Managing patients’ expectations in orthopaedics

Excerpt

The specialism of orthopaedic surgery covers many subdisciplines. Most of these deal with degenerative changes occurring as a result of the normal aging process. Some will follow trauma or are as a result of congenital malformations. Patients, however, are pre-conditioned to look for a ‘cure’ and are not that happy to learn if one is not available. It is more likely that the aging or degenerative process will be ‘managed’ throughout the patient’s life time. A number of papers attempt to deal with this problem and attempt to build statistical models to allow predictions to be made about patient outcomes. They are all aimed at improving patient outcomes [1]. These patients need careful handling as they need to understand that the aging process cannot be cured and resultant symptoms can only be managed. There are many both operative and conservative options, but the aim is to control the symptoms they experience to allow a return to function as close to normal as possible. The message which used to be imparted to orthopaedic trainees in the UK was ‘masterly inactivity or supervised neglect’ depending upon the consultant’s approach. This followed the concept of ‘first do no harm’ rather than leaping in with an invasive procedure. Orthopaedic meetings are full of examples where there is a ‘triumph of technology over common sense’. Explanation to patients is therefore the key to a successful outcome for all parties. It is apparent that patients are more interested in physical recovery than a return to work or for financial objectives. For that reason, orthopaedic surgeons are encouraged to consider assessing the socioeconomic well-being of their patients [2]. …