WAKEFIELD – With the recruitment of Dr. Ian A. Madom, another piece of the puzzle has been put into place at Ortho Rhode Island, a collaborative statewide orthopedics practice launched in 2015 that now has 17 locations and more than 55 care providers throughout Rhode Island and Southern New England.
Madom, who joined the team of surgeons at South County Health Orthopedics Center in October of 2016, specializes in conditions of the spine. He is expected to lead the development of a new spine center of excellence in South County, adding to the medical group's areas of expertise, which includes: hand, joint, pain management, shoulder, spine, sports medicine, joint reconstruction, primary care sports medicine and podiatry.
South County Health Orthopedics Center is one of three founding members of Ortho Rhode Island, including Blackstone Orthopedics & Sports Medicine, and Foundry Orthopedics and Sports Medicine.
Recruited by Dr. Michael Bradley, president and CEO of Ortho Rhode Island, Madom said he was thrilled to be back in Rhode Island, the place that he and his family consider "home."
Madom had done his residency training at Brown University and Rhode Island Hospital, completed a one-year orthopedic spine surgery fellowship in Utah, and then practiced in Syracuse, N.Y, for six years.
What was attractive about the new position, Madom told ConvergenceRI, was the challenge and opportunity to change the model of how spine care is delivered.
"Many spine care practice models are a little broken," Madom said. "Communications are often not optimal, with a focus on procedures rather than providing value."
“We can do better,” he continued, saying that through his work at South County Orthopedics, he wanted to explore and construct alternatives to way that things are done with spine care.
Coordinated care
The primary challenge, Madom said, is a utilization problem. "Patients are coming in, they are being given many different treatments from different providers, and no one seems to know what each other is doing," he explained.
"Back pain," he continued, "is the second biggest cause of disability. It's also the second biggest cause, second only to the common cold, why patients go to see their primary care physician or medical doctor."
Many times, the patient is sent to physical therapy for four weeks, Madom continued, with little thought to the patient’s needs, costing $40-$50 for each visit.
The patient wants something that will give them back functionality in their life, Madom said, but the evidence is not there for some of the treatments.
"There is no unified way or place where the patient can obtain care, get a consistent message of what works and what doesn’t work," Madom said.
The goal, he explained, is to provide patient-centered care from a single organization that can offer a spectrum of treatment options for them, and what the role is for each of the treatments.
"We need to be honest about how we can help patients, and about where we can’t help them," Madom said.
Reducing the number of back surgeries
Back pain, Madom continued, is a complicated problem. "It is multifaceted; there are certainly aspects we understand, many that we don't. The important part, when it comes to pain, is addressing the mental health aspects with chronic back conditions," he said.
One solution, he continued, is to reduce the amount of spine surgeries that may not help to begin with. "The literature is not good, it’s very inconsistent, regarding surgeries for back pain," Madom said.
The thing that surgical procedures manage really well, he continued, is leg pain, arm pain, and more axial conditions.
Shared decision-making
The best strategy, Madom believes, is to think about a comprehensive approach, with shared decision-making with patients.
"With pain," he explained, "people can get exhausted by it, and then get beaten down by it, and then start to lose the ability to manage the rest of their lives."
With shared decision-making, Madom’s approach is to engage with patients: this is what’s going on with you; this is one way to think about it; surgery is an option; I don’t know if it is the best way for you.
"It’s a really important conversation to have," Madom said. "It's one of the perspectives that I want to bring to the spine program that we’re trying to create. It's about patients, it's about people; it's about the data to back it up, depending on an individual’s circumstances."
Madom paused, and added: "It is a little daunting to set up a new program. At the same time, it's exciting. It's a great opportunity. I am passionate about it; I believe it is what the patients need."
Busy times
Since arriving four months ago from Syracuse, N.Y., Madom said that he has been busier than expected at work, both administratively and clinically.
In addition, Madom travels every other Friday to New Haven to attend classes at Yale University, where he is finishing up his MBA in the Executive Healthcare program. "It’s been a bit of a wild ride; it's been busier than I expected," he said.
