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Dr. Tomaino's Blog

The Wizard of Oz--NO

May 23rd, 2009
I have a beloved patient from Pittsburgh who recently visited me to have thumb basal joint surgery. After fixing her wrist around 10 years ago while I was on the faculty at the University of Pittsburgh, she affectionately referred to me as the "Magician"---and still does.

Ofcourse, coming all the way up to Rochester for treatment was about trust, comfort level and confidence--not some kind of special "magic" that I am capable of!!

Magician, No.

Authentic, honest, and accountable, Orthopaedic surgeon, Yes.
At least I try every minute of every day.

Although seeing a happy patient after making the right diagnosis, gaining their trust, and performing an excellent surgery is "magical"--- the real litmus test of a successful result is their satisfaction.

Dr. Shaw Wilgus, from Baltimore, has referred to certain procedures/surgical strategies as "Surgical Gymnastics"-----meaning that there may be too complex an element to the plan, which might diminish the liklihood of success. Indeed, a well thought out treatment strategy should be well conceived based on "best practice" and the "evidence base".

And, it should be a plan that you (the patient)understand, and have had a chance to investigate and question, if you like-----even challenge! Afterall, you are the "customer". This type of dialogue may be tough to complete in the office, at times, however, which is exactly why I give every patient my email, via my website.

This brings me to this blog's title. I saw a patient this week for a 2nd opinion who had seen his Shoulder surgeon once in the office after multiple dislocations. He was told that he might need a complex bone-grafting procedure of the glenoid, but that he, (the doctor), was not entirely certain. His plan was to present the case at an upcoming conference to solicit feedback. There was no return phone call or feedback, however. Rather, his secretary called to schedule a date for surgery. And, by the way, the doctor was on vacation not at a conference.

On that day, the patient did not see the surgeon before or after the surgery. Postoperatively he has seen the Physician's Assistant mostly.

In light of this scenario, whether completey accurate or perceived, it's no surprise that he is not entirely happy. What I found after my evaluation was that the surgery had been performed well, and was well-conceived. But, the absence of pre- and postoperative dialogue left tremendous doubt in the patient's mind as to how he is doing----indeed, he is having a slow recovery.

He, the patient, referred to his Surgeon as the "Wizard of Oz".

This really resonated with me, particularly if you remember the scene from the movie when the man behind the drapery is revealed. A fraud----no! But certainly not what he appeared to be.

My message this week is "Caveat Emptor". The days of having "blind" respect for your physician should be over, particularly if you have one who overly leverages their "support"--whether it is PA's, residents in training, or other staff. Make certain you have dialogue.

Surgical Gymnast--NO. Wizard of Oz--NO.

Magician--although I like the complement, Linda--NO!




I understand when you were at UR orthopaedic dept you routinely saw over 120 patiens in a day. How is it possible to be so thorough with pre & post operative dialogue when seeing that volume of patients?

May 28th, 2009 @ 1:37 pm

While at my former practice I had the opportunity to be supported by a PA, 2 residents, and a fellow. While this support enabled me to see many patients, it was primarily to meet demand---as I never wanted a patient to wait more than 2 weeks. Most importantly, however, I made myself available in many cases by email and phone to allow further dialogue after office hours. This is still my practice, and your reply is evidence of how transparent access to me is 24/7. Thanks for your comment.

Dr Tomaino


May 29th, 2009 @ 11:30 am

Dr. Tomaino,

The last respondent appears to be someone that is associated with your former practice who is apparently threatened by your distinguished and differentiated level of personalized care and access that so many of your patients have commented on in this very site. Keep doing what you are doing so that other patients like myself throughout the Greater Rochester area have a choice to receive unsurpassed care from someone who cares without having to wait or be served by a medical student -- "Wizard of Oz -- not for me, and not for any patient who can see you for their care".

May 29th, 2009 @ 7:03 pm
Diane O.

What a joy it is to connect with a doctor/surgeon who so very obviously cares about people, that surpases the office visit. Thank you Dr. Tomaino, that in a city and/or world that too often is insincere, another example indeed does exist. area

June 27th, 2009 @ 9:54 am
Concerned Patient

Dr. Tomaino often gives patients an injection and books them for surgery on their first visit. You'll hear him say "a bird in the hand is worth two in the bush". So he'll get them signed up for surgery early even before they've had a chance to see how the injection works. Because he is so skilled at manipulating the workers compensation system that pays much higher than regular insurance, especially for surgery and injections, he has made this one of his practice focuses.

Be careful of any doctor who has to promote himself. Self aggrandizing attitude is well displayed on this website. It is an obvious show of shameless self-promotion when these stories of "wizardry" (though the title is shunned) are proclaimed.

Thereare lots of doctors out there who can do what Dr. Tomaino can do. People who are good at what they do don't have to tell you they are. Notice how Tomaino puts down residents, med students and fellows when it's convenient but admits that he couldn't see 120 patients/day without them when at the university. Be careful of those who tell convenient truths that change over time.

July 1st, 2009 @ 1:45 pm
Dr Tomaino

One of the risks of having a Blog is that it provides open access to everyone, even those who would like to distort reality and the truth. Marketing so that patients are aware of options----choice----is not meant to be shameless self-promotion, but I suppose it may be perceived that way by some.

I suspect that the reply above was not written by a concerned patient since the 1st paragraph of their reply is nonsense. When a patient's claim is covered by Compensation, preapproval is required. We may indeed begin the process of preapproval if an injection is not a guaranteed fix---to avoid unnecessary delay for a patient. Any decision to proceed with surgery is the patient's after careful consideration of options, and thorough dialogue with me.

Further, I do not, and have not put down medical students, residents and fellows. I was one and have trained innumerable. This intimation further suggests that "Concerned patient" may not be who he/she says they are. The fact remains that at this practice patients will not be seeing a resident or fellow.

Tell us what's really on your mind.



July 5th, 2009 @ 10:39 pm

I must say I am a bit saddened by the previous posts, but I cannot say I am surprised. The world today is full of people always wanting what their neighbor has (or more), but they don’t want to work for it. If they don’t get it handed to them they will seek to take down whatever or whomever they see as “having more” so that they can be on top. It is much easier that way.

If you look into Dr. Tomaino’s works and accomplishments, you won’t have to go far to see that his isn’t a practice for personal need, but rather for the need of the MANY patients out here like me. If you truly visited the office you would see this.

As for the “stick ‘em and cut ‘em” description, this could not be further from the truth. I had been to 4 Doctors and 2 therapists without getting a diagnosis. One junior physician had actually come up with the dx, but was put aside by someone more senior. By the time had arrived at Tomaino Orthopaedic Care, (one week after calling for an initial appt.!) I WAS hoping he would come out shooting with a proper dx and schedule the surgery that day. That DID NOT happen. He looked at what I had been through over the previous six months and still started at the beginning by eliminating the obvious. I left that day with another six weeks of noninvasive treatments. It was another six weeks before surgery was scheduled.

Over that past three months I have been in constant contact with either Dr. Tomaino personally or one of his staff in the office. I always get the answers I need. The office visit itself is brief and to the point, but my questions are answered. If they aren’t he is only an email away. Often replying within 10min.; at times from outside of the country!

His philosophy treats not just the physical problem, but the emotional side as well. I hope that the previous posts will not deter potential patients from contacting Tomaino Orthopaedic Care. You will not find a more compassionate or spiritual doctor anywhere. The staff is amazing as well!

July 7th, 2009 @ 9:00 pm
Kimberly G.

I read the one blog statement by a so called concerned patient. I am very sorry that there has to be such people of this nature out there. I feel it's a blessing having a surgeon that is available and to be good at what he does. Obviously this person hasn't had much experience with doctors, waiting to see a surgeon nor not being able to talk with one with questions or answers. Most often you talk to secretarys, PA's and have to wait to even see a surgeon for many months. Any questions, you have to wait for until you see the surgeon.
It's very rare to have a surgeon email or even pick up the phone to answer a valid question.
I feel Dr. Tomaino is a exception to this, is one of a kind and to be appreciated, not put down for doing good.
I have found Dr. Tomaino to be very honest, upfront, direct, to the point. AND I don't feel he would ever push a surgery through, nor talk bad about other associates or doctors. We need more surgeons and doctors like him.
I am thankful for his expertise, honesty, concern, being available and follow through.
I was raised that if you can't say something good , then don't say anything at all. Maybe the so called concerned patient ought to think twice before broadcasting negative feelings.

August 23rd, 2009 @ 2:45 am

I stand by what I call you ~ a magician! When you have been able to provide pain relief that surpassed my expectations through surgery that other "specialists"doubted would even work, you have proven your incredible, unsurpassed skill and expertise to me beyond a shadow of a doubt! And you've done this twice ~ first with a wrist and most recently with an extremely painful thumb joint. Add your unlimited accessibility when problems/questions arise, your dedication to provide the best surgical experience available (from pre- through post-op), your compassion, care, confidence and encouragement that are so reassuring, & I cannot think of a more fitting term than "magician"!! You are truly a one-of-a-kind doctor whose patients' loyalty speaks for itself! Please continue being the unique blend of doctor, encourager, and friend to those who are so in need of your talents, skill, and expertise!
I remain forever grateful to the MAGICIAN I know as Dr. Tomaino!! You are an amazing blessing in the field of health care! May God continue to bless you and your practice as you strive to provide the absolute best care humanly possible, and succeed exceedinly well at that on a daily basis. Thank you, Sir, for the pain free years you've given me and so many others!!!

September 28th, 2009 @ 1:53 am

I have had a shoulder and elbow operation with Dr. T. I had already been to more than one orthopedic surgeon and had more than one operation. When I first came to Dr. T, he diagnosed the problem with both my shoulder and elbow. He offered non-surgery options first. when I finally had my two surgeries about 6 months apart, it was by MY choice. I had been in pain for over 20 years. Now, my elbow is pain free and my shoulder is pretty much the same. Now, i have been seeing Dr. T for my thumb (basal joint). He has left it up to me to decide when it is time for an operation. As i am stubborn and have a high tolerance for pain, it will be awhile. But it gives me comfort to know that Dr. T will be ready when I am. I travel 2 hours one way to reach Dr. T's office. There are probably a few that are closer here in NY or just over the border in PA, but Dr. T has my total trust.

December 28th, 2010 @ 1:04 pm
Dr Tomaino

I hope you have a blessed 2011----I am very privileged to beable to help you in any way!

December 29th, 2010 @ 12:30 pm

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