Now that excitement of the London and Boston Marathons are over, we’re continuing to see the injury fall out in clinic. Some patients are broken to the extent that that they may even require surgery – this sometimes represents as big a challenge for us, as it does the patient…..
Have you ever experienced the following situation?
You send a patient to have a consultation to explore possible surgical options, and then the next time you hear from them, is when they hop into your consulting room on crutches, clutching a scrunched up op-note, dated two weeks previously…?
If you or your patient have ever experienced the ‘it happened yesterday’ surgical planning process, let me ask you, how did it make you feel? What would you have wanted to have contributed/asked/or wanted to prepared for?
Of course, when it comes to emergency surgery, there is little or no time to engage everyone in the decision making process. Time is of the essence if an odontoid peg has been mashed in a horse riding accident, or a patient sustains a fractured femur in a cartwheel involving their leg, the bending of a £6,500 Cervelo Dura Ace road bike, and the bonnet of an Uber cab (the shame).
In contrast, how often do we really NOT have time, time to at least say, ‘let’s discuss it’, and get even some pre-hab done…?
Ask yourself- what’s the rush?…
It’s as if private medicine has become synonymous with fast medicine, but really good private medicine means well-timed, well-planned, and well-prepared, patient convenient surgery…. We’re all accustomed to a six-week period of pre-hab for an ACL repair, but somehow in other situations, the patient’s rush to get better, means we’re all dragged along for the ride.
I’m going to make a little confession here – as a human, I’ve been occasionally guilty of defaulting to ‘let’s someone else decide’ (you know what that’s like. You’ve had a beast of a day; decision fatigue means your cranium morphs into an idea-vacuum when your well-intentioned partner asks you ‘what you’d like for dinner’). I have a sneaking suspicion that we quite like abdicating responsibility, and I suspect some patients need to be encouraged to become more, and not less involved in the management of their condition.
Isn’t it amazing how some people put more effort into planning their holiday, or a stag-do, than they do into getting ready for surgery?
In the elite sporting world, we may have the privilege of being able to accompany our patients to consultations, but mostly this isn’t practical.
How best, can we help our patients to prepare for these kinds of clinical interactions?
The GMC asks that when doctors “delegate the care of a patient to a colleague, they must be satisfied that the person providing care has the appropriate qualifications, skills and experience to provide safe care for the patient”.
Only in very rare situations would I advocate referring a patient to a clinician we know personally know little about. In those situations, it may be worth prepping our patients by asking them to think about, a few key areas, and to make notes.
Patients might find the following useful, when preparing to meet with a surgeon, (besides the usual ‘housekeeping questions’):
If I weren’t to have surgery, what would the natural course of progression be for my particular condition?
Might I be ‘missing the boat’ if I don’t take action now? How would delaying things impact on any potential surgery?
Is it just you who will be carrying out the surgery, or will your registrar / fellow (for first year medical student;) be operating on me?
What would you recommend for me if I were a member of your family?
What happens if you find something unexpected at the time of surgery, and how frequently has that happened in the past?
What’s the worst case scenario that could happen during the surgery, and how would that impact on me in the long term?
How am I likely to feel and function in the first two weeks following surgery, and how will this impact on my ability to work/commute/drive/look after my children?
Why are you recommending I have surgery now?
Do you have patients who would be willing to share their surgical experiences with me?
Above all, I think we need to encourage patients that they must buy into the concept that they need to the person who is ultimately responsible for their health. This means their full engagement in the pre-hab and re-hab process and when embarking on surgery. If work or family commitments are likely to get in the way of that process, then surgery should perhaps be delayed until the patient really does have time to attend for those physio/osteo/strength and conditioning sessions.
Or putting it another way, a good surgical outcome means Bosu ball over Boardroom, every time.