Purpose of the study: Our aim was to look at, how we are following the British Orthopaedic Association (BOA) guidelines regarding the clinic times. The decrease in doctor working hours and increase in sub-specialisation has added to the problem.

Methods: 55 Orthopaedic clinics were observed and time mapped to the nearest second by an independent observer. 5 clinics observed for each of 11 clinicians (5 Consultants and 6 Registrars). The patient factors viz age, sex, mobility, BMI, site of disease were recorded. The clinician factors viz. seniority, sub-specialisation were also recorded.

Results: Of total Clinic time, 45% spent for consulting follow-up cases, 26% for new cases and 29% lost in in-between patient transit time. Of the total clinic time, patient time was 75%, procedures 4%, investigations 3%, consent 4%, dictation 13%, teaching 1%. Mean time for consultation was 13 minutes 6 seconds for new and 8 minutes 43 seconds for follow up patients which was significantly less than that recommended by BOA guidelines (15 – 20 minutes for new and 10 –15 minutes for follow up patients).

Conclusion: Since the British Orthopaedic Association (BOA) guidelines in 1990, there has been a change in patient’s expectation, responsibility of the clinician towards well informed patients, detailed investigation, consenting in clinics etc. Despite the clinics over running in time the BOA guidelines are not being adhered to potentially compromising quality consultation and training at the cost of pressures to see the recommended 22 unit patients per clinic. There is a need to revise BOA guidelines regarding clinics to provide more time in clinics per patient to maintain quality of care and training.

Background: The British Orthopaedic Association (BOA) guidelines regarding consultation time were published in 1990. There has been a change in the expectation of the patient and the responsibilty of the clinician to provide more information to the patients and more detailed investigation and consent forms to fill with a greater emphasis on clinical governance and increasing awareness of the patients over the years. The decrease in doctor working hours and increase in sub specialisation can not be ignored.

Methods: 55 Orthopaedic clinics were observed and time mapped to the nearest second. 5 clinics observed for each of 11 clinicians (5 Consultants and 6 Registrars). From the time the clinician entered the consultation room to start the clinic till the time he left after finishing the clinic the entire span of time was mapped with a stop watch by an independent observer. The patient factors viz age, sex, mobility, BMI, site of disease were recorded. The clinician factors viz. seniority, sub-specialisation were also recorded.

Results: Of total Clinic time, 45% spent for consulting follow up cases, 26% for new cases and 29% lost in in-between patient transit time. Of the total clinic time, patient time (time spent by clinician with the patient) was 75%, 4% spent on procedures, 3% on investigations, 4% on consent, 13% on dictation, only 1% on teaching. The mean time for consultation was 13 minutes 6 seconds for New patients and 8 minutes 43 seconds for Follow up patients which was significantly less than that recommended by BOA guidelines (15 – 20 minutes for new and 10 –15 minutes for follow up pateints in Orthopaedic clinics).

Conclusion: Despite the clinics over running in time the BOA guidelines are not being adhered to potentially compromising quality consultation and training at the cost of pressures to see the recommended 22 unit patients per clinic. There is a need to revise guidelines to provide for more time in clinics per patient to maintain quality of care and training.

Clinical decision-making could be difficult when Magnetic resonance imaging (MRI) is used for the diagnosis of knee injuries. We retrospectively studied 565 knee arthroscopies done between 2002 and 2005, 110 of which had suspected ligamentous injuries, evaluated clinically, with MRI and subsequently by arthroscopy.

The aim of the study was to know the extent of correlation of clinical, MRI features with arthroscopy and whether MRI could be justifiably used to deny an arthroscopy. All patients with a strongly suggestive history were examined in the clinic by experienced orthopaedic surgeons and MRI was requested. Clinical examination was repeated under anaesthesia by the operating surgeon who not necessarily had examined the patient initially. The clinical and arthroscopy findings were recorded systematically. 3 Radiology consultants of varying musculoskeletal experience reported the MRI films. The clinical and MRI findings were compared with arthroscopy for the extent of correlation.

We observed that overall Sensitivity of MRI for meniscal injuries was 73%, being more for medial than lateral and 86% for cruciate ligament injuries. Clinical examination had a sensitivity of 33% and a specificity of 93% for meniscal injuries, sensitivity of 86% and specificity of 100% for cruciate injuries. MRI was not able to demonstrate synovial plicae in 13 knees and chondral defects in 3 knees. 96 Knees, which were normal clinically, were found to have meniscal tears on MRI in 65 and subsequently confirmed by arthroscopy in 39.

We conclude that an accurately performed clinical examination with positive signs alone, will be justified for arthroscopy and a negative MRI will not be a sufficient evidence to deny an arthroscopy. Also the reporting will largely depend on the quality of information provided by the clinician, technical factors and the musculoskeletal experience of the person reporting the films.