Recording - 10-25-2024 13:42:32

00:00 Just how easy it is. This is Mark Swiontkowski at the 40th meeting of the OTA here in Montreal. And I have been able to track down a few colleagues to get to talk to them about their involvement in the organization. So I have my good friend Bill Obremskey the chief of trauma at Vanderbilt University Medical Center, a place where I started my career. It's a great place, and he's built a phenomenal program there. And I just want to ask Bill, when was your first OTA meeting? Hey, you know what you can do?

00:35 My first OTA meeting was in 1998.

00:40 Yeah?

00:41 What town was that?

00:44 Louisville.

00:47 Sounds right. Nobody's going to fact check this discussion. Don't have to worry about that.

00:51 So.

00:51 And you were a resident? You were.

00:54 No, no. I was just returned from my AO fellowship and joined the UNC faculty at the University of North Carolina. Working at WakeMed Medical Center.

01:04 Right. With Doug Dirschel.

01:06 Doug Dirschel had hired me. I convinced him, twist his arm to hire me. After I had finished my Air Force career. Spent some time in Basel, Switzerland, which you sent me to when I had asked for advice on where to go for fellowships. You returned in a letter. We wrote letters in that and said, it's all set. You're going with Prieto Regazzoni. It's in Basel, and you will enjoy it thoroughly. These are the dates you're coming.

01:31 Going.

01:32 Yeah, yeah.

01:33 Regazoni. What a great guy.

01:35 Yeah.

01:35 A lot of fun.

01:36 And it was an invaluable experience.

01:38 Yeah.

01:39 So you went to your first meeting in 98, and what were your initial impressions at that young stage of your career?

01:47 Well, I'd already decided. I, you know, I wanted to do trauma. But it was feeling like you really had found a home.

01:55 Yeah.

01:55 In that, you know, in the Air Force, it was all about sports medicine or, you know, total joints and general. General orthopedics. And I'd had an opportunity to teach with the University of Arizona since I was a Davis Monthan Air Force base. And I realized I really wanted to spend time teaching and that I liked the trauma. You know, when I came to Harborview with you, I thought I was going to be a sports medicine doc. Billy Garrett, your buddy, had convinced me that I wanted to be a sports medicine doc.

02:27 Well, you were an athlete at Duke, so let's be clear that it wasn't an association that was out of the. Out of the blue or anything like that. You had a reason why you were.

02:40 It was a normal course of events. I played football at Duke and First orthopedic surgeons I'd ever met were part of the team. Yeah, it was enamoring and I enjoyed that. But I got to Harborview and I realized that I liked the real problems and as I like to say I like to do. I decided to do something more useful with my life and be an orthotrauma surgeon. Just like egalitarian aspect of it and taking care of people no matter what their walk. Walk of life.

03:08 Yeah.

03:08 Well, I think we both agree that sports surgeons do a lot of, a lot of good. I know we're just tongue in cheeking it here because of our career choices, but yeah, they do a lot of good. So, okay, so you found a home and obviously you from the get go are really interested in education. So how did you get involved with the OTA in teaching besides doing teaching in your own centers where you were working?

03:35 Yeah, so with the ota, I, you know, was involved in AO teaching and been to AO courses and kind of involved in the OTA educational component with doing OTA courses as well. And it was, it just reminded me of the course learning and Chip Rout was such a palpable teacher that you could just feel that he loved expressing his knowledge and passing it on. And I think that infected me as well and the honor and privilege of passing things on. I should have had a feeling in her life that I always think you ought to help those behind you. And this is one way that I could fulfill that desire.

04:17 Yeah.

04:18 Well, also, you obviously had huge contributions in research. And how did you get involved with that?

04:27 Well, I would say a couple things. Billy Garrett first, when I worked in the research lab, he just sort of gave me a card and said, go read for a month and come back and tell me what you want to study. And he was a sports scientist and he really wanted to understand and the whys. And I, as a child, I was a natural why child and I was quite annoying. I always wanted to know why things worked and hence why I really loved biochemistry and organic chemistry and physics when I was doing the pre med stuff because they help explain the physical world of things. And then one day I was walking around Harborview talking to an attending named Mark Swiontkowski about how great fixing humerus fractures was and we should fix them all. And he stopped and he said, why don't you go read about that and talk to me about it tomorrow. And so I did my homework and I had to come with my head down and say, I guess Gus Sarmiento has got some articles that says you don't have to fix them all. And they really heal pretty well. But that was my first experience of going to the literature and finding an answer in medicine, in orthopedics, in orthopedic trauma. And to this day it sticks with me. And why I commonly share with residents or learners the why. Why we do things based upon either the principles of anatomy, physiology, biomechanics, or basic science or clinical science.

05:55 Yeah.

05:55 And then we need to support what we're doing with not just because it's really cool at fixing humorous fractures. There's a reason why we do it.

06:04 Yeah. Yeah. That's great.

06:06 And it's your fault that I did that.

06:07 Yeah. Well, I'm not going to accept total blame on that, but for sure, you have ridden the wave of increasing method. Methodologic change and advancement and the degree of difficulty to do things right to limit bias. And you keep plugging forward with these projects that take, you know, five, seven years sometimes and working a lot on infection now. So why it's much easier to go treat more patients, right?

06:41 It is easier, but it also doesn't feel good when I don't really feel like I know the right answer and the literature or people's experience can't explain it to me. And I think that's driven the why has driven my desire to do a number of researches and other research projects and even 10 years. This week, Monday, I sent into JAMA Surgery our PO vs IV antibiotics, which we started with the DoD 10 years ago. It took us that long to get it finally done. To help answer a question, are PO antibiotics as good as iv? You have to wait for the article to really hear the rest of the answer.

07:21 I think I know a little bit about. About the results of it.

07:23 I think you do. You based it. Part of the reason also is that I did that is it's your fault because we were giving people PO antibiotics when they leave after their osteomyelitis treatment. When you were at Harborview in the 90s.

07:36 It is a frustrating, lengthy, difficult procedure. But in the end you feel like maybe. We talked about this earlier today about getting people to change practice based on evidence that maybe you might be able to influence care decision making if people will actually read what's published. And it's a bit frustrating. As we were discussing so well, you've moved up the ranks. I know you chaired a lot of committees and participated in a lot of things in the ota, and all of that work has resulted in your being in the presidential line. So what's the track record, what committees were you. I know there's too many to remember, but what committees were you involved with?

08:17 Not too many. You put me on the first one, the Membership committee, which was a lot of work and not a lot of glory, but I think really helpful in that. We, during my tenure on that, that we introduced or made a pathway for international members to become ota, participate in the ota, I think that was really groundbreaking and changed our worldview of the organization. And then Paul Turnetta asked me to start a task force called the Evidence Based Medicine Committee, and that eventually morphed into a committee. And then I chaired that for a couple of years or two terms, a total of 10 years tenure on that. And that was extremely satisfying. And trying to develop clinical practice guidelines on a wide range of things to help our practitioners sort our colleagues sort through the wheat and the chaff and provide at least, if not the highest level, at least reasonable recommendations for treatment. Which, you know, you told me about the Cochrane Collaboration long ago, and I've been frustrated by them, is that they often don't make a statement that we can't choose for or against, but clinicians have to make a decision. And if you at least have some colleagues who have been thoughtful and utilize the available literature to make a recommendation. I helped with that process with the Evidence Based Medicine Committee for a number of years.

09:47 Yeah, your passion comes through on that subject so well. So you've done a lot of work with this association and have been involved from the early, I think, start of the organization, more or less. And what do you think is going to look like when you're done with your five years on the board? What's your prediction?

10:14 I hope that we have resources to help any surgeon worldwide via their phone, access the latest and greatest knowledge or best recommendations and technique videos on how to take care of anything to do with musculoskeletal trauma. I think that's a huge future goal and I think the OTA is the only organization in the world that can do that because we have the motivated members with the content knowledge and the, I would say, desire and motivation to do it, not for profit, but for the good of the world.

10:58 Good of the world and the good of the patients we serve so well. We look forward to your five years of leadership. I know this organization is in great hands and thanks for spending 11 minutes and 15 talking with me. I apologize to the listeners for the, for the racket in the background. We were just outside of a conference room and maybe we can filter some of that out. Thanks, Bill. And I'll let you get back to the meeting.

11:22 Thanks, Mark. Yeah.