I don’t know if there is proper protocol for these columns, so I am taking a bit of a chance and going to mention my kids. I had the opportunity (or maybe it was a fatherly requirement) to spend about 10 hours each day for two days straight in a climbing gym, plus a 90-minute drive each way both days to see my kids compete in a USA Climbing Regional meet.
Just like in medicine and spine care, many things are available now that were not around when I was younger. My kids don’t love when I say “When I was a kid….”, and I also need to make sure I am not saying that to residents, medical students and junior faculty. But, when I was a kid, rock climbing, especially as a sport, was not available. My daughter Aran is 16 and competes against some of the strongest climbers in the nation. Often, the national champion in her age group is from our region. She loves the fact that climbing is always different, and always a challenge. My son Liam is 14, and at the age where some in his category are 5 feet and others nearly 6 feet tall. But just as climbing makes no compromise for gender, it is not necessarily beneficial to be taller. On the rock wall, everything is equal. He also loves the challenge, and is an extremely supportive member for others on his team (climbers from the same gym).
As I sat in the car driving, and while in the gym waiting for climbers, I began to realize the many similarities between climbing and spine care. Both have expanded and now offer many more opportunities. We may not have as much science behind the benefits/risks of climbing compared to running, football and many other “traditional” sports. This is true of new surgical techniques and devices as well as the myriad of nonsurgical options. Spine care does not depend on gender, and no matter how good we get, there are always new challenges. Each new patient is like each new climbing problem. Even if a new patient looks to have the same problem as a previous patient, we become aware of their precise differences so we don’t fall/fail. We use past experiences, analyze those experiences and learn from them, whether dealing with spine patients or climbing rocks.
In climbing, as in life (including spine care), sometimes we win and sometimes we don’t. Neither of my children advanced to the next round, but both found solace in their efforts and performance compared to prior climbing competitions. Both learned and both grew. We should approach our daily roles as physicians, surgeons, therapists, chiropractors, researches, nurses and physician assistants the same way. Spine care is never easy, and it may not necessarily get easier in the future. But we can always continue to learn and get better.
This edition of SpineLine begins with From the Desk of the President. I am again happy to introduce F. Todd Wetzel, MD, as President of NASS. While he did have a guest column earlier in the year, this is his first official presidential column since taking office back in October. We are looking forward to a wonderful year. His column addresses a very important aspect of the continued future of spine care related to nonspecific low back pain and the problems associated with “nonspecific.” My past mentors including Joel Press, MD, and Stan Herring, MD, (two past NASS Presidents) used to say, “A nonspecific history leads to a nonspecific exam, leading to nonspecific diagnosis and nonspecific (bad) outcomes.” Even today, however, I had a patient who seemed surprised when I said we did not have a 100% definitive way to determine where his pain was coming from. As Dr. Wetzel points out, challenges are ahead.
Our Current Concepts section includes an article in our regular Spine in Sports series. This edition includes “Critical Questions for the Bicyclist with Low Back Pain” by Erik Moen, PT. Moen provides an overview on the multiple potential issues related to cyclists and back pain.
The remainder of this section is devoted to a NASS 2016 Recap. For those who were unable to participate in the Annual Meeting, this will give a flavor for the extensive science and multiple events presented that week. I would like to extend special thanks to Chris Bono, MD, for his leadership over the years, and also congratulations to all winners and nominees of the Best Papers, Research Awards and other recognition categories at the Annual Meeting.
The Socioeconomics & Politics section begins with Coding Q&A. The current article from coding experts Michael Furman, MD, Scott Horn, DO, and Charles Mick, MD, is “CPT Coding for Percutaneous and Endoscopic Disc Procedures.” Just as rock climbing wasn’t around when I was a kid, neither were these codes. A lot of work is done by NASS Health Policy Committee members (who, by the way, volunteer a lot of time) to get these codes right and to fight for correct reimbursement.
Along those lines, Regulatory Policy presents “2017 Medicare Physician Payment Final Rule Released” by NASS Health Policy staff Allison Waxler, MS. NASS continues to work to ensure correct coding, and to address discrepancies between CMS and AMA/CPT/RUC code values.
Jordan Abushawish, MPP and NASS Advocacy Chair and Board Member John Finkenberg, MD, give us an Advocacy column on “Election 2016: Little Changes in Congress Despite Trump Surprise.” An increasingly high number of health care providers (physicians and others) seem to be involved in politics. I am sure this group will have more to say as changes come with the new administration.
Finally in this section, the Ethics column includes “Drug and Device Reps in the OR: A Teachable Moment” from Ethics Chair and Board member David Rothman, PhD, and Paul Arnold, MD. Drs. Rothman and Arnold offer interesting perspectives on this practice as we continue to recognize how we are influenced by others, including interactions that may otherwise seem incidental.
NASS News rounds out this edition with a variety of other tidbits related to the Annual Meeting, upcoming events, milestone members and special thanks to NASS donors.
I would like to extend a special thanks to NASS members and staff who helped cover for me during the week of the NASS Meeting. As usual, I will close with a thank you to all of the contributors, section editors and especially NASS Staff for their dedication in providing another edition of SpineLine. As always, we are receptive to any comments or suggestions that will help make a difference. Keep climbing…
* This column originally appeared in the November/December 2016 issue of SpineLine. To read more of that issue, click here.