A brief (and somewhat personal) history of the orthopaedic clinic at the University of Iowa Hospitals and Clinics, 1978-2011.

It seems I have reached that age where others are asking for my memories of times past Here are a few thoughts from an “experienced” orthopaedic nurse - I know they will bring back memories for some of you, and some will be startled or amazed at how things used to be. In 1978, the orthopaedic department moved into the new Roy Carver Pavilion. The New York Yankees won the World Series versus the LA Dodgers. The Bee Gees “Stayin’ Alive” was everywhere on the airwaves. Grease was a hit movie and LaVerne and Shirley was a hit television show. James Michener's “Chesapeake” was on the best-seller list. Medicare was only 13 years old, patient representatives had been around for just six years and all of the orthopaedic nurses were young and beautiful. There were no warning labels on cigarette packages or alcoholic beverage containers. Fee-for-service payments for medical care prevailed. Doctors were the “captains of the team.” Advancements in medical technology and pharmacology were accelerating. The inpatient areas were always full. Hospital stays for back pain were not uncommon. Total joint replacements required a stay of approximately ten days. There were virtually no outpatient surgeries. Most residents were single and without children, and spent most of their waking (and many sleeping) hours in the hospital. There were no female residents. Scrub suits were not tolerated in clinic. There were no computers anywhere in the clinics. The cast room was not physically connected to the clinic. There were curtains in the examination rooms but no doors, and patients were expected to be compliant During the 1980s, changes came rapidly. Ash trays were moved to the lounges only, then into specific rooms and finally out the door. Video games, aerobics, minivans, camcorders, and talk shows became part of our lives. The decade began with double-digit inflation, President Reagan declared a war on drugs, Kermit didn't find it easy to be green, hospital costs rose, and the world lost many fine talents to a newly discovered disease, AIDS. Many patients were admitted to surgery directly from the orthopaedic clinic. They arrived as early as 6:00 AM to be prepared for the operating room. The most memorable patient for me was a man who came in for thumb surgery. He had never been to The University of Iowa Hospitals and Clinics before, but he had received a letter telling him the date and time of his appointment. There were apparently two men with the same name in his small Iowa town, and the letter was delivered to the wrong man. After everything was sorted out the gentleman said, “I wondered how they knew my thumb hurt." Outpatient surgery became more routine in the 1980s and hospital stays became shorter. The department accepted a female resident. Cable was born and MTV had an enormous impact on music and young people. America was reading Ken Follett, Robert Ludlum, Frederick Forsyth and Tom Clancy. Computers could be found in homes and could be seen in offices, but they were still not in the clinics. The internet was impacting businesses and health care. Patients were asking more questions and becoming better informed. Teams of health care providers were being formed, with physicians as one of the team members. In 1993, the orthopaedic clinic moved into their current location in the lower level of the John Pappajohn Pavilion. Almost immediately, we began to outgrow our new space. More people were seen as outpatients, more specialties within the department were defined. The general population was living longer and required care for their chronic conditions. Obesity was increasingly impacting the care for orthopaedic patients. The inpatient area remained in the Roy Carver Pavilion (RCP) but went from occupying all of 4RCP and 3RCP to only 3RCP Secretaries became administrative assistants. Clinic nurses began to be assigned to specific teams. Many residents were now married with children. The number of females in the residency program gradually increased. Medical dramas became popular on television. Hip-hop and alternative rock went mainstream. Major League Baseball players went on strike in 1994, prematurely ending the season. The World Series was canceled for the first time in 90 years. The Goosebumps book series was very popular among pre-teens and older children. Globalization, which had intensified during the post-Cold-War ‘90s, continued to influence the world in the decade following 2000. The internet was a prime contributor to globalization, and it began to also influence health care. Via the internet, more information could be shared among providers and much more information could be obtained by patients. The popularity of and knowledge about the Ponseti Method for treatment of clubfoot particularly benefited from internet-based information sharing. Subspecialties within orthopaedics became much more clearly defined and teams became more specialized. Clinic patients often had more severe orthopaedic problems. Attracting patients to The University of Iowa Department of Orthopaedics became a prime focus. The number of staff physicians and residents increased substantially. Medical technology and pharmacology exploded. Physician assistants, advanced nurse practitioners, medical assistants, social workers and other professionals became valuable additions to the healthcare team. The “War on Terrorism” and the War in Afghanistan began after September 11, 2001. The Human Genome Project was completed in 2003. Television saw an increase in reality shows. E-readers were on the rise. Harry Potter and Twilight were the books to read. Now it is 2011. It has been fun to look back. We have gone from a busy day consisting of 100 patients to expecting 200 or more patients on any given day. We have stopped packing all wounds with acetic acid and use Wound Vacs® (KCI) more often. Casting has changed -most casts are now fiberglass and are applied by nursing staff. We have a female staff doctor and more female residents. The changes within our department and in the practice of orthopaedics in general have been enormous. Our department has gone from having a patient come to clinic just because he got a letter, to actively recruiting patients. We have traveled an often arduous road with third-party payers. We have incorporated the use of technology into every phase of our work life. I miss some of what I know ‘used to be', mostly the family feeling in the orthopaedic department of the past Do I want to go back? Honestly, I must say, “No, I do not want to go back.” I am proud of my small part in the development of the Department of Orthopaedics and Rehabilitation at The University of Iowa Hospitals and Clinics. As a group, our department has always strived for perfection. We are constantly learning to improve our system of care. There is only one thing that is painfully clear, now. The residents are still under 30 and I … am not