The Surgeon Interview

SURGICAL TECHNOLOGY

The Surgeon interview

by Larry Parker, MD

Sitting down with a surgeon can create some anxiety. Obviously if you are needing to consider an operation you have a significant problem, and you are looking for some help. In an emergency setting, the problem or injury is paramount, and the gravity of the situation is the primary driving factor to proceed to the operating room.

Your surgeon will discuss the risks of surgery but generally the risks of not having the operation far outweigh the risks of delaying or avoiding the operation. Even in the emergency setting your surgeon is going to assess you as a patient to predict the potential outcome of your procedure. A surgeon will look at some obvious data like age, gender, and associated health issues. But there are some other not so obvious factors that are important to your surgeon. Let’s discuss.

Most orthopedic and specifically spine conditions are chronic and involve pain and functional limitations as the primary issues. In most cases, conservative non-surgical options can be utilized successfully for a while but at some point the decision to consider a surgical approach is contemplated.

From a patient’s standpoint, is it a good idea to understand the implications of having an operation. Patients want to know about the surgeon’s reputation and qualifications. How many times has the surgeon performed the procedure? What are the risks and benefits of the surgery? What is the recovery like? What can I expect as the outcome? These are all very reasonable considerations, and I would strongly recommend a patient do their homework before signing up for a surgical procedure. But it is important to understand that just as you are going to evaluate your surgeon, your surgeon is going to evaluate you as well. And this surgeon to patient evaluation is just as important in the outcome of the procedure.

The first thing that I assess when I interview a patient is why is he or she here. What are the patient’s motives? What do they need help with? Because whatever the problem and whatever the treatment is those are the primary actors that will affect the outcome of the treatment. In fact, I can perform the exact same operation for the exact same clinical problem and the outcome can be entirely different based entirely on the patient’s motives. To say it more simply, a patient is not going to perceive improvement from a procedure if he or she is not motivated to get better. Now you may be surprised by this assessment because you would assume of course every patient wants to get better. Why else would they be considering an operation? Surgeons and physicians call this variable secondary gain. Secondary gain means that patients may have extenuating circumstances that can affect the outcome of the treatment. Patients injured at work or patients who are ready to retire or may be contemplating disability would be examples. Patients injured in a car accident or present with a slip and fall injury may have incentives not to get better if they are involved in a lawsuit. It doesn’t mean that people who face these circumstances are bad folks or even that they don’t have a real problem and need help. From a surgeon’s perspective it is nothing personal against the patient to consider these factors, but it is very important in developing a treatment plan and especially if surgery is involved that THE PATIENT understands these factors may affect outcome! Patients need to understand and be counseled on these issues so that the expectations of results from surgery are understood before the procedure is done. Some more important things that I assess when interviewing a patient is what type of work someone does. If you work on an assembly line or do manual labor the timeline for returning to your regular job duties will be different than if you have a desk job. Is the patient a heavy smoker? How much alcohol or pain medication does a patient use? Does a patient exercise and what kind of physical condition is the patient in? All these variables affect surgical outcome. Sometimes making some corrections on these issues prior to surgery is important and the surgery is delayed. Insurance companies are now denying certain operations on patients who smoke or are significantly obese. To conclude, I think it is important for patients to understand a surgeon is going to interview you as a surgical candidate and that your outcome of a surgical procedure is as much about the patient as it is about the surgeon. So be ready to participate in the discussion so that you can help your surgeon help you!