Smart, skilled, compassionate, confident, perceptive,
honest, straightforward, and trustworthy.
These are just a few words that come to my mind when I think
about what an orthopaedic surgeon should be. As a person with cerebral
palsy, I am no stranger to orthopaedic surgery. When I look back
at the eight surgeries I've had throughout my childhood, and when
I think of those that might come my way sometime in the future,
I realize that the relationships I have had with my orthopaedic
surgeons have had a big impact on my overall medical care. Of course,
the most important part of an orthopaedic surgeon's job is based
strictly on skill and medical know-how. As surgeons, you already
have the education and experience you need to help your patients
deal with their physical challenges. The general public seeks and
relies on your expertise. But I think there is more to being a good
orthopaedic surgeon than having the ability to perform medical procedures.
I think it is important to establish a partnership of sorts with
your patients in order to make their medical care as effective as
it can be. This partnership is based on simple things, like looking
at an x-ray with your patient and explaining what you see or listening
carefully to your patient's concerns and addressing them honestly.
For your patients, having surgery is a big deal, not an everyday
occurrence. It is essential that the lines of communication between
patients and doctors are open and in good working order.
When I found out that I would be speaking with you today, I decided
to talk to my family, friends, and doctors about their perceptions
of the doctor-patient partnership. I'm an expert surgery patient
in my own right, but there are countless aspects of orthopaedic
surgery that I have never faced. So, I asked others about their
surgical experiences, sewing together a colorful patchwork quilt
of varying opinions to share with you.
Practicing medicine is both an art and a science, and there is
a delicate balance between the two. Patients need medical care and
doctors can help them, but mutual understanding through effective
communication is the only way to bridge the gap that often exists
between patients and their doctors. Communication is the key to
the doctor-patient partnership.
The first step in the partnership is realizing that both patients
and doctors have shared responsibilities in medical care. To be
a good patient, I have to disclose all of the information I know about
my condition to my doctor and I must be truthful. I have to give
the relationship with my doctor a chance to grow. Now, sometimes
that can be hard to do with a specialist I only see three or four
times, but I still have the responsibility to ask questions of my
surgeon, like "How many procedures like this have you done before?"
and "Why do you think this procedure will work best for me?" In
turn, I expect honest and thorough answers from my doctor. I want my
orthopaedic surgeon to act with the highest level of professional
competency and to stay on the cutting edge of the field. At the
same time, I want my surgeon to admit to me if he or she doesn't
know the answer to one of my questions, and then I want him or her
to take the initiative to find the answer.
In pediatric orthopaedic care, it is the parents' responsibility
to ask these questions of their child's surgeon. As doctors, encourage
your patients and their families to ask questions. Maybe ask them
to write down questions or fill out a questionnaire to help facilitate
discussion during their appointment. Then, when families and patients
come in to meet with you, take the time to sit down and talk with
them. Try not to keep them waiting, and if you are running late
have someone let them know how long you will be.
Listening has been a key part of the medical profession from
the very beginning. Before medicine made the technological leaps
that are evident today, one of doctors' primary roles was to listen
to patients because sometimes there was little else they could do
for them. I encourage you not to let technology get in the way of
your listening skills. As a patient, I can tell you that it is very
comforting to know that I am being heard.
I remember one time when I wish I'd been listened to a little
more seriously. I was in the fourth grade and had two full-length
casts on my legs with a bar in between because I had had my hamstrings
and adductors lengthened and my Achilles tendon reimplanted. I was
thirty-six inches from toe to toe, and I had to be turned sideways
to fit through most doorways. The best part about the whole thing
was that I got to sleep in my parents' queen-sized bed because I
didn't fit in my own twin bed. Still, it wasn't a pleasant time
for me because the suture in my heel hurt so badly. I told my doctors
about it again and again, but they didn't cut the cast away to see
what was putting pressure on my heel. Six weeks later, when the
casts finally did come off, it turned out that the suture had eaten
a hole an inch deep, and about the size of a quarter, in the bottom
of my heel.
Working with children can be particularly complicated when it
comes to effective communication because the entire family is involved. Sometimes
parents might not follow your instructions, there may be hygiene
or nutrition issues, or relatives may give conflicting medical advice.
So, it is vital to interact with parents in an effective way. Oftentimes,
you will have very complex information that must be understood, and
you will have to figure out a way to convey it in layman's terms.
Be aware of different learning styles so that you can present the
information using a variety of different modes. Use written instructions,
diagrams, and hand-drawn pictures for the visual learner; use 3-D
models for the kinesthetic learner; and explain what you want to
do as clearly as you can for the auditory learner. Do whatever it
takes to get your point across. My orthopaedic surgeon says that
one of the most important things he does every day is talk to people
on their level. He works hard to get the family and the patient
involved in decision-making.
I think it is important to master your communication skills and
to identify your strengths when it comes to dealing with patients.
I think it's just as important to identify your weaknesses. Do you
feel awkward or uneasy around a patient? Do you have a good bedside
manner? If you don't, recognize it and surround yourself with people
who will enhance your practice. Your support staff can complement
your weaknesses with their strengths. The hospital you are affiliated
with, the nurses who take care of your patients, and the way your
patients are treated before and after surgery all reflect on you.
Make sure that the people who work with you represent you well.
I can think of one physician's assistant, from my orthopaedic surgeon's
office, whom I always looked forward to seeing. He had a gentle
manner, he always told me exactly what he was doing, and he even
came to visit me after surgery. I appreciated the extra time he spent
with me more than I can express.
A friend of ours named Patti, whose daughter Holly has cerebral
palsy and some developmental delays, agrees that an orthopaedic
surgeon's support staff can do a lot to foster good communication.
She said that one of Holly's orthopaedic surgeons did not always
communicate with her, which made her very uncomfortable. "One doctor
would always talk to my husband and not to me," she said. "Even
if I asked a question, he would look right past me and address the answer
to my husband." Patti said she was able to overlook this rift in
communication after three surgical nurses assured her that this
particular surgeon was the best in his field. Patti went on to say
that the surgeon had an obvious passion for his work and made a
concerted effort to communicate with Holly despite her developmental
delays. She said he was extremely attentive to Holly before, during,
and after surgery, which made a big difference to the entire family.
For pediatric orthopaedic surgeons in particular, I think it
is important to remember that, although you must address the needs
of the entire family, the child is your patient. I remember taking
a tour of Children's Hospital in Denver, before I had surgery, to
look at the operating room and to meet key personnel. I was told
what to expect on the day of surgery, and I even got to pick out
a flavor for my anesthesia. This helped to put my family and me
at ease. I felt like I knew what was going to happen and that I
had some control over it. I like that. Not all patients like to
be in control, though. I have discovered that there is a fine line
between how much patients want to feel empowered and how much they
want to be taken care of. A friend of my mother would prefer not
to hear the details of a surgical procedure at all. Thus, it is
essential that you recognize the fullness of your patients. They
are individuals with varying values and lifestyles. It helps to
be aware of your patient's family, job, finances, cultural background,
and mental and spiritual health. In times of emergency, this will
not always be possible and the best you can hope for is to make
the situation better.
From my perspective, the most important element after surgery,
besides the success of the surgery itself, is pain management. I
think it is what patients tend to worry about most - at least I
do, and I'm very open with my surgeon about my concerns. I appreciate
when my surgeon is honest about how much a certain procedure will
hurt and how recovery from surgery will affect my lifestyle. I also
appreciate getting the medicine I need when I need it. That can mean
the difference between a good day and a bad day. An orthopaedic
surgeon I know recently had his hip replaced, and he told one of
his patients that he was stunned at the amount of pain involved.
He said the experience would make him a more empathetic doctor.
I have to admit that, as a child who continually had surgery
over a period of fifteen years, I eventually became a different
kind of patient. I started out as a youngster who was eager and positive
about surgery because I knew it would help me. As I got older, I
recognized the pain and rehabilitation involved with surgery and
it got a lot harder for me each time I had an operation. I get very
nervous and nauseated before surgery, just anticipating what lies
ahead. On the other hand, my experience does have its advantages.
Now I know how my body reacts to different surgical situations and
anesthesia, and I know how to handle them well because I've been
through them before. I often find that my surgeon asks me what kind
of pain management I prefer, and I feel like I play a much more
active role in my preoperative and postoperative care.
Both doctor and patient must learn to have a good sense of humor.
Although a surgeon should never make light of surgery's risks, I have
found that a shared laugh always makes things run a little more
smoothly. For example, my surgeon and I made a bet whether or not
the wire he had put in my knee during one surgery had broken like
we planned. I thought it had. After he took the wire out, the first
thing I heard when I woke up in recovery was that I had won the
bet. My surgeon even took the time to put a special purple cast
with a pink heart on my foot once. Granted, these are things you
would do for a child, but regardless of whether you are operating
on children or adults it's the small kindnesses that matter the
In a world where communication technology is growing, more and
more medical information is available to patients. They can access
information about doctors and surgical procedures from their desktop
computers. Some patients are even shopping for doctors on the Internet.
I think you should be aware of what is on the Internet so you can
address the information your patients collect and not feel threatened
by it. Patients and doctors can work together to gather information, giving
patients a chance to actively participate in their own care.
A doctor told me that people generally expect the family physician
to have a good bedside manner, but a good bedside manner is not
necessarily expected of the specialist that only sees a patient
for a short time. As a patient who saw her orthopaedic surgeon much
more often than she saw her family doctor, I would say that the
doctor-patient partnership is important for all physicians. I have
put my life in the hands of orthopaedic surgeons many times, and
because of their hard work, their dedication, and their willingness
to work with me for my own well-being, I am more physically independent
today. I am so grateful for all they have done. So, what do I think
an orthopaedic surgeon should be?
Smart, skilled, compassionate, confident, perceptive, honest,
straightforward, and trustworthy.