Table 5 Surgeon subthemes and sample quotes*

   "...there's often times not enough communication between the orthopaedic surgeon and the therapist, the internist, the physical medicine doc, so that poses a particular difficulty" [36 M, SURG]

   "A good part of healing is communication between provider and the recipient." [56 M, SURG]

   "I think that as I'm learning as I'm going through, the expectations of a patient and the expectations of the physician are often different. They may not be well communicated at all times." [33 M, SURG]

   "...depending on how much time you have to spend with people and so on. You may miss the boat in terms of what they're expecting." [>55 M, SURG]

   "...what I do in my practice is tell patients that when I put a total joint in you, follow up is extremely important. It is the duty of the surgeon to maintain contact with his patients." [64 M, SURG]

   "...by three months, I can usually determine how people are going to do and either reassure them and send them off or follow up on an as needed basis only... I think it's probably a waste of time to bring people who were doing well at discharge back for a long term follow-up." [56 M, SURG]

   "So you play this game with the insurance company and you get caught in the middle of the game as a patient...One of the biggest changes we've seen is with rehab. You know, only a certain patient population can now go to rehab and it's not the population you'd think." [33 M, SURG]

   "The other thing that's non-existent for the most part is home physical therapy for the debilitated patient or the patient who is unable to get transportation somewhere or has social issues that would preclude them from being able to get to therapy. Those patients fall through the cracks, and for them it's a huge issue." [36 M, SURG]

   "...approaches from physiotherapists vary greatly so that I don't refer anybody to a therapist for any purpose without knowing what their approach is." [56 M, SURG]

   "Well, the main indication for joint replacements is disabling pain and stiffness, and so the most important outcome is pain relief." [56 M, SURG]

   "I recognize that it's a professional conflict to a certain extent but the ultimate responsibility for the outcome falls to the hands of the surgeon and if the therapist from the patients' perspective makes them worse or doesn't do a good job, it doesn't really matter because they still blame the surgeon in a sense for their poor outcome." [55 M, SURG]