It is very common for a patient to bring a friend or family member along to their office visit with me. I think this is generally a good thing, as we cover a lot of information in a brief period of time. Studies have shown that patients recall only a small fraction of what was discussed with their doctor. Perhaps a second set of ears can improve this a bit.
Some of the more complicated discussions I have with patients concern the decision to proceed with surgery. It is important that patients have reasonable outcome expectations and understand the potential risks involved and the need to commit to thorough and careful rehabilitation.
As most of my surgery is elective, at some point the patient must chose to proceed surgically. For elective operations, there is never a "need" or requirement for surgery. It is a lifestyle choice. Each patient has their own risk/benefit analysis. I view my role is to educate regarding the procedure and possible risks, to present all non-operative options, and to make some predictions about potential outcomes based on the patients medical history, and particular problem.
When dealing with a chronic progressive problem like osteoarthritis of the knee, patients have usually tried a variety of non-operative treatment options prior to considering surgery. Even when non-operative treatment has failed to adequately control symptoms, patients don't always know if they should proceed surgically. While working through this discussion, I commonly find the 3rd party often suggesting the patient proceed surgically. I do not talk people into elective procedures. And I will often address the 3rd party's comment with a statement of my own: "it's very easy to sign someone else up for surgery."
The odds are dramatically in the patients favor when considering most orthopedic procedures. We can reliably achieve meaningful improvements in quality of life. The vast majority of patients, once rehabilitated, tell me they waited too long to proceed surgically. Nevertheless, the point that a patient decides to have surgery is a major turning point in their life.
If a patient does not appear convinced that surgery is appropriate, I suggest they not make the decision in the office with me in front of them. I recommend that they go home and think things over, to determine if their quality of life is acceptable as-is. A patient should never feel pressured into undergoing a elective operation. We can always do surgery, but we can never take it away. I think patients intuitively understand this, and often the third party does not.
Patients can easily decide to proceed with elective orthopedic surgery when the time is right. The threshold in a particular patient is unique, and is based on countless factors including pain, desired activity level, past experiences, support system, finances, work requirements, etc.
The psychology of recovery after orthopedic surgery is extremely important, and I feel under-appreciated. A future post will address the psychology of healing.
For now, I will suggest that an excellent surgical outcome begins with positive feelings about the decision to proceed with surgery. When a patient feels it is the right time in their life, that they have exhausted alternatives, that they have a surgeon they can trust, and that they have an optimal support team, the stage has been set for a positive result.
Orthopedic Surgeon focused on the entire patient, not just a single joint.
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