Hi my name is Dr. John Shim and today I want to talk about the three types of patients that I see who decide they want to have surgery. You've already had the evaluation the surgeon is already determined that you need an operation or you would benefit from an operation and you have already scheduled the procedure but depending on the type of patient you are there may be some issues that you need to resolve. The first type of patient I typically see is that hard-charging optimist, the master of the universe, the person who always is on time, always behind because they have another project they need to get to and the last thing they need is back surgery, but once they decided to have the surgery they want it now. The problem with these folks is there too much in a rush to get things done they think spine surgery is an obstacle to getting on with their life and it is but because they're in a rush they don't take the time to want to find out about what they can do to help their situation. They don't explain the situation to their families very well and sometimes they don't even hear the discussion with the doctor. If you're that type of patient you need to slow down you need to get the right advice you need to prepare your household. Your friends and your families all need to be aware of what's happening to you and then you need to slow down enough so you can recover, follow the instructions of the doctors and do the things that will benefit your recovery. The second type of patient that we see is the medical pessimist. This is that person who always has the complication or problem. They go to the grocery store they buy eggs and they buy the rotten eggs for these folks it's very difficult not to be pessimistic, but that pessimism is a problem you have to feel comfortable and confident you're making the right decision. The good news for the pessimist is as they start making improvements they start changing their attitude and start feeling better. I find a medical pessimists who have been the properly selected patients for the operation you should do very well I'm very very grateful because the outcome is much better than they thought it would be the final group of patients is the realist. These are actually the best patients they understand their problem they logically ramped up the intensity of their care over time they understand that there's a risk and benefit to everything they do and they do the research to make sure they're getting the best information for their particular situation. For me these patients are very pleasurable to take care of because they follow my instructions they understand their problem and they ask thoughtful questions that help them recover from this process of surgery. I know all of you are in a significant amount of pain that's why you chose to have the surgery but you must think what kind of patient am I? Am I that hard-charging optimist who may not understand the gravity of the situation are you the medical pessimists who just doesn't think anything's can get better so you actually put yourself down to much so sometimes you don't see the benefit or are you the realist who really understands a problem and therefore does all the things properly to improve your outcome. I hope you understand that it's important for you to look at yourself while you're going through the process of having surgery and planning for surgery. This is Dr. Shim discussing spinal surgery patients thanks for listening
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