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Cultivating trust with patients a must for orthopedist

Cultivating trust with patients a must for orthopedist

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Nearly every surgical procedure has changed since Steve Irwin began his practice with McLean County Orthopedics in 1983.

"There's not anything I do that was part of my residency program," Irwin notes. But while arthroscopic procedures and joint replacements have revolutionized his field, this longtime orthopedist says some things have not changed.

"The fine art of surgery is still there," Irwin says. "And the style of practice — that hasn't changed." Irwin's "style of practice" centers around first establishing a relationship with his patients.

How you question a patient is vital, according to Irwin.

"It's how you get to the depth of their story," he explains. "You aren't taught questioning technique in medical school," Irwin says, "but you acquire it in residency."

Trust is vital. "You're asking questions that could bring a lawsuit in other arenas," Irwin says. "Medicine is unique that way."

He tries never to "talk down" to a patient. "Why would I?" he asks. "They come to me because I've had the training, I can do things they need, but I can't do the things they can."

Irwin waxes emotional when he talks about his patients. "For over 20 years, I've been treating the greatest generation," he says. "And they really are just that. They are amazing. I love working with them." Now Irwin is starting to see a new generation of patients.

"The baby boomers are a different breed," he says. "They have higher expectations; they are not willing to take a compromise," he says. "They have a different way of looking at medicine — more like consumers."

And while Irwin welcomes patients who come armed with information, he sometimes discovers that their Internet findings are incomplete or just plain wrong.

The problem list for patients has stayed the same for both generations of patients, Irwin reports. "But how they are treated is vastly different," he said.

"Minimally invasive" are the buzzwords leading the surgical industry these days. "There's a lot of merit to it," Irwin says. "Patients recover better, there is a more assured result."

When he began doing orthopedic surgery, Irwin routinely opened knees and shoulders. Now, most of those surgeries are done arthroscopically. "It may surprise some to know that the visibility is better this way," he says. "I can see much more of a joint."

"It's orthopedics that has pushed the technology of minimally invasive surgery," Irwin says. "It took general surgery 20 years to catch up."

Irwin has done replacement surgery on every joint except ankles (he thinks fusion is a better solution). And while he replaces elbows, shoulders, wrists and fingers, it's most often knees and hips. He splits his time about 50-50 between the two. More than 90 percent of the time, the damage is arthritis-related. "Even though it's elective surgery," Irwin says, "joint replacement can come on very quickly. I tell my patients, it's a quality of life decision."

Some people will choose to ratchet down their life rather than go through a joint replacement. Others choose surgery — but they have to win Irwin's approval first.

"The rehab is absolutely critical," he says. "I've turned patients down when I felt they wouldn't do the rehab.

"My greatest ability is to pick out patients who will participate, who have a goal and will work hard," Irwin says. "After all," he adds, "I do the same surgery on everyone."

Surgically implanted joints last longer than they used to. "They'll last at least 10 years and some of my patients are 20 years into a replacement and doing fine," Irwin says. The methods of implantation haven't changed markedly, but the joint materials have.

And that brings up the whole issue of marketing. There's a lot of it in medicine today, and not just pharmaceutical ads on TV.

Irwin questions its value. There's a marketing push for mobile-bearing versus fixed-bearing knee joints, he says. Based on marketing information, Irwin has had patients ask for mobile-bearing knees. He turns them down or refers them to a surgeon in Chicago if they insist.

"The Journal of Bone and Joint Surgery, the gold standard publication in our field, ran an evidence-based article which says both types of knees yield the same results but the mobile-bearing knees have more complications," Irwin says. "It's hard if you want to have a practice based on evidence, you have to fight to keep that and watch out for marketing."

Part of the reason Irwin so values the principle of "evidence-based" is his training as an engineer. After receiving a master's degree in chemical engineering from Cornell University, he spent six years working for Chevron, some of it designing oil refineries. The son and grandson of physicians, Irwin was 28 when he enrolled in medical school.

The decision involved uprooting his family, including two small children, from San Francisco to Chicago. "I was the oldest person in my class," Irwin recalls.

Irwin was 37, he says, when he "came home" to Bloomington.

"I practice in a great part of the world," he adds with a smile. Irwin is a generalist in a field that is becoming ever more specialized. "In 20 years," he says, "if you have a shoulder problem, you'll go see a shoulder guy."

Two years ago, Irwin stopped taking call duty. With no more late-night runs to the emergency room, Irwin now works 40 to 45 hours per week, instead of his habitual 85 to 90. Irwin plans to work five more years.

In retirement, he and his wife, Kathy, will pursue their shared hobbies of scuba diving, boating (their current boat is called Bone Breaker), biking and bird watching. Irwin spends one morning a week operating at BroMenn Regional Medical Center and two performing outpatient surgery at McLean County Orthopedics.

In between, he sees patients, always taking the time to first establish a relationship.

Irwin says he recommends the field of medicine.

"Every profession has its problems but there's not a field with greater autonomy, self-direction or self-satisfaction," he says. "You're helping people. It really brightens my day when patients tell me about a good result. There's a tremendous inner satisfaction in that."

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