Dr. Lindsay
A few weeks ago in clinic I was a little bit more tired than usual at the end of the day. I had slept well, had my normal amount of caffeine, and saw the typical number of patients. I even had my PA and operations manager, who both had been out over the past year, back in clinic and had two great medical assistants. It started out as a great day, but at the end of it I was spent.
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June 2023I reflected on the day and realized that an unusually high number of the patients that day didn’t need surgery. Many had come because they thought that I would finally be able to “fix” them. They truly believed that surgery would correct their symptoms, but I knew it wouldn’t correct their chief complaint no matter how much they wanted it. And I understand: it makes sense that the patient would try to convince me to operate. Without surgery, the “quick fix” for their symptoms is gone, often without a replacement.
Unfortunately, not all symptoms can be corrected with surgery. Many patients believed that I was withholding care from them that they expected to get or felt that they deserved. I could feel myself starting to feel defensive while trying to provide the correct clinical care. I was asked, “Is this because of my insurance?” (I don’t look at coverage prior to the visit). When I would start explaining why surgery wouldn’t correct their problem, new symptoms would appear out of the blue that patients thought would increase the likelihood of me saying yes—but unbeknownst to them only made surgery even more wrong. But spending almost the entire day providing multiple explanations to these patients was exhausting.
During training, we learn the importance of knowing when to operate and are told that even more important than learning when to operate is learning when not to operate. Little is discussed about the difficulty of telling a patient who wants surgery that surgery won’t fix their disorder. These visits take a great deal of time and patients still often leave frustrated due to a “wasted” trip. What can we do as a specialty to educate our patients and referring providers to decrease the number of patients coming in with an expectation that surgery is the only answer?
I’m asking myself how I can do a better job of counseling patients in clinic who don’t need surgery. As we move toward a value-based system, we’ll need to have a better understanding of what’s important to our patients, clinical practice guidelines and outcomes measures that have been determined to be important to the patient and the provider, and the cost of providing high quality care.
Most patients are grateful for the honest assessment of their condition, however, and are appreciative of our time and expertise. It’s these patients that help me get through the day.