One of the most interesting parts of my job is that I get to interact with so many different types of people on a regular basis. Their different personality types color many of the decisions we make in the office more than most people realize.
When you are studying to be a doctor, much of the initial schooling focuses on the hard sciences: anatomy, physiology, biochemistry. But once you get through that and are a practicing professional, you find that the emphasis shifts significantly.
You find that much of your everyday work comes down to helping different patients, navigate similar problems in their own way.
Decision-making can be difficult. There is often more than one good answer for any problem. Each person handles common challenges in their own way, often dictated more by their personality and life experiences than any hard and fast scientific facts.
Since much of what we do as orthopedic surgeons is elective or planned surgery, there is actually considerable leeway in how we make decisions regarding whether we do an operation or not.
I have seen thousands of patients in my clinical practice over the last number of years.
While this is not an exhaustive list, I find that patients often fall into one of (a least) 4 categories:
1. The patient who wants you to make all the decisions.
These folks recognize their limitations in a sense. They realize that that they possess less specialized knowledge about all of the medical issues that they face. Or they feel that they are too emotionally invested in the decision and want an independent person to help make the decisions for them.
They are trusting not only that you the physician are competent, but that you will place yourself in their shoes and make the “best decision.”
This can be a double-edged sword for the physician. When the benefits far outweigh the risks for a given treatment, then it’s easy. You have been granted permission by the patient to use your independent judgment to act on their behalf.
But when risk/benefit ratio is more ambiguous between choices, and the patient does not want to give their opinion one way or the other, then things can be more challenging. In those cases it’s usually my job to dig deeper and figure out what they value most and how our choices will affect those values.
2. The patient who “just wants the problem taken care of” whatever the risk/price.
Often a patient like this has been dealing with pain for a long time or has had pain that is so disruptive to their life that they just want it to go away. They may have already tried a number of options or seen other doctors and are looking for a definitive solution.
It can sometimes be difficult to talk this patient OUT OF higher risk options like surgery because they “will do anything” to get rid of the problem. You often have to caution a patient like this against doing TOO much.
With a patient like this you usually have to take a step back for a minute. You need to figure out whether their problem is truly as severe as they are saying and warrants a more aggressive solution or whether their urgency to “do whatever it takes” is driven by other factors: desire to get back to work, lack of sleep, social support issues.
If the problem is one that can be handled conservatively, then it’s important for us to reassure this individual and patiently walk them through their options before jumping into a riskier alternative.
3. The patient who doesn’t want to consider surgery ever.
These are usually relatively straightforward patients to deal with. They may have a certain amount of pain but have decided to live with the issue on their own. Since they’ve made up their mind that surgery is not an option, their remaining treatment options are usually low risk. As long as their coping skills hold up with time, they often do very well because they adapt to whatever circumstances come their way.
4. The patient that just wants to know whether the problem will get worse if they keep living their current lifestyle.
This type of patient may be on the fence. They recognize that something may be wrong but are not sure about doing something. They are seeking education.
In this case it’s my job to help them understand the natural history of their own condition.
The explanation I give them either reassures them and they go about their life or they take some action based on their newfound knowledge
There’s no right or wrong way to approach your own arm condition. Everyone has his or her own best strategy. But it’s important to recognize that each of us may process medical issues differently and that we should recognize the value and limitation of each approach.
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