right hand dominance, age, and sex of the primates. Indeed, the sex of the gorillas does not seem to have been established. A 33% drop out rate in the gorilla group is a serious drawback. The authors' explanation of non-compliance suggests a certain lack of determination by one of their investigators.
  "A Cox's proportional hazards muddle incorporating censored data is clearly appropriate to properly assess investigator survival time and should be included.
  "The major fault with the experimental design is the failure to satisfy item nine of the BMJ clinical trials statistical checklist. Thus it is clear that an affirmative answer to the question: "Was the potential degree of
blindness used?" is not possible. In a truly blind study the authors should not know anything about the results
and neither should the reader.
  "Regretfully, I must therefore turn down this paper on statistical grounds and recommend it for publication."

More recently, researchers performed a slightly more statistically valid study comparing the hand size and IQ's of orthopedic surgeons with anethetists. (The researchers' humor has not appreciably improved in the 20-some-odd years since the previous studies.) This article, by the way, gives the "correct" or "standard" version of the joke you've heard: "Orthopaedic surgeons: as strong as an ox and almost twice as clever? Multicentre prospective comparative study." These researchers, tongues firmly in cheeks,concluded:

  "The stereotypical image of male orthopaedic surgeons as strong but stupid is unjustified in comparison with their male anaesthetist counterparts. The comedic repertoire of the average anaesthetist needs to be revised in the light of these data. However, we would recommend caution in making fun of orthopaedic surgeons, as unwary anaesthetists may find themselves on the receiving end of a sharp and quick witted retort from their intellectually sharper friends or may be greeted with a crushing handshake at their next encounter."

Does any of this help you with your decision about which medical specialty to choose? Madame L hopes you won't drop out of college or quit your day job, whatever it is, to become a comedian, anyway...unless you're better with humor than these doctors!


Madame L

P.S. In the spirit of obstinate perfectionistic contrarian grammarianism, Madame L wants to point out that if you tell that joke in the future, you should say that orthopedists are stronger than OXEN, or that ONE orthopedist is stronger than AN OX.

1 comment:

Jeff said...

Ummm... "obstinate perfectionistic contrarian grammarianism" (or OPERCONG for the appropriate acronym) is something I would never aspire to. Life is too short to do that to my neighbors. And it could become shorter, if you don't have a preposition to end with.

But to your med student: tell him to straighten up, stop dragging his knuckles, and do something SMART: like become a neurologist, the Sherlock Holmes analogy in the medical profession. Of course, it requires consummate intelligence.

If he HAS that, then tell him not to quit his day-job as a stand-up comedian. You never know what the Individual Mandate will do to your manhood, you know.

George Carlin couldn't talk fer jack, but he sure could bring home the moolah. And Gallagher made millions by smashing watermelons...