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