Pioneer: Augusto Sarmiento, MD
In this month’s column, we feature Augusto Sarmiento, MD, an international leader and pioneer in orthopedics. He is a past president of the American Academy of Orthopedic Surgeons and the Hip Society and consecutively chaired the Departments of Orthopaedics at the University of Miami and the University of Southern California.
How did you decide on a career in orthopedics?
Augusto Sarmiento, MD: While working as an intern in the military hospital in Bogota, Colombia under the supervision of William Vargas, MD, I was impressed by his enthusiasm and sincere commitment to the welfare of his patients. His example inspired me to pursue an orthopedic career.
Who have been your most important mentors and what were the most valuable lessons you learned from them?
Sarmiento: Austin T. Moore, MD, was a mentor for his teaching style and overall objectivity. Sir John Charnley, FRCS, served as a mentor for his organizational skills and the importance he gave to honest follow-up with his patients. Also, the hundreds of residents who, in the process of observing their maturing, provided me with the opportunity to learn the importance of gradual progression from basic principles to clinical judgment and surgical skills.
What has been your most important contribution to your specialty?
Sarmiento: I believe my most important contribution was the clinical and laboratory research on fracture healing in diaphyseal bones and the healthy role that functionally controlled motion plays in enhancing osteogenesis. This work led me to develop a functional treatment system that frees the joints adjacent to the fracture and encourages gradually increased activity. Also, my failed attempt to develop the first hip prosthesis made of a titanium alloy was an important contribution.
How do you envision the future of orthopedics?
Sarmiento: I see orthopedics facing serious challenges in the not too distant future. I anticipate that the declining loss of professionalism and ethical conduct in its ranks will bring about unhealthy consequences. The rather rapid morphing of medicine from a profession into a business where profit is becoming its raison d’etre may also challenge the long-held vitality.
The significant control of education by the pharmaceutical and surgical implant industry, if allowed to continue unchecked, might also have a major detrimental effect. An exaggerated fragmentation of the discipline could result in erosion and loss of territory to others.
What advice do you have for the next generation of orthopedic surgeons who want to learn from your experiences?
Sarmiento: My advice to the next generation of orthopedic surgeons is to make a sincere effort to sustain traditional professionalism and high ethical standards that made possible the enviable position our discipline held for generations, and prevent the continued emphasis in making orthopedics primarily a great “business opportunity.” Speak up without fear of retaliation realizing that only the weak remain silent in days of crisis.
Realize that the education of the orthopedist, currently to a high degree in the hands of the pharmaceutical and surgical implant industry, must be balanced, while ensuring its control by the medical discipline.
Follow closely the evolution of subspecialization and begin, as soon as possible, to anticipate the consequences of its role in the increased cost of care, and the resulting erosion of the territory, which until recently was entirely the domain of our eclectic discipline.
Finally, remain cautious about the thus far perceived benefits that guidelines bring to our education as the possibility exists that, in the process, free thinking may be curtailed. In addition, the fear of litigation from not adhering to them may result in improper care in many instances.
For more information:
Augusto Sarmiento, MD, is from the Department of Orthopaedics and Rehabilitation, University of Miami School of Medicine, in Miami. He can be reached at firstname.lastname@example.org.
Disclosure: Sarmiento has no relevant financial disclosures.