Does Optimism Help Spine Surgery Results?
People who undergo elective spine surgery usually fall into three general groups:
1. Hard charging optimists – People who do not have time for the pain, and dysfunction, of spine problems. These folks are often in a rush to go directly to surgery.
2. Cautious realists – These patients spend appropriate time to understand their problem and the risks associated with their treatments. The decision for surgery is a logical, measured process.
3. Medical Pessimists – The people who are always the “ones who get the complications”. No treatment has ever been successful. They are convinced surgery will not work, but are willing to try, as there does not seem to be any other options.
There is a fourth group, but this population probably should not get surgery. This is the group that insists on surgery when surgeons have advised against it. We will discuss that group on a separate blog.
From the perspective of the surgeon, appropriate criterion for surgery requires:
1. A specific complaint that is not improving, or even worsening.
2. The complaint causes or can potentially cause significant pain, and loss of functions.
3. There is no improvement despite conventional non-surgical therapies.
4. Diagnostic testing such as MRI’s show a finding that corresponds to the complaint.
5. Physical examination findings are consistent with the MRI related complaint.
6. Patient has a realistic expectation about the goal of the surgery. As the joke goes, if you did not play the piano before the surgery, you will not be able to play the piano after the surgery.
How do these people tolerate surgery?
In group one, the Hard Charging Optimist, my greatest concern is about the usual urgency of going directly to surgery. These folks have a “I control my destiny” attitude that is great, but also can be associated with impatience. They will often not wait for the non-surgical options to work, or will return back to full activities too soon. Still, this group tends to do well with surgery, as optimism has been associated with faster return to function. The science is still not hard about this, but I too believe realistic optimism is a benefit for any medical treatment.
In group three, the Pessimist group, the results of surgery will still be good as they meet the criterion for surgery as outlined above. For this group, the hardest thing is to not let the minor setbacks interfere with the recovery. This group needs positive feedback and a supportive group of friends and relatives who can encourage activity and patience. In my experience, this group will take longer to recover, but are usually the most grateful group as they eventually experience a positive outcome, despite their pessimism.
In group two, the Realist group, I find myself spending the most time with them. In the end, this group is very careful to follow all instructions, and recover as expected. I find the conversations most stimulating as this group may ask questions that cannot always be answered specifically. I personally fall into this group. As a surgeon, I am methodical, realistic, and have expectations based on the science.
To me, the ideal type of surgical patient would be the one who is informed, realistic, yet optimistic. There is plenty of research suggesting that in certain medical conditions such as heart disease, joint replacement, cancer treatments, etc., optimism is beneficial to regulate the levels of pain, and associated with faster return to activities in these patients.
If you are a pessimist, you cannot change your personality. Still, having confidence in your surgeon, the surgery and the science will have positive effects!
- Singletary B, Patel N, Mims A, Smedley A, Swords J, O'Bierne R, Morris MS, Safford M, Heslin M. Gaps in the Postoperative Conversation: A Comprehensive Review of Current Practices and the Unmet Needs of Surgeons, Families, and Waiting Room Personnel. Am Surg. 2017 Jul 1;83(7):812-820. PubMed PMID: 28738957
Hi my name is dr. John Shim and today I want to talk about the three personality types of patients that I see who decide to have surgery. Surgery has already been scheduled but depending on their personality there may be some issues that need to be explored. The first personality is that of the hard-charging optimist the master of the universe the person who is always on a tight schedule because they have another project that needs management. From their perspective they have no time for back surgery and like all their decisions once decided they are now all in and want it done now. These folks aren't a lot of rush to get things done. To them, spinal surgery is a temporary obstacle to getting on with their life. These folks may not take the time to find out about the nuances of their situation they may not explain the situation to their families very well and sometimes they don't even hear their risks discussed with the doctor. If I'm describing you then you need to slow down. You need to get the right advice you need to prepare your household your work and your family all need to be aware of what's happened to you then you need to slow down enough to recover. You must follow instructions of the doctors and do all the things that will benefit your recovery. The second type of personality is that of the pessimist. If that's you then you believe you will always have the complication but that pessimism is a problem. Patients need to feel comfortable and confident they're making the right decision. The good news for pessimists is as you start making improvements you start changing your attitude and you start feeling better. I find pessimists who have the appropriate indications for the operations often do very very well. These patients are often the most grateful because the outcome is much better than they thought possible. The best personality for spinal surgery is that of a realist if that's you you do your best to understand your problem you logically ramped up the intensity of your care over time you understand there's risks and benefits and you do the research to make sure you're getting the best information for your particular situation. For me these patients are very pleasurable to take care of because they follow my instructions and they understand their problem and they ask thoughtful questions that help them recover from the process of surgery. I know all of you are in a significant amount of pain that's why you chose to have surgery but you must think what kind of personality do I have? Am I that hard-charging optimist who may not understand the gravity of the situation? Am I the pessimist who just doesn't think anything is going to get better? Does your negativity cause delayed decisions and sub optimal efforts for improvement? Are you the realist who logically understands the problems and therefore does all things properly to improve your outcome? Understand that it's very important for you to look at yourself while you're going through this process of having surgery and planning for surgery. Your attitude your personality may have bearing on your outcome. I'm dr. John Shim discussing spine surgery patients. Please consider these issues while making your decisions. Thanks for listening