It’s a pain in the neck! Who can help me?

Orthopaedic surgery is a long established surgical specialty. Practitioners complete training which focuses on those musculo-skeletal conditions for which surgery is the preferred treatment option. Diagnosis and assessment are performed to exclude those for whom surgical intervention is not indicated. Finestone and others argue in their recent IJHPR paper that we need a subspecialty to cater for these patients – medical orthopaedics. They explain that almost all of the very many patients who seek help for musculo-skeletal conditions do not need surgery, and that orthopaedic surgeons are ill equipped to deal with their complaints and have little to offer. Their paper sets out the case for a new discipline of medical orthopaedics to complement the discipline of orthopaedic surgery. This commentary examines the case for a new approach to musculo skelketal conditions. It discusses the steps which might be needed to decide whether any new discipline should be established, and goes on to set the terms for a debate on the merits of a multidisciplinary approach compared to a purely medical one. Leadership in clinical disciplines has historically rested with medically qualified health professionals. Nowadays this has given way to an understanding that health problems, especially long term conditions, commonly benefit from different expertises coming together. For musculoskeletal conditions, might this be an example where the best outcome would be to look beyond a medically led model? This is a commentary on http://www.ijhpr.org/content/2/1/42/.