March 7, 2018
3/7/2018: I was invited to write this short manuscript by the editor in chief of the Journal of Bone and Joint Surgery.
What’s Important: Making a Difference May Include Being Different
Johnson, Lanny L. MD
JBJS: March 7, 2018 – Volume 100 – Issue 5 – p 443–444
The Orthopaedic Forum
I probably made a difference in orthopaedic surgery as one of the pioneers of arthroscopy and the inventor of the motorized shaver and other instruments. However, a recent review of the biographies of those chosen for the American Orthopaedic Association’s (AOA’s) Distinguished Contributions to Orthopaedics Award made it clear that my career path was very different from those who are acknowledged by organized medicine.
Many of the AOA luminaries came from families with medical genealogies. There were no doctors in my family. We only knew our family doctor, E.E. Woods, MD, who removed my tonsils in his office under ether anesthesia in 1938. He was way ahead of his time in doing outpatient surgery.
I had been an athlete in high school and had wanted to become a coach, but my high school coach thought that I should be a surgeon based on results from the Kuder Preference Test. I had rejected that idea, thinking I was not smart enough—my IQ was 112. Plus, my family had no money.
Most of those chosen by the AOA for the Distinguished Contributions to Orthopaedics Award had attended elite private colleges. I had attended a state school (called Michigan State College at the time) on an athletic scholarship. My high school coach had convinced me to try veterinary science, which I did for 1 year, and then I changed my major to premed. My application to the prestigious University of Michigan Medical School was rejected. I graduated from Wayne State University Medical School in Detroit—without honors.
Perhaps my only likeness with the AOA honorees was my residency at Barnes Hospital in St. Louis, which was then, and still is, a prestigious program. My mentors there were H. Relton McCarroll, MD, and Fred C. Reynolds, MD, who were both American Academy of Orthopaedic Surgeons (AAOS) presidents.
Those chosen for honors by the AOA typically came from large university academic groups. I had a desire for academic medicine and had been offered opportunities right out of residency to head a program at Syracuse and a new program in Shreveport, Louisiana. However, I accepted a family member’s advice that I was not a good fit for academic medicine and declined. By contrast, I started a solo private practice in East Lansing, Michigan, where there was no medical school at the time.
I was interested in sports medicine and went to all of the relevant continuing education courses, where I learned that the experts of the day were 100% correct in their clinical diagnoses, personally confirmed by them during surgery. I was not that good, and was looking for ways to improve. I heard a lecture by Bob Jackson, MD, in 1969 about arthroscopy with a large Watanabe scope. Then, at an AAOS technical exhibit, I saw a needle scope. I popularized the use of this scope in an outpatient setting using local anesthesia at a time when arthrograms were the diagnostic standard. Subsequently, I saw that hand debridement by arthroscopy was primitive, and I invented motorized instrumentation, including a shaver.
Most of those honored by the AOA belong to multiple prestigious orthopaedic organizations, most of which initially rejected my applications for membership. The rejections arose partly because the orthopaedic surgeons in my community said I was performing an unethical and immoral operation. Today, those purportedly inappropriate procedures are among the most common and successful orthopaedic procedures that are performed.
I was rejected from membership in the Michigan Orthopaedic Society for 11 years. Five years ago, I received that society’s inaugural Lifetime Achievement Award. I was a candidate for AOA membership on 4 occasions before finally being admitted at 60 years of age. Each application was sponsored by a different AAOS president. My practice received a site visit by the American Orthopaedic Society for Sports Medicine (AOSSM) president, Les Bodner, MD, and secretary, Royer Collins, MD. After their visit, they voluntarily submitted my application for membership, but I was blackballed. Three years later, I was asked to give a 2-hour program on arthroscopy at the AOSSM national meeting, and was then granted membership. From all of these initial rejections and subsequent recognitions, I learned that I must accept, weigh, be thankful for, and respond to legitimate criticism.
Unlike those typically honored by the AOA, I was never a traveling fellow, nor do I have a long list of academic appointments or awards. I had published in The Journal of Bone & Joint Surgery while I was a resident, but had only 1 publication thereafter. Noting that, the former JBJS Editor-in-Chief, Paul Curtiss, MD, invited me to submit. The submissions were all rejected. Dr. Curtiss was kind enough to tell me why: a prominent Harvard professor who reviewed for JBJS said I was a known liar.
I was never elected to a leadership position in organized medicine. To be fair, I was offered several opportunities to serve as president of large national orthopaedic associations, but the same family member mentioned above directed me to decline. I have never been named a “distinguished” anything. I have received no National Institutes of Health (NIH) or other prestigious grants; I have always funded my own research.
So, with all of these differences from the mainstream orthopaedic leadership, how can someone like me make a difference? I was influenced by the 1958 AAOS presidential address by H. Relton McCarroll, MD, entitled, “What Good Thing Could Come Out of Nazareth?” The message was that an orthopaedic surgeon can make a contribution no matter where he or she practices. I practiced in a remodeled student-rental house across from an 80-acre cornfield. In the early days, there were no traffic lights between my home and my office.
Without the usual academic credentials, I have made a difference by combining personal curiosity, devotion to duty, and a responsibility to improve as an orthopaedic surgeon. However, the key ingredient was providential influence. I never generated any ideas—I only received them. Then, I simply applied the time and energy that was necessary to verify with convincing proof the validity and usefulness of the idea that was given.
I also have been influenced by various wise sayings from the ancient literature:
Do not take into account a wrong suffered.
Do not think more highly of yourself than you ought.
Do not let your praise come out of your own mouth.
Be ambitious for a quiet and peaceful life.
Follow the Golden Rule.
At age 84, I still want to make a difference. I was recently granted U.S. patents on a phytochemical-coated implant to prevent biofilm infections, a disease-modifying osteoarthritis drug, a new broad-spectrum antibiotic, a wound-healing reagent, and a skin acne healer, with others in the pipeline. I hope readers can see that being different does not preclude a person from making a difference.
Disclosure: On the Disclosure of Potential Conflicts of Interest form, which is provided with the online version of the article, the author checked “yes” to indicate that the author had a patent and/or copyright, planned, pending, or issued, broadly relevant to this work (http://links.lww.com/JBJS/E637).