An e-mail list is a simple Internet device to aid communication between people with a common interest. One subscribes to the list by sending in ones e-mail address, usually to a robot which adds the address to a list of members and sends back a confirmatory message. The system will check that the subscriber is a member of the COA (Figure 1).

From then on, any message addressed to the list may be sent to all list members. If a subscriber replies to the list, the message is also automatically sent to all members. If a members e-mail address changes, the list can be informed and the change made there. Using a list to keep in contact with a large number of people with ever changing addresses is made much easier. Once a topic is started by a question or assertion posted by the originator, a thread may develop with several respondents adding comments, answering questions or adding new ones. We expect to see topics in the areas of clinical case presentations, notice (and reviews) of events and updates on what is happening in orthopaedics across Canada.

In addition to sending out the messages, the robot posts a copy of the message in an archive. Depending on the way we set it up, this archive may be accessible to the public, to all COA members or only to list members. Because orthopaedics is a very visual subject, we expect list discussions to have attached images and these images should be archived also.

We all know that advocacy for our patients needs is critical if orthopaedics is to advance. But it is very difficult to know what type of arguments are listened to, what type of advocacy is successful. For example, someone pointed out that the waiting list for joint replacements in Newfoundland was so long and the resources so limited that patients at the end of the queue would likely never get treated. This analysis grabbed public attention. The Editor of the COA Bulletin is trying to get the message out by having a section on news from the front, but the e-mail list has a role too.

Successes and failures in this area can be disseminated almost immediately by posting a short report to the list. Furthermore, those interested can ask for details and follow-up reports from the person who posted the item. If we all combine to work out the most potent and telling tactics, and then apply them simultaneously across the country, there is a great danger we might be successful! The value of using an e-mail list for this type of discussion is the speed with which the word gets out.

Many orthopaedic surgeons have already subscribed to orthopaedic mailing lists. The Orthopaedic Trauma Association hosts one and the orthopod mailing list has a large international membership. On occasion, the discussion on these lists degenerates into political or personal attacks and on other occasions, non-orthopaedic subjects become prominent. With these experiences in mind, we propose that a moderator reviews all the postings before they are sent round the list (Figure 2).

The role of the moderator will be twofold; 1) to make sure that messages are on the subject, succinct and professional, and 2) to ensure that questions posed by members of the list do get answered. Canadian orthopaedics is a small enough world that the moderator should be able to identify and appeal to the appropriate expert.

If the messages on the list are bilingual, we believe that it will, in a small way, act to reduce isolation and enable Anglophone orthopaedists to share the expertise of their Francophone colleagues and vice-versa. Ideally, the message originator would provide a translation but very few of us (Anglophones) are bilingual to that degree. If the traffic is light we may be able to get translation through the COA Secretariat or we may be able to recruit a bilingual moderator with tact and tenacity who knows where all the bodies are buried and has time on his hands. If no such paragon volunteers, we should just set it going, do the best we can, and see what happens!