In the last AO entry, I shared how as much as docs council our patients prior to an elective surgery, patients continue to only hear what they want to hear. Ultimately, I see these misguided — and unrealistic – expectations time and time again.
In this entry, I want to share my five simple rules to the best surgical recovery and eventual outcome.
1. Have the lowest expectations possible. The journey will always be better and who knows, you might be pleasantly surprised in the beginning, middle, and the end.
2. Listen to what you are being told and believe it, unless it seems too good to be true. You just might have yourself a used car surgeon there, professor. When we are telling you all this time-related, restrictive, terrible jibber jabber that is likely to happen, it is not CYA, it is to realign your expectations to what will actually happen. We mean it!
Several times per year a previous patient returns after they have left me to find a doc who told them what they wanted to hear. There are plenty of these docs to go around. Hey, we need the business just like the next guy and there you are, ripe for the picking. Of course there was a surgery, and that patient’s expectations were not met. Should I apologize for telling you the truth?
3. Get ready because you are about to get the ball and you need to be prepared to carry it. If you need help after surgery, get it arranged beforehand. If you are going to use crutches, get them and practice ahead of time. If you have some time constraint in the weeks/months to follow, cancel them or move your surgery.
Nothing, but nothing, pisses me off more than talking to the family immediately after surgery and being informed about a cruise they are going on in two weeks. Usually, it comes with an attitude like “what do you expect us to do about it?” You should have thought about that earlier because now YOU got the ball and you don’t want to fumble it. Come on, just a little common sense, please. It goes back to the idea they that they only hear what they want to hear.
4. Ask questions. Not stupid stuff. (“Will it hurt?”) Of course it will hurt. Ask about timeframes, what can you do at what time, when can you drive, when can you run, when can you return to your sport, and so forth. When can I go on a cruise? And when you get an answer, believe it.
5. Multiply by six. If I tell you swelling will occur for nine months, you will hear six weeks (9 months divided by 6). Please pull out your smart phone and do a little ciphering. Voilà, there you are back to nine months and your expectations are where they should be.
I almost always draw out what I write out for my patients, with a circle around it. Let’s say, for example, this was nine months for swelling, amongst many other items. Almost invariably they come back at 6 weeks and inquire, again usually with a bit of an attitude, as to their swelling and why is it going on so long.
At this point, I’ll take out the drawing, point to the circle with “swelling-nine months” hand-written and I ask, “What about this did you not understand?”
Maybe some of you can help me with the answer I almost always get: “Yea, but?” My reply: “But what?”
Even when I write it out for you, you still only digest what you want…
Great series. Particularly with the swelling issue. It is amazing. I tell people before and after foot and ankle surgery. Always 3 times total and the bewilderment amazes me. Disrupted veins from an incision (until incision less reconstructive surgery is discovered) + gravity (walking on one’s hands is only for gymnasts) = swelling for a long damn time. Sad, but true.
I would add another category. Bargaining- I seriously think sometimes going to the office is like going to a swap meet. A favorite line of mine. “Are we now negotiating your recovery? I think the bone needs x amount of time to heal, but if you have a different opinion, let’s hear it.”
I just came across your blog and I love it. It’s so good to read what doctors really think. I am preparing for hip replacement, and I’ve done my homework. I’ve read journal articles (I teach statistics), and I have seen four surgeons with different recommendations. One surgeon specializes in laparoscopic surgery to repair cartilage and said my hip was too far gone. Next surgeon almost always recommends hip resurfacing, third one doesn’t do hip resurfacing, and the fourth one said he does both hip resurfacing and minimally invasive total hips, but he gave me three good reasons why I should get a replacement. So he is my surgeon. He was non-defensive when I asked how many of these procedures he has done and what were his infection and complication rates. I’m glad your blog has confirmed that a good doctor won’t balk at such questions. I *love* the term “rescue patient.” I have “rescue students” who were scarred by bad math teachers. Looking forward to reading the rest of your blog!