Should I have surgery??

So, here’s how the conversation goes:

Patient:  I have this and that problem.

Me:  Well, we’ve discussed normal anatomy, what is going on in your situation, and why you have your problem, and also the treatment options.  You can do A, B, C, and even D (often: surgery).

Patient:  Well, what do you suggest?  [Editorial opinion:  reasonable question.  I mean, you are the doctor!!]

Me:  I would be asking the same question if our roles were reversed, but whatever I suggest, you (the patient) would have to agree.

Here’s the deal:  In my experience, most patients have enough pain or other symptom to make an appointment and decide to see the doctor.  They are looking for help and relief.  However, my impression is that also in many instances, the moment when they make that decision to go to the doctor is the point where they stop thinking about it.  I think most patients, who didn’t happen to go to medical school themselves, assume the doctor will tell them what to do.

One teeny detail:  With any treatment, the only guarantee is that there is no guarantee.

If you come to see me, you’ll probably hear these points, as I feel like a broken record: *

–I can guarantee I will do the best I can, but I can’t guarantee a result.  Some people form more scar than others, some bony fusions (surgery to get bones to grow together) don’t fuse.  Sometimes the hardware might get loose before healing occurs, and some cases have problems for unforeseen reasons.

–If I did 100 cases and was super happy with my performance in every case, I know I wouldn’t have 100 happy people.  I very rarely will make someone worse, but there are the occasional cases where I think what the patient wants to say is “thanks for trying doc, but it didn’t really help.”

–The word “risk” is describing the possibility that you might have a less than great result, and all cases have risk.  No driver can guarantee they won’t get in a car crash.

So, bottom line: though if I were the patient I would be asking the doctor the same question (should I have surgery?), the decision of whether to proceed needs patient input.  There is always an option to think about it until you are comfortable with the decision.  Unless a patient is facing imminent danger by my not recommending surgery, I will share the options with the patient, try my best to help form a plan, but I don’t push folks into the operating room.   The main question, which the patient has to decide is:

“Can you stand it?”

Whatever you decide, we are here to help

 

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*for the young people, sounding like a “broken record” means repeating yourself, as these round things they used to have called records, might have a defect in the groove and might repeat the same part over and over again.  That’s your history lesson for the day.    😊