Recording - 10-24-2024 13:16:52

00:02 This is Mark Swiontkowski coming to you from the 40th anniversary of the orthopedic Trauma association. And I'm taking the opportunity to review some really important contributors to the orthopedic Trauma association through these past 40 years. And it's my honor to be interviewing doctor David Helfet from New York, who was in the presidential line early on and made huge contributions to this organization. So let's start, David, with how did you get involved with the OTA? What was your first meeting that you can remember?

00:40 I think it was in Baltimore. And it was.

00:42 That was meeting number one, wasn't it?

00:44 It was Otha.

00:45 That's right. It was worth speeding, trauma, hospitality.

00:47 And I wasn't involved at that stage, but I'd come back from Switzerland, and I was doing trauma in Baltimore. And, you know, we went. All the people involved initially were at level one trauma centers, Baltimore, Harborview, etcetera. When I came back, I was at Hopkins and at Union Memorial for a few years before I went to Tampa. So I went to the Otha meeting, and Ted Hanson, who I knew from my Davos experience, said to me, you remember? I said, no. He says, well, you need to become a member. And that's exactly what happened. And that was a Baltimore meeting.

01:22 Yeah.

01:23 And that, I think was in 1984 or something like that. Yeah.

01:27 And I think that's about right. Cause I think I remember Mike Chapman incorporate, doing the incorporation of the organization in 88. So it would have been maybe 86 somewhere.

01:37 Whenever that was. Whenever that was. It was Otha.

01:40 Yeah.

01:40 And it was actually Sig Hansen, who I knew from Davos. And the courses said to me, you're not a member. Almost like when dragged me by my collar.

01:51 Yes, Doctor Hansen, I'm on it. So what's the next meeting that you can remember?

01:56 Well, I was from then I basically went, I've been in every meeting. So between and partly related to the AO and partly related to ODA. In the early days, the AO was more significant than OdA. And a lot of the people that actually developed the OTaE came from the experience of the AO. And so I was very involved in the AO. And so it was a natural evolution, I think, to become part of Oda. And we didn't have courses really at Oda in those days. All the courses were really through the AO. And then that evolved over time. And then, I think in North America, there were a lot of institutions that didn't feel like that everything should be through this organization, the AO relationship with Sunteers, etcetera. And so that actually also promoted ODA to be an alternate source.

02:49 Yeah. Or complementary, I hope. So. You talked about your experience with the AO. So how did that all start? I know the story, but people listening don't know the story.

03:02 So when I was at Johns Hopkins, during my residency, Andy Weiland had done a AO fellowship with Hans Billenger, and he was one of the junior attendings. And then I really wasn't a trauma guy yet. And Andy Weiland organized for Maurice Muller to come give a lecture at Johns grand rounds at Johns Hopkins. And then my chief, then Robbie Robbins said, david, you free for three days? You are his. The words he used. You're his valet, driver and maid. Whatever he needs for three days, you should take care of it. And then he gave this lecture, which at that time was probably 19 8019. No, 1978, 78 79. And it was a wow for me, you know, like, you have cartoons and you see w o w with an exclamation. That was because we'd been treating all these things in traction and we were rounding as residents, and all of a sudden I saw what they could do with these patients and the internal fixation, and I was really blown away. So you could see my eyes were just lit up. So he said, well, why don't you come and spend some time with me? And I guess I did a good job as his maid and valet and driver. And so I said, well, I've still got another year of my residency. He said, well, come after. So that's how I ended up with a six month fellowship in Bern. And my timing was impeccable because Maurice Muller just retired from chief of the incest battalion and went to the private hospital in Lindenhofenhe and rhino guns just over his cheap. So I got to work two days a week as assistant to Maurice Muller, and three days a week I operated with Rhinel guns. And for some reason, they. I ended up their first assistant for most of those months. And because, you know, in that system, the junior guys don't get to do or see much of something. And I learned more surgery in that six months than I learned in a couple of years at Johns Hopkins. I mean, these guys were unbelievable surgeons. And so. And then Maurice Muller, that's. So I was there from July through December, and in December he says to me, why don't you come with me to Davos? And I'm thinking, davos? He says, yeah, the AO courses. I'll take you along with me. So he drove me to Davos, okay. And then I helped carry his bags up to the, in the Schwarzerhof to the top floor. And then I was in the laundry room down at the bottom with a. Fred Behrens and Eric Johnson. Three of us were down in the laundry room. Anyway, it was wonderful. I got introduced to the AO then, and that was 81, beginning of 82. And I became a member of the AO from then on. And my first AO course was in 82.

05:54 Wow.

05:56 And that course is a very interesting story, really. That course was in Vermont, at Snuggler's notch, Smuggler's notch in Vermont. I was a table instructor. I wasn't a lecturer. I was a table instructor. And that was the first time Emile Latournel was invited to come to the US by, I don't forget who invited him. And so he gave a talk at that course. It was a basic course, but he gave a talk on acetabular fractures. And again, the wild light went off in my head like this. Washington would be the ultimate. And so I spent time with him intermittently, not a six months like that, and got to know him very well. And so I was very fortunate. Very fortunate. You know, I think there's something that, there's a message that we should. These experiences. I'm sure you had the same Mark The idea that you can run a surgery residency without mentors is a myth. You really, this idea you're going to go hop from one person to one person to one person. You can experience everybody. I think you lose something in surgery. Maybe it's good for, you know, librarians or something, but I think in surgery you need a mentor who can actually steer you as a surgeon, help you develop surgical skills and then develop and help you through your career. Yeah, and we lose that now with this idea that you're just another resident or another person in the clinic system. And this week he was so and so. Next week he was so and so. For me, my experience and the fellowship that I ran for many years was a mentorship fellowship. And we only, there were only five of us involved and we all trained in the same place. And it was a school. And it's very interesting. On that drive down to Davos with Maurice Mueller and then driving back, I noticed in some of his slides that he gave talks. He gave maybe four or five talks. He recommended doing things that we weren't actually doing in the hospital when I was scrubbing with him. And so I said to him, professor, you know, not everything was by the book in the hospital, but everything was by the book in your lectures. And he looked at me still driving, looked at me like this and kept driving. And he said, you have to teach a language before you. This is a guy speaking in English. Okay. With his fifth language. He says, you have to learn the language before you can use idioms.

08:30 Fantastic.

08:31 And so you have to teach the language, and then once you become familiar with the techniques or the language, whatever you want to call it, then you can deviate from that because you understand what the basic principles are and what is necessary. And that was very telling for me. Yeah, we can imagine. That is in his fifth language.

08:51 Wow. Very talented guy.

08:53 And those guys were outstanding surgeons.

08:55 Yeah.

08:55 And Emil, too.

08:56 Yeah.

08:57 Outstanding.

08:58 Yeah. So what year were you president of the OTA?

09:03 I was worried you could ask me that. It was 96 or 98.

09:06 Okay.

09:08 One of those two years.

09:10 Yeah. So you were, what, 7th or 8th or something like that? Or.

09:14 Yeah, I followed, I think, when was Kellam?

09:19 I think Jim was the fifth. So that would have been 894.

09:24 And then I think, I'm just wondering who handed me this. I can't remember. Well, it was one of those years.

09:30 Don't worry. Nobody's gonna fact check any of these.

09:33 Interviews in that period of time. Yeah. And it was great. You have to be on the board for a while. So I was on the board and doing various other jobs in Oda. And then my year, it was great because you had a year to prepare yourself as president elect, and you spent a year, and then you spend another year afterwards. And I think that system is very good for continuity. I think that you learn very quickly when you do something like this in an organization like this, who the people you can rely on and who the people you can't rely on, because there are a lot of people that want to be part of an organization, but they don't really fulfill all their obligations. And you learn that very quickly if you have a period of time that you're working with people. And it's not that they're bad people, they're just not on. This is not their focus, but they want the credibility.

10:26 Was there any one particular issue that stands out in your mind when you were leading the organization? Any problems or.

10:34 Yeah, I think. Sorry. I think the issue that was raging at that time was, should ODa have competitive courses?

10:43 Oh, with the AO?

10:44 With the AO.

10:45 Okay.

10:46 And what was the place for that? Based on my history of the AO and the good job they did with the courses, I thought it would be much better at that time for the ODA to spend its time and money doing other things and not really just competing with the resident courses, etcetera. Obviously, that's the way it was. And then the next generation came into Oda, and obviously they decided differently. And I don't. This is my bias, and I'm quite happy to be biased, and as long as I claim I'm biased. I've been to a couple of the ODa courses, and I don't think they do as good a job as the AO does in these courses. This idea that you give canned lectures, it's not your own lecture. This idea that you give the same lecture six times, I think that there's no passion. There's no. It's not your own work. It's not your own. And the thing I loved about the AO courses and having senior people at the AO courses is they showed their own works. They remembered the patient. They talked about the patient. It wasn't just an x ray. It was a patient. It was a passion, and we'd like you to learn about it. And so I'm not a great fan of how it's evolved now with these resident courses. Not because it's not the AO, it's just not for me. I wouldn't give the same lecture six times, and it's not my lecture.

12:14 Yeah, probably would never give a lecture. That's not your own experience.

12:21 And what I liked about the AO in the early days is no one asked someone else to give them a lecture in the early days. You know that you were selected because you had cases and you knew what was going on, and you gave your lectures over the years. And I'm sure the same thing happened to you, Mark, I get calls up from some guy, listen, I've been asked to give this lecture and says, yeah.

12:45 Can I have your slides?

12:46 Can you have your slideshow? And it's always been. And I've basically said, no, it's not because I'll send you some cases. You want some cases, but you got to make your own slides. I mean, jeez. Yeah, you're getting up there to lecture and answer questions. And unfortunately, I think that what I learned in the early days, the AIO, and when you listen to people like Reinhold Gantz and Reese Miller and Hardy Weber, I, Tom Rudy and Al Gore and Emil Latournel, all of them talked about their patience and the passion they had for a perfect reduction and the outcome and how crestfallen they were. When they showed you a case that didn't work out like that. It was their, it was their life. And I think that that's getting lost. Yeah, that's so important.

13:37 Yeah. There's no real shortcut to expertise. Mentorship, as you pointed out, is extremely important. And you've got to put the work in and be the most critical of your own work, as anybody is, and continue to try to improve. And I think your career demonstrates that.

13:54 And lucky guy.

13:55 Yes. Yeah.

13:57 But, you know, I would fault you a little bit if I can. I have the option here.

14:02 It's still running.

14:04 You know, I think we publish too much stuff. That doesn't change what we do just because some guy wants a publication.

14:11 That's true.

14:11 So when I talk to the residents and the fellows and they come to me with an idea and I say, how's that going to change what we do? That's my first question. And if they say, well, I said, well, then it's a waste of time. Why are we doing that study? Spend your time doing a decent study that actually either will refute something we're doing or give us some increased knowledge about the injury or the blood supply or something about what you're doing or is going to change how we do it. But just to put another me too study, the amount of money, time and effort is wasted in these studies because the system that we have now is, if you look at your academic credentials is based on a certain amount of your publications and youre. And these sites.

15:01 Yeah, it's numbers generated, it's not impact. I couldn't agree with you more.

15:09 So it's interesting, I was asked for one of the major institutions to go on a panel to decide if this person deserved to be a professor, which we happen all the time. And then the med ed at that institution contacted me and said they would like to know a copy of my cv. And then they wanted to know some things I've never measured, you know, the quality of my work, which I never. Who cares? I don't look at that sort of stuff. So I got my research guide to look it up. And my impact, you know, my h factor. H factor. My h factor is 80.

15:49 Yeah, it's outstanding. Yeah.

15:51 Okay. And that, and if I would like to take out, and without knowing that, and I would like to take out the first 50 of my cv, which didn't contribute to that age factor. And so I sat back and thought, so here's a guy who's not trying to do anything just to pump up my cv, but if you do stuff that actually makes a difference, you don't have to have. So I have, now I have 400 publications, whatever it is, but you could take 100 of those, and I would quite happily take them off the list. But I think it's important in your career not to think about. I'd need another publication, but think of how many people do you think would actually quote this or read it? And what difference would that make?

16:33 Or change practice or change practice.

16:36 So I think that the editors and the journals, we should do less and mandate first question that someone submits. How is this going to change anything?

16:51 Yeah, yeah, yeah. I couldn't agree with you more.

16:57 And as you know, we have people, unfortunately, we have people that are so called academic surgeons who don't operate, number one, or aren't allowed to operate in the institutions. So as a surgical specialty, there should be some criteria to be an academic. Do the other surgeons in your department refer their family to you?

17:24 That would be a good metric. Good metric.

17:26 You understand?

17:27 Yeah, yeah.

17:28 Do the anesthesia people refer their family to you? Do the nurses and the protects. Yes. And if you do that, okay, we'll accept your paper because.

17:39 Yeah, that would be a great standard. Well, thanks, David. You're continuing to train fellows, and that's excellent. You're continuing to share your expertise, and you've contributed a lot to the OTA, and I think the organization is very strong, and you were there pretty much at the beginning, so thanks for that and thanks for spending 15 minutes.

18:02 Absolutely. I'd like to say one other thing. Since I was no longer in the leadership part of the Oder, and I was very involved in EaO, I did less in the leadership of ODA. But I must congratulate all the people who worked their ass off, excuse the language, to take this to where it is now, which is a hell of a lot better organization than when I left it in the late nineties. And it really has become for North America the premier force behind our academic credentials and in the society of North America, the American College of Surgeons and all the other things. So I thank them for their efforts. They have done a remarkable job.

18:45 Well, thanks for that, and thanks again for chatting with me. Of course.