Orthopedic surgery is a big deal. Far too often a patient comes to me after an orthopedic surgery surprised by the outcome and long path of recovery.
It makes me cringe when I ask them if they knew about basic expectations going into the surgery, and they didn’t. Too many times they don’t even really know what was done, or why, and they didn’t know what to expect after the surgery.
How does this happen?
How the surgical appointment usually goes
The surgeon or their team members probably zipped over a few basic anatomy lessons and expectations or gave the patient a handout with some FYI bullet points.
They talk casual and fast, giving the air that it’s no big deal and just makes sense. After they’ve sped through their lecture they ask you, the patient, if you have any questions for them. “Uhhhhh…I don’t think so…”
In the end, patients tend to trust the surgeon or get frazzled during the appointment and forget to ask any good questions. Or they have no idea what they should ask.
They just know the surgeon is pointing at an MRI saying, “This is the worst (knee, spine, hip, whatever) I’ve ever seen. How are you even walking? You need to do the surgery now or you’ll be unfixable in 5 years.” Or something like that.
The patient quickly justifies the decision to go ahead based on the surgeon’s input. “Oh cool, I’m unique, the worst the surgeon has ever seen. I guess I have to do this surgery. Actually, I need this surgery or I’ll never get better!”
Boom. The patient is sold. No hard questions asked. Schedule the surgery. They don’t remember anything the surgeon said except that they had the worst trainwreck of a body they’ve ever seen, so getting it all “fixed” is the only option, right?
Coming in with the right mindset
Surgeons are generally really good at what they do, which is performing the surgery. It doesn’t mean they’re great at diagnosing the source of your pain or determining who is actually appropriate for surgery.
Surgeons don’t get people out of pain without surgery. That’s not what they do. So they actually aren’t great at deciding who could get out of pain without the surgery.
Their job is to perform surgery without complications, so that’s what they get good at.
It’s important to realize this going into the consult because it helps you prepare to be bold and ask the necessary questions.
How the surgical consult should go
So, let’s walk through important questions you should always ask before scheduling any orthopedic surgery.
- What exactly do you think is causing my pain, and how do you know?
This is the all important first question. It’s concerning if they only cite MRI results as their reasoning for why you need surgery. For example, “Your knee is bone on bone,” is a terrible reason to get a knee replacement.
Study after study shows that imaging does not correlate well with identifying the source of musculoskeletal pain or determining the functional ability of the patient imaged. That means a surgeon can’t determine the health of your joints, or whatever you’re looking at, based on an image.
You need to hear their thought process based on the symptoms you tell them you are having, clinical signs from physical tests they perform with you, and the MRI results.
Anything short of this and you know your surgeon doesn’t know how to diagnose your pain. Again, make them explain their thought process!
- What exactly would you do to solve my problem? Is it a brand new technique?
Once they give you a specific diagnosis, you obviously need to know what they are going to do to address the problem and how that is going to be the solution you need.
I also highly recommend avoiding new techniques. It sounds all fancy and awesome to get the new technique, but orthopedic surgery is nothing like phones. It’s not awesome to be the first in line for a new surgery.
Why? Because there’s a higher chance you’ll be back in that line for revision surgery. No bueno.
- How many patients have you done this surgery for?
- What are the possible complications from doing this surgery? What are some of the complications you have seen from your patients after this surgery?
- Do you do long-term follow up with your patients? 3, 6, 12 months, or longer? Do the results last that long or did they need additional surgeries?
- Should I expect to be pain free after the surgery? How long after the surgery should it take for me to get to pain free?
- Will performing this surgery lead to any long-term problems or health risks that I would not have experienced otherwise?
Make them define “success rate”
If they try to answer your questions by citing their success rate, usually a percentage, ask them to define what success means. Definitions of success rate vary, for example:
- Does success simply mean patients without complications from the surgery?
- Does success mean they have no pain and they’re back to pre-pain function? If so, at what time point? Is this based on 3 months after the surgery, or 12 months, or 24 months? Or just immediately after the surgery?
- Is there anything I wouldn’t be able to do again by having this surgery? Like running, skiing, jumping, etc (whatever physical activities you enjoy)?
- What do you do with the patients who aren’t a “success?”
- Are there any common traits among your patients who were successful? How about those who weren’t successful?
With that last question, you’re trying to dig into the surgeon’s experience and results. If they’re actually good, they will be trying to improve their ability to determine who is appropriate for surgery, and thus improve their results.
With that, they should be reviewing who was successful and why, and who wasn’t successful and why. Let’s use a spine surgeon for a quick example.
- Is there a certain age range that is more successful with this surgery? How about a certain weight or BMI? How do patients with diabetes do?
- Is this technique more effective for patients having pain only in their back? How about pain in their back and down the back of one leg, or both legs? What if they have numbness?
We could go on and on with these questions. The idea is you want the surgeon to know many variables that make it more likely for the surgery to be successful or not, and to be able to apply those variables to you specifically to give you a solid prognosis for your surgical outcome.
You can do this
Does reading all of these questions already make you feel uncomfortable because you don’t like confrontation? That’s exactly the feeling you need to fight against.
The questions above are a starting point. You can ask more, just come prepared, having thought it through beforehand.
Is there a chance that you are going to annoy the surgeon or NP or PA with all of these questions? Absolutely! I would tell you to expect that to happen. You should expect it because patients don’t usually do this.
To the surgical team, it’s yet another surgery. It’s what they do day after day, no big deal. If you start pounding them with questions, they might try to make it feel like you are worrying too much or taking too much of their time.
If that happens, push back a little! These are reasonable questions to ask before letting someone knock you out, open you up, and cut up your tissue for a few hours.
If they cut you off, brush off your questions, don’t answer them directly, or don’t promise to find you the answers, then that is your answer! Get out of there.
It’s confirmation they don’t know how to diagnose the problem or understand who is truly appropriate for their surgical techniques. Just because someone is good at performing the surgery doesn’t mean you need it!
You can never go wrong by simply asking the questions that make the clinician explain their thought process behind what they are doing and why. It’s your life and health on the line!
I hope I’ve armed you with more than questions, but also empowered you to find the right answers in the medical world to give you your best opportunity to get out of pain. No matter what someone’s title is in the medical world, you should come prepared to ask hard questions.
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