The work of a medical equipment trading company (dealer): Orthopedics edition

In a previous article, I explained the work of medical equipment trading companies (dealers), focusing on their job responsibilities.
This time, I'd like to write about the work involved in the orthopedic field, which is a distinctive area within our delivery operations.
This content is intended for those considering a career in the industry, as well as for new employees at dealerships.

Business in orthopedics

In orthopedic surgery, the main source of revenue comes from renting out surgical implants.
This includes sports orthopedics, which deals with ligaments and cartilage; trauma treatment, which involves plates and screws applied to fractured areas; artificial joint systems to alleviate joint pain; and spinal treatment, which aims to improve conditions such as lower back pain.
Roughly speaking, the cost per case is as follows:


Sports orthopedics < Trauma << Joints < Spine


As you can see, spinal implants are quite expensive, followed by joint implants.
Because the spine is operated on near nerves connected to the brain, the reimbursement rate for this procedure is commensurate with its high risk.
Therefore, if we consider only the hospital's revenue, doctors specializing in spine and joint disorders are making a lot of money.
Therefore, I feel that they often have a strong voice within the hospital.

However, dealers cannot afford to be picky about the jobs they take on.
Due to the unique nature of the delivery method, hospitals often use only one dealer for their orthopedic departments.

Therefore, when a doctor requests our services, regardless of whether it's profitable or not, the basic principle is to prepare everything flawlessly.
It's basically impossible to accept only profitable surgeries and refuse unprofitable ones.

Request from a doctor

Basically, the doctor should be the first to contact you with a request.
For example, "I'm having surgery to create an artificial hip joint on April 1st, so I'd like you to arrange for all the necessary equipment."
For anyone working in orthopedics, the importance of sterilization is something they learn the hard way.

Normally, all instruments used in the sterile field during surgery must be sterilized.
Generally, high-pressure steam sterilization (autoclave) is the most common method, but for urgent cases or for heat-sensitive instruments, low-temperature plasma sterilization is used.
Almost all rental instruments used when implants are placed in orthopedic surgery are sterilized using an autoclave.
Therefore, even if the equipment is handed over to the hospital, it cannot be used immediately.

In any case, you must make arrangements taking into account the time required for sterilization.

If it's a scheduled surgery, it should be fine as long as the doctor requests it at least two days in advance.

If you arrange it two days in advance, the items will arrive the day before the surgery, giving you plenty of time to take them to the hospital.
However, caution is advised if the request itself is made the day before the surgery.
If the surgery starts in the morning, there won't be enough time to sterilize the equipment even if it's brought in on the same day.
Autoclave processing takes about three hours, so even if you bring it in at 9 AM, it won't be ready to use until around noon.

This means that if a request is received the day before surgery, and the surgery is scheduled for the morning of the same day, the instruments must be delivered on the same day the request is received.
Depending on the hospital, there may also be a set time for the final sterilization of the day.
In this situation, it becomes necessary to rush to pick up the items or to have them delivered on the same day via chartered transport.

Also, some implants are designed to be placed on either the left or right side.
It's a good idea to ask which hand or foot you mean, specifically left or right, to avoid panicking later.
In any case, preparation for orthopedic surgery begins with a request from the doctor.
If it's a scheduled surgery, I think it's essential to strongly request that they contact you at least two days in advance.

Regarding the delivery of goods

There are various methods for receiving and delivering delivered goods.
In a typical hospital, you would check with the hospital staff how many pieces of equipment are inside, and take pictures if necessary.

If there are many small items, they may get lost or multiplied after use (due to hospital belongings getting mixed in), which can lead to problems.
It's a good idea to leave some kind of record that you can check later.
Additionally, some items, such as implants and instruments, are pre-packaged in sterile packaging.
While sterilization isn't necessary in this form, it often results in a large volume, making it difficult to transport.
Some hospitals require you to bring the documents a few days in advance, while others only accept them the day before.
In large hospitals, due to the high volume of surgeries and lack of storage space, it seems that they often only accept documents the day before.

On the day of surgery

Now, if all the handovers have been completed by the day before, there's actually nothing in particular you need to do.
What scares me is when the hospital contacts me during surgery.
At this point, if you are missing something, it is usually too late to make up for it.

Therefore, it can be said that this will be a day of judgment, a test of whether or not you were adequately prepared.

Instrument retrieval and usage check

The day after the surgery, the instruments and implants that were inserted will be retrieved.
After the surgery is finished, the hospital will return the instruments to you after they have been cleaned and sterilized.

At this point, it is extremely important to check that no items have been lost.
The instruments used vary depending on the type of surgery, but they can be numerous, complex, and intricate.
In addition to checking the score, you need to carefully verify whether the return is truly the same as what you put in when you invested your time and effort.

If you return the item without realizing it's missing, the manufacturer might later claim that some items are missing and demand payment for the lost items, which can lead to a lot of trouble.
Hospitals, in particular, almost never take responsibility once the dealer has taken the car away.
Their argument is understandable, since the dealer might have lost it after it was picked up...
You need to take the time to check everything carefully, even if it seems like a hassle.
Furthermore, checking the use of implants is also important.
Products that come in pre-sterilized packaging make it easy to determine whether they have been used or not.
However, with implants, which come in many similar types, it can be difficult to tell what materials are used and what are not if they are not individually packaged.
Therefore, it is important to carefully check the equipment when retrieving it.
As you gain experience, you'll learn what to use and in what quantities for each surgery, but it's difficult when you're not used to it.
For this, there's really no other way than to diligently study each surgery, one by one, and learn what kind of procedures are performed and what kind of equipment is used.

summary

The work that dealers do in the field of orthopedics mainly involves arranging and supplying implants used in surgery.
In such cases, it is important to check the left and right sides of the surgical site, ensure that no sterile materials are forgotten during the handover, and verify the amount to be used.
It's difficult until you get used to it, but once you do, you'll realize that it's actually mostly patterned, so it will become easier.