Dennis W. Jeanes
For the Canadian Orthopaedic Foundation

Before you read any further, if you haven’t already, pull out your 2002 agenda, find the page with May 26 (the last Sunday in May) and ink in between 11:00 am and 12 noon, “HHH - MUST ATTEND!!!” Now make a note to have your office manager mark the same thing in his/her office calendar.  

And if fate should decree that you’re not on call that day and can actually participate in your local Hip Hip Hooray event, then you’ve made Dr. Clive P. Duncan a very happy man. There! Now read on.

In 10 years, Dr. Clive P. Duncan hasn’t missed a Hip Hip Hooray walk and considers the event as “one of the most enjoyable days of my year. It’s a family affair - mine, theirs. Patients turn up with their spouses, children, grandchildren, neighbours. It’s an extraordinary family event - almost like a big wedding.”

Although he emphasizes that surgeons lead very busy lives and he has particular empathy for surgeons in small communities “who are very commonly on call or exhausted from last night’s call,” Duncan wonders why less than 100 surgeons attend such an important and pleasurable event: “It’s puzzling. To see how patients respond to meeting their surgeons is incredibly moving. I only wish the remaining 800 or so surgeons could have the same experience.”

By the same token, a patient’s disappointment can be quite an uncomfortable experience: “While I’m out there shaking hands with walkers and volunteers, what I hear most often is, ‘Where’s my surgeon?’” This year, Duncan took aside one of his absent colleagues - a man whom he describes as a “10-out-of-10 human being and surgeon” - to tell him that one of his patients had travelled more than 400 miles to see him at the Hip Hip Hooray event. “I’d bet my bottom dollar he’ll be there next year,” he says. “I could tell from the expression on his face.”

The psycho-dynamics of Hip Hip Hooray aren’t exactly complex. It’s hero worship, plain and simple. Surgeons may have many patients to tend to, but their patients have only one surgeon. It’s human nature to want to hang out with the person in whom you’ve placed your complete faith, who freed you from disability and changed your life. Sure, they want to say thanks and participate in the walk to give something in return, but what patients really want is to reassure themselves that their surgeon is a real human being - that their care was personal, that the emotional bond is real and continues.

So why then do only 10 per cent of orthopaedic surgeons turn out across the country for Hip Hip Hooray? Aside from being on call, Dr. Clive P. Duncan thinks there are a number of influencing factors, and none has to do with golf. “My colleagues are already very extended. The demands of the profession are very intense, and the need to have family time, very real.”

And then there’s the belief that Hip Hip Hooray promotes exclusively joint arthroplasty and that the fundraising benefits go primarily to hip and knee research. An effective counter to this misperception is to recruit the doubters and open up participation in disbursing the funds.

In Vancouver, the logistics of Hip Hip Hooray are handled by a self-directed lay committee, which works with “a ‘shadow surgeon-chair’ who’s in the background,” says Duncan, “pumping up the event with colleagues, remaining available as a resource, giving brief speeches from the podium - all that stuff.” The chairmanship rotates every year through the different subspecialties, so that this year a trauma surgeon is the shadow chair; next will be a paediatric orthopaedic specialist, and after that term, a spine surgeon. To make sure everyone’s interests are best served, the disbursement committee consists of the lay-committee chair, shadow surgeon-chair, nurses, PTs and others. The application for funds is formal and competitive, but it is inclusive.

Other communities are using similar organizational models, notes Doug Thomson, CEO of the Canadian Orthopaedic Foundation: “In London, for instance, the disbursement committee has a strong commitment to continuing support of health care professionals, so nurses, residents and therapists receive significant funding. It’s in keeping with our philosophy that all the major partners in a Hip Hip Hooray event should have a say over how the money raised is disbursed.”

But, says Thomson, fundraising and its rewards shouldn’t be the only motivator for surgeons to participate in Hip Hip Hooray, which he considers also “the profession’s number-one public relations event with its number-one, most powerful supporters: the patients.” Fundraising and advocacy are two sides of the same coin. Any advocacy campaign with ministries of health for improvement to orthopaedic care, he feels, will depend greatly for success on a unified front between surgeons and the patient community: “No public relations agency, no matter how good its account managers, can substitute for genuine social contact, and the perfect opportunity is Hip Hip Hooray. It’s a crucial step if our advocacy efforts are to have credibility.”

Dr. Clive P. Duncan thinks surgeons can contribute to Hip Hip Hooray in at least three ways: “The first is during the build-up in the months before the event, when you’re shaking hands saying ‘Come back to see me in a year, and by the way, we’ll see you and all your friends at Hip Hip Hooray in two months, right?’ That’s where we need the initial surgeon contact.”

But like any advocacy campaign, grassroots organization makes the difference between a modest and a runaway success. Accordingly, the second way surgeons can contribute to the effort is by bringing their office managers enthusiastically on side. Although much of the logistical effort of making direct-mail contact with patients is now centralized and automated, the office manager is the crucial point of contact when local volunteers need phone numbers and other help to make reminder calls in May.

The third way to help is the easiest: show up in person at the appointed time and date, and be your charming self. “There’s a one-hour nucleus to the programme, during which we need the surgeons to participate,” says Duncan. In Vancouver, “we’ll either get them up on the podium to sing a song or say a few words or flip pancakes - whatever. That’s what the patients have come to see; they’ve come to see their surgeon.

“Orthopaedic surgeons in Canada are incredibly dedicated to their communities. Hip Hip Hooray makes this commitment even more visible. Take, for example, the leading hand-surgeon in our town, who has seldom missed a walk. He cycles to the event, says hello, and although he likes to stay in the background, his presence is really noticed.”

The real value then of Hip Hip Hooray may not be so much the money raised but rather the intangeable benefits - the shared jokes, the good will and the warm handshake. People, especially patients, will remember when needed later for a higher purpose, such as advocacy.

Orthopaedic “solutions,” not orthopaedic “problems,” that’s how patients and volunteers see themselves, according to Doug Thomson. Contrary to expectations, the most devoted supporters of orthopaedic care are the patients who have undergone revision surgery. “The patients with two canes and multiple revisions are often the most committed and vocal,” he says, “because they know how far they’ve come. The same applies to those recovering from severe skeletal injuries or enjoying the outcome of complex spine reconstruction.

“To my knowledge, there’s no event like Hip Hip Hooray. Given that so many surgeons haven’t experienced this event before, perhaps when they attend, they’ll find it kind of infectious. Surgeons are truly among friends at Hip Hip Hooray. All it might take to become a lifetime convert is to participate just once.”

And lest you have any doubt about his thoughts on the matter, Dr. Clive P. Duncan has this plainspoken message: “Just give us one hour a year for Hip Hip Hooray. Try it. You’ll like it, and you’ll be back.”