Ethics in Clinical Orthopedic Surgery

Abstract

Introduction

Orthopedic surgeons, owing to their specialized role, have a set of medical and moral responsibilities that span beyond the confines of the operating room. The primary objective of this exploration is to emphasize the pivotal ethical and professional standards that these surgeons should uphold.

Methodology

We derived key ethical and professional aspects by reviewing standard medical practices, professional guidelines, and through consultations with senior orthopedic professionals. These aspects covered both the conduct inside the surgery room and the interpersonal relations outside.

Results

Several core areas of conduct were identified.

Patient-Centered Care: Prioritizing the holistic well-being of the patient.

Communication: Ensuring that all communications are both transparent and respectful.

Informed Consent: Properly securing consent after ensuring the patient is adequately informed.

Confidentiality: Taking measures to safeguard patient information.

Professional Behavior: Upholding the highest standards of professional conduct.

Continuous Learning: Remaining committed to updating skills and enhancing competence.

Interpersonal Relations: Building healthy and constructive relationships with industry representatives, professional peers, and hospital staff.

Personal Life Balance: Recognizing the importance of a balanced personal and professional life for holistic well-being.

Conclusion

For Orthopedic surgeons, strict adherence to the outlined ethical and professional principles is essential. Such commitment not only ensures the trust and safety of patients but also serves to maintain and elevate the prestigious standing of the orthopedic community in the broader medical landscape.

Introduction

Orthopedic surgery, a vital branch of medical science focused on musculoskeletal conditions, encounters a wide range of both common and unique ethical challenges. Like all areas of medicine, the central tenet remains the unwavering commitment to patient welfare, which is deeply rooted in the timeless principle: "First, do no harm." But as technology progresses and the boundaries of what's possible expand, new ethical considerations surface.

Understanding and navigating these ethical considerations is crucial not just for the well-being of patients, but also for upholding the integrity and trustworthiness of the orthopedic profession. Factors like informed consent, patient autonomy, and potential conflicts of interest take center stage, often intersecting with complex medical decisions about treatment options, resource allocation, and innovative surgical techniques. Moreover, the very nature of orthopedic conditions—many of which affect mobility and quality of life—bring additional ethical layers concerning patient dignity, identity, and societal roles.

This exploration into the ethics of clinical orthopedic surgery aims to elucidate these challenges, offering a framework for current and aspiring orthopedic surgeons, and indeed all healthcare professionals, to ensure they uphold the highest standards of ethical conduct. The journey will delve into the foundational principles, the ever-evolving dilemmas, and the essential role of ethics in ensuring the best outcomes for patients and the broader medical community.

The Patient–Surgeon Relationship

Establishing a positive patient–surgeon relationship holds tremendous significance as it directly impacts the quality of care and treatment outcomes. Patients should feel at ease, knowing they can openly communicate their questions and concerns with their orthopedic surgeon. Involving patients in the decision-making process regarding their treatment plan is crucial, empowering them to actively participate and understand the potential risks and benefits of various options. Understanding that patients may experience anxiety, fear, or pain, surgeons must display empathy and offer reassurance throughout the journey.

Respecting the diverse cultural, religious, and personal values of patients is of utmost importance. Upholding patient autonomy and supporting their decision-making process are integral aspects of compassionate care. Surgeons should remain accessible and responsive, ensuring patients feel supported and informed throughout their treatment. By fostering a trusting and open relationship, patients should be confident that they can reach out to their surgeon at any time with their questions or concerns.

Example: Mr. Sharma, 58, sought a knee replacement from Dr. Verma, a noted orthopedic surgeon. During their meeting, Dr. Verma appeared distracted (busy with phone calls), often interrupting and dismissing Mr. Sharma's concerns. Without adequate information, Mr. Sharma was hurriedly asked to sign a consent form. After the surgery, he struggled to reach Dr. Verma for post-operative pain and guidance. This neglect undermined Mr. Sharma's trust in healthcare, making him wary of future treatments.

Informed Consent

In clinical practice for orthopedic surgeons, informed consent holds immense significance. It entails the process wherein patients are thoroughly informed about the risks, benefits, and alternative treatments or procedures, and voluntarily agree to undergo them [1]. Historical evidence of informed consent can be traced back to 18th- and 19th-century clinical medicine, as explored in Ruth R. Faden's comprehensive historical account [2].

The primary purpose of informed consent is twofold. First, it ensures that patients possess a comprehensive understanding of their treatment options, encompassing potential risks and benefits. This empowers patients to make informed decisions about their care. Second, informed consent plays a pivotal role in safeguarding both patients and orthopedic surgeons from legal liabilities.

During the informed consent process, discussions should cover the nature of the procedure, associated risks and benefits, and any available alternatives. Orthopedic surgeons must actively encourage patients to ask questions and provide adequate time for patients to contemplate their options before arriving at a decision. By adhering to this diligent approach, orthopedic surgeons foster a climate of trust, respect, and collaboration with their patients.

The age of medical consent varies globally, influenced by cultural, social, and legal norms. In India, the Indian Majority Act of 1875 sets the age of majority at 18, rendering those younger legally unable to give valid consent for medical treatments, including orthopedic procedures. Consequently, minors' medical decisions lie with parents or legal guardians, protecting the child's interests. However, in emergencies, when waiting for consent risks the patient's well-being, clinicians can act in the patient's best interests. In contrast, the USA generally uses 18 as the medical consent age, though there are state-specific exceptions. Similarly, Europe lacks uniformity in its approach. The UK allows 16- and 17-year-olds to consent, with even younger individuals allowed if they display "Gillick competence." France has an age threshold of 18 with nuances, Germany and Spain consider16-year-olds under certain circumstances, and Italy requires parental agreement for 16-year-olds. Such disparities emphasize the necessity to understand regional regulations and the pivotal role guardians play in young patients' healthcare decisions.

Example: Mrs. Patel, a 65-year-old woman, was experiencing chronic hip pain. After an evaluation, Dr. Matthews, an orthopedic surgeon, determined that a hip replacement was the most suitable option. During the pre-surgical consultation, Dr. Matthews gave Mrs. Patel a consent form to sign. The form was filled with medical jargon, and no plain-language summary was provided.

Dr. Matthews, in a rush due to his tight schedule, simply told Mrs. Patel, "This is a standard procedure, and you need it to relieve your pain," without delving into the specifics of the surgery, the potential risks, alternatives, or post-operative care. He did not inquire about her understanding of the procedure or give her an opportunity to ask questions. Relying on the surgeon's expertise and feeling overwhelmed, Mrs. Patel signed the form without a clear understanding of what she was consenting to.

Following the surgery, Mrs. Patel faced complications and prolonged recovery, which she was not prepared for. She felt betrayed and uninformed, leading to a loss of trust in her surgeon and the healthcare system at large. This situation exemplifies the consequences of inadequate informed consent in orthopedics.

Patient Autonomy

Patient autonomy is a fundamental principle that grants individuals the right to exercise control over their medical treatment, including the ability to accept or decline it [3]. In the realm of orthopedic surgery, patient autonomy assumes particular significance, as decisions regarding procedures can profoundly impact a patient's quality of life. Thus, it is vital for orthopedic surgeons to uphold and respect their patients' autonomy in the decision-making process.

This entails considering the patient's unique values, preferences, and goals while recommending a treatment plan. Instead of making decisions on behalf of the patient, the surgeon's role is to furnish the necessary information and support, enabling the patient to make an informed choice.

In situations where the patient lacks decision-making capacity, such as in cases of severe cognitive impairment or mental illness, the orthopedic surgeon should collaborate with the patient's family members or legal guardians to ensure decisions are made in the patient's best interests. By valuing patient autonomy and involving them in the decision-making process, orthopedic surgeons foster a patient-centered approach that respects individual rights and choices.

Confidentiality

Confidentiality stands as a paramount principle across all medical domains, including orthopedic surgery. Upholding patient privacy and safeguarding their medical information is a fundamental duty of every orthopedic surgeon [4]. By empowering patients to have control over the disclosure of their information, confidentiality aligns with the essence of autonomy, encouraging patients to become active participants in their care.

To ensure patient information remains secure, orthopedic surgeons should utilize protected electronic medical records (EMRs) or store paper records in locked facilities accessible only to authorized personnel. When communicating about patient information with other healthcare providers, secure methods such as encrypted emails or secure messaging apps should be employed. Public areas or places where information may be overheard should be avoided entirely for any discussions pertaining to patients.

Additionally, it is vital to educate the staff about the significance of patient confidentiality, familiarizing them with the rules and regulations surrounding patient privacy. By adhering to these practices, orthopedic surgeons create a culture of trust and respect, honoring the sanctity of patient information and promoting the highest standards of ethical conduct in clinical practice.

Non-maleficence

The fundamental principle of "First, do no harm" lies at the core of medical science [5]. For orthopedic surgeons, adhering to the principle of non-maleficence is paramount in ensuring patient safety and preventing any unnecessary harm. To achieve this, the orthopedic surgeon must exercise due diligence in evaluating the safety and efficacy of the chosen treatment method.

A comprehensive assessment of the patient's condition is essential before recommending any treatment or procedure. This involves obtaining a detailed medical history, conducting a thorough physical examination, and ordering relevant tests or imaging studies. The use of evidence-based guidelines and protocols is crucial to ensure the patient receives the most suitable and effective treatment.

Throughout the patient's care journey, the orthopedic surgeon should closely monitor for any potential complications or adverse effects of the treatment. If any issues arise, prompt action must be taken to address them promptly and effectively. By steadfastly applying the principle of non-maleficence in their practice, orthopedic surgeons play a crucial role in providing safe and effective care to their patients, minimizing the risk of harm.

Beneficence

Beneficence originates from the Latin term "benefactum," signifying a "good deed." It epitomizes the act of helping others purely out of genuine care and concern, without seeking praise or recognition for being kind. In the realm of medical ethics, the principle of beneficence requires healthcare providers, including orthopedic surgeons, to prioritize the best interests and well-being of their patients [6]. This entails cultivating trust with patients, attentively listening to their concerns, and furnishing them with relevant information.

Orthopedic surgeons must take precautions to avoid causing harm to their patients. They are obliged to carefully assess the risks and benefits of any recommended treatment, avoiding unnecessary interventions. Throughout the entire process, the surgeon's aim is to provide the patient with the most favorable outcome from the surgery and subsequent post-operative care.

Moreover, orthopedic surgeons are expected to act as staunch advocates for their patients, ensuring they receive the utmost quality of care and are treated with utmost respect and dignity. The crux of beneficence lies in the unselfish dedication to enhancing the well-being of those they serve, embodying the essence of compassionate and patient-centric healthcare.

Justice

The orthopedic surgeon has a profound responsibility to ensure equal and just treatment for all patients, irrespective of their race, ethnicity, gender, religion, or socioeconomic status. This entails unbiased allocation of healthcare resources and a steadfast commitment to avoiding any form of discrimination. The surgeon must uphold accountability for their actions and decisions by adhering to the laws and regulations governing their profession. Engaging in continuous professional development and transparently disclosing any potential conflicts of interest or financial incentives that may influence their practice are essential aspects of their accountability.

In a survey involving 1748 trauma surgeons, it was evident that ethical challenges, particularly in communication, were commonly encountered [7]. Among these surgeons, the experienced ones exhibited higher self-efficacy scores in effectively addressing ethical issues, indicating the importance of experience and expertise in navigating such complexities.

Dealing with Geriatric Patients

Effective communication is crucial when dealing with geriatric patients who often experience a range of physical and psychological impairments. Marks has extensively discussed various issues related to elderly care [8]. Due to their vulnerabilities, older patients may have weaker bones, reduced muscle mass, and slower healing times, making them more prone to fractures and extended recovery periods. It's important to consider these factors and the heightened risks of surgery or anesthesia while devising a treatment plan.

In the evaluation of geriatric patients, obtaining a comprehensive medical history becomes vital in identifying underlying health conditions that may impact treatment decisions and surgical outcomes. Conditions like osteoporosis, diabetes, hypertension, or cardiovascular disease must be carefully taken into account. Depending on the patient's medical history and condition, non-surgical options, such as physical therapy, medications, or assistive devices, should be considered as part of the treatment plan.

Involving family members or caregivers in the patient's care can greatly benefit geriatric patients. Engaging them in the treatment plan and providing information on how to support the patient's recovery is essential. Moreover, geriatric patients may necessitate more intensive postoperative care, including pain management, physical therapy, and vigilant monitoring for potential complications.

In addition to addressing physical aspects, it's crucial to attend to the unique emotional and psychological needs of geriatric patients. This includes identifying and addressing issues like anxiety or depression, which might be related to their health status or social isolation. Planning for these emotional needs in advance and involving the patient's family and primary care physician as needed, will contribute to a comprehensive and holistic approach to geriatric care.

Dealing with Pediatric Patients

Dealing with pediatric patients in clinical practice demands specialized skills and knowledge. Since many children may not have the capacity to provide informed consent directly, doctors must ensure true informed consent is obtained through third parties [9]. Communicating in an age-appropriate and understandable manner with both the child and their parents is crucial. Taking time to explain the diagnosis, treatment options, and potential risks in a gentle and respectful manner is essential. Building a rapport with the child and family and being patient with their questions and concerns helps ease their nervousness and fear.

For certain pediatric orthopedic conditions, a multidisciplinary approach involving pediatricians, physical therapists, and other specialists may be necessary to deliver optimal care. Preventative measures, such as proper nutrition, exercise, and safety precautions, can also play a significant role in managing pediatric orthopedic conditions, and it's essential to discuss these aspects with the child and their family.

Dealing with Poor Patients

As an orthopedic surgeon, providing quality care to all patients, regardless of their financial status, is paramount. Understanding that financially struggling patients may experience stress and anxiety, it's crucial to empathize and listen to their concerns. Transparency about treatment costs and potential out-of-pocket expenses allows patients to make informed decisions about their care [10]. In cases of financial hardship, it's important to explore community resources that can aid patients. Providing information about local charities or government programs that assist with healthcare costs can be beneficial. Emphasizing preventive care can help patients avoid more serious and costly orthopedic issues in future. Depending on individual circumstances, considering the provision of certain services free or at a reduced cost for patients in need is a compassionate approach. Ultimately, every patient deserves quality care, irrespective of their financial situation.

Managing Patient Non-Adherence

Noncompliance with treatment plans can stem from diverse reasons, including patient misunderstandings, fear of surgery or complications, financial limitations, or personal beliefs. Establishing an open and honest communication channel with patients is crucial. Encouraging them to voice concerns and fears, and actively listening, helps identify the root causes of noncompliance. Collaboratively developing solutions tailored to their needs becomes essential. If a patient is unwilling or unable to adhere to the recommended treatment, exploring alternative approaches better suited to their situation is warranted. Recognizing that noncompliance is not a single entity but a complex issue with varying underlying causes is vital for effective intervention. Employing a differential diagnosis approach, as suggested [11], can lead to more successful outcomes in managing noncompliant behavior. Each patient is unique, and strategies that work for one may not apply to another. Therefore, a personalized approach is crucial to address noncompliance and improve patient adherence to treatment plans.

Dealing with Angry Patient

Handling angry patients can pose challenges for healthcare professionals, including orthopedic surgeons. Staying composed and calm is crucial in such situations. Avoid becoming defensive or emotionally reactive. Actively listen to the patient's concerns and allow them to express their feelings. Physicians should identify the cause of the anger and employ de-escalation techniques to enhance care [12]. Patients often seek validation and understanding, so acknowledging their frustrations is essential. If appropriate, apologizing for any errors or misunderstandings can help. Providing clear and concise explanations about their condition, treatment options, and relevant information is beneficial. The key lies in maintaining professionalism, empathy, and a focus on finding solutions that meet their needs. By doing so, the situation can be diffused, and trust can be established with the patient.

Example: Mr. Sahoo, a 42-year-old construction worker, had undergone a wrist surgery three months ago after a job-site injury. Though the surgery was deemed successful, Mr. Sahoo still experienced discomfort and limited mobility, impeding his return to work.

During a follow-up appointment with Dr. Patro, the orthopedic surgeon, Mr. Sahoo entered the clinic visibly upset. "You said I'd be back to work by now! I can't even lift heavy objects. What did you do to my wrist?" he exclaimed.

Dr. Patro calmly invited Mr. Sahoo to sit down and talk. "I'm genuinely sorry for the distress you're feeling. Let's go over your concerns and see what's happening," Dr. Patro began, creating a safe space for Mr. Sahoo to express his frustrations.

After listening intently, Dr. Patro thoroughly examined the wrist, reviewed the X-rays, and explained the healing process, highlighting that sometimes it could take longer than anticipated due to various factors. He acknowledged Mr. Sahoo's legitimate concerns about his livelihood and proposed a revised rehabilitation plan with the inclusion of a specialist physiotherapist.

Dr. Patro also assured Mr. Sahoo that they would work closely together to optimize his recovery and explore all available avenues, ensuring he'd return to his job in the best condition possible.

Mr. Sahoo, feeling heard and acknowledged, left the clinic with renewed hope and trust in his care plan. This scenario illustrates the importance of patient-centered communication, empathy, and proactive problem-solving in orthopedic practice when confronting challenging situations.

Social Responsibility

As a healthcare professional, an orthopedic surgeon bears a significant social responsibility toward both their patients and the broader community. Upholding the principle of providing high-quality care, regardless of socioeconomic status, is paramount. Engaging with the local community through health fairs, public lectures, and wellness events is a way to promote health and well-being. Advocating for patients' rights, including equitable access to quality care and respect for cultural and personal beliefs, is vital. According to the AMA's code of medical ethics, medical personnel must support access to medical care for all individuals [13]. Embracing this ethical stance reinforces the surgeon's commitment to the well-being of patients and the community as a whole. By fulfilling these social responsibilities, orthopedic surgeons contribute to the betterment of healthcare accessibility and inclusivity.

Working in Area of Limited Resources

In resource-limited settings, orthopedic surgeons must possess in-depth knowledge of various injuries and conditions they may encounter, along with suitable treatment options. Expertise is required to prioritize treatments based on injury severity, available resources, and potential outcomes. Collaboration with other healthcare professionals like physical therapists, occupational therapists, and primary care physicians ensures comprehensive patient care. Working with local medical facilities and organizations to share resources optimizes care delivery. An orthopedic survey revealed that over 80% of surgeons using orthobiologic products lack accurate cost perception [14]. In such settings, the surgeon's ability to make informed decisions about treatment options becomes crucial for effective and efficient patient care.

Medicolegal Issues

Like any medical specialty, orthopedic surgeons encounter various medicolegal issues in their clinical practice. Medical malpractice lawsuits can arise if they breach their duty of care toward patients. This might occur due to misdiagnosis, surgical errors, or inadequate follow-up care. To mitigate such risks, maintaining accurate and comprehensive medical records is essential, encompassing medical history, examination findings, test results, treatment plans, and progress notes. Orthopedic surgeons must adhere to relevant regulations and laws, including safety protocols, proper certifications, and ethical standards. The axiom "you learn from your mistakes" is undervalued in healthcare, emphasizing the significance of prevention in handling medicolegal issues and safeguarding against negligence suits [15]. By focusing on prevention and strict adherence to best practices, orthopedic surgeons can minimize the likelihood of facing medicolegal challenges and ensure optimal patient care.

Here are few hypothetical cases that illustrate the importance of ethics and adherence to standards of care in orthopedics.

Improper Consent

Scenario: Dr. Mohanty performed a spinal fusion on Mrs. Mahapatra. However, the consent form only mentioned discectomy. Post-surgery, Mrs. Mahapatra suffered complications.

Court Verdict: The court ruled in favor of Mrs. Mahapatra, stating that Dr. Mohanty had not obtained proper informed consent, leading to a breach of her autonomy.

Failure to Diagnose

Scenario: Mr. Aggarwal, after a fall, visited Dr. Jain complaining of hip pain. Dr. Jain dismissed it as a minor strain. Later, it was discovered as a hip fracture.

Court Verdict: The court deemed Dr. Jain negligent for failing to properly diagnose and treat the fracture, leading to further complications for Mr. Aggarwal.

Improper Technique or Equipment:

Scenario: During a knee replacement for Mr. Murmu, Dr. Neradi used an outdated technique and a recalled implant. Mr. Murmu developed post-operative complications and chronic pain.

Court Verdict: The court held Dr. Neradi liable for using a recalled implant and not keeping abreast of modern techniques, compromising patient care.

Failure to Address Post-operative Complications:

Scenario: Ms. Kapoor underwent an ankle surgery with Dr. Das. She developed signs of deep vein thrombosis (DVT) post-surgery, which Dr. Das failed to address promptly.

Court Verdict: Due to the severe consequences of the untreated DVT, the court found Dr. Das negligent in post-operative care.

Unnecessary Surgery

Scenario: Dr. Tripathy suggested and performed an invasive shoulder surgery on Ms. Panda, while physical therapy might have been a more appropriate first-line treatment.

Court Verdict: The court deemed the surgery unnecessary and held Dr. Tripathy liable for not considering non-surgical alternatives and not acting in the best interest of the patient.

The Surgeon Specific Issues

A. Maintaining Competence

Continuing education and staying up-to-date with scientific advancements are crucial principles in medical practice [16]. Similarly, orthopedic surgeons must constantly update their knowledge and skills to utilize various surgical tools and techniques, such as arthroscopy, joint replacement, bone grafting, and fracture fixation, within their sub-specialty. Professional development involves staying informed about the latest treatments and technologies, even adapting to virtual methods during the COVID-19 pandemic [17]. Surgical skills play a vital role in an orthopedic surgeon's clinical practice, influencing surgery duration and patient outcomes [18]. Collaboration with researchers allows orthopedic surgeons to investigate new implants, surgical procedures, and interventions, identifying areas for quality improvement [16]. Adherence to laws, regulations, and ethical principles like autonomy, beneficence, non-maleficence, and justice ensures ethical and professional practice [19]. By embracing a bioethical approach, orthopedic surgeons can address a wide range of clinical care issues and continually enhance patient care and outcomes.

B. Relationship with Industry

The industry provides orthopedic surgeons with technologically advanced medical devices that can enhance patient outcomes and quality of life. In return, the industry benefits from the clinical expertise and input of surgeons in developing new products and technologies. Orthopedic surgeons participate in clinical trials to evaluate the safety and effectiveness of new medical devices, drugs, and therapies, providing valuable data for product refinement and market introduction. Moreover, the industry sponsors Continuing Medical Education (CME) programs, equipping orthopedic surgeons with the latest clinical knowledge and training on using new medical devices and technologies. These programs foster communication between surgeons and industry representatives, facilitating the sharing of experiences and feedback.

However, this relationship is not without challenges. In the USA, the industry must adhere to the AdvaMed U.S. Code of Ethics [20], ensuring interactions with surgeons align with the Code's values and avoid circumvention. The Code aids the industry in making reasonable and appropriate decisions in line with ethical principles.

C. Conflict of Interest

Conflicts of interest in healthcare occur when personal or financial gains could impact a provider's patient care decisions. For orthopedic surgeons, potential conflicts may arise in various ways. Financial interests in medical devices, implants, or pharmaceuticals, such as owning stocks in a company that produces specific implants, could influence their choice of treatment options for patients. Research grants or consulting agreements from device or pharmaceutical companies might sway research findings or treatment recommendations. Referral relationships with other healthcare providers or facilities may affect referral decisions, potentially disregarding the patient's best interests. To manage conflicts, transparency is essential. Orthopedic surgeons should openly disclose any financial interests or relationships that could influence their decision-making. The American Academy of Orthopaedic Surgeons has established guidelines to prioritize patients' interests above all else [21].

D. Publicity of Orthopedic Surgeon

The primary objective of publicity in a clinical practice is to enhance visibility and raise awareness of the services offered by the orthopedic surgeon. This can be achieved through diverse marketing strategies, including advertising, public relations, and social media. Advertising may encompass print, radio, or digital ads on search engines and social platforms. Public relations involves fostering positive media relationships to promote the surgeon and their practice. All advertising and publicity efforts must adhere to relevant regulations and ethical guidelines for medical marketing. Success relies on the specific goals of the orthopedic surgeon, their practice, and the preferences and needs of the target audience. It is crucial for physicians to avoid false or deceptive advertising, as it undermines the essential trust relationship between the physician and the patient, potentially harming patients' access to necessary treatments [22].

E. Professional Rivalry

Professional rivalry can pose concerns in the clinical practice of orthopedic surgery, but its extent and nature can vary based on factors like practice size, location, and personalities involved. In some cases, rivalry may manifest as a lack of cooperation or communication among orthopedic surgeons within the same practice or hospital, leading to inefficient resource use and potentially suboptimal patient care. This can also create tensions and conflicts, negatively affecting the work environment.

Another form of professional rivalry may be competition for patients, leading surgeons to engage in advertising, marketing, or reputation-building efforts. While healthy competition is natural, it may also lead to unethical behavior like false advertising or over-promising outcomes [23]. To address these issues, maintaining a professional and respectful attitude toward colleagues is crucial. Encouraging communication and collaboration among orthopedic surgeons can optimize patient care, resource utilization, and foster a positive work environment.

F. Role of Professional Organizations

Professional organizations play a crucial role in supporting orthopedic surgeons' clinical practice through various services and resources. They facilitate the field's advancement, surgeon education, and patient care quality. Offering continuing education opportunities like conferences and webinars, these organizations keep surgeons updated with the latest developments. By developing and promoting clinical practice standards, they ensure evidence-based and high-quality patient care. Supporting research and innovation through funding and collaboration among researchers is another vital aspect. These organizations advocate for surgeons and patients at different levels, striving for improved access to care, research funding, and reimbursement. Moreover, they provide valuable networking opportunities, fostering knowledge-sharing and research collaboration among surgeons. Overall, professional organizations play a vital role in advancing orthopedic surgery's clinical practice. Taking an examples of EFORT, its president Rolf Soiron has observed that society like EFORT should go beyond the traditional exchange of clinical experience only; it should routinely assess hot topics in the emerging health care environment in Europe and as well, their impact on the profession; and it should explore doctors’ adapted roles in Europe’s changing societies [26].

In conclusion, ethical considerations are fundamental in the clinical practice of orthopedic surgeons. They can uphold ethical standards by staying competent, continuously updating their surgical and soft skills, respecting patient autonomy, minimizing harm, and acting in the patients' best interests. Avoiding conflicts in their professional life and maintaining a proper work-life balance are also vital aspects of ensuring ethical practice. By adhering to these principles, orthopedic surgeons can ensure that they maintain the highest ethical standards in their profession.

Funding

None.

Data availability

Not applicable.

Declarations

Conflict of Interest

The authors of this manuscript declare that they have no conflicts of interest to disclose.

Ethical Standard Statement

This article does not contain any studies with human or animal subjects performed by the any of the authors.

Informed Consent

For this type of study, informed consent is not required.