No one should want to see a Spine Surgeon. The evaluation is secondary to pain, and loss of activity. Spine Surgery is painful. It is a necessary, difficult process that is beneficial to the patient in the long run. That definition can also be considered a form of “Tough Love”.
Those who have delivered “Tough Love” know it can be equally hard on the deliverer of this love. When I was in training, I often had significant jitters about the nature of the planned surgery. I was comforted knowing that my Professor was nearby, in case the surgery became more difficult. I had concerns about the patient’s pain experience during the post-operative period. It was difficult watching some of the pain responses.
When I first started my practice, I had that false confidence of all new surgeons. while I appeared steady, and competent, secretly I would wonder if I was really prepared for all the potential complications. After more than 20 years in practice, I no longer have jitters, but I still make a mental check list, and subconsciously prepare Plan A, B, C and D. I know the patient will go through some pain. I also know the operation should provide a benefit in the long run.
There is another form of Spine Surgeon “Tough Love” that most will not understand.
Many people will have significant pain shortly after having a disk herniation. If the patient does not have significant nerve related weakness, or loss of bowel and bladder function, there is a good chance the pain will subside within 6-8 weeks, and surgery can be avoided.
Occasionally, a patient will have such significant pain, that they would ask for immediate spine surgery to relieve the pain. As they do not have nerve related progressive weakness, or Cauda Equina Syndrome, the prudent course is to wait, take medications, and avoid surgery for 6-8 week period. Statistically, greater than 95% should get better, but initially, it can be a very difficult initial few weeks. Often times, the patients and their families have great frustration by that recommendation, and will seek other opinions and treatments. Without a trusting relationship, it can get contentious.
Waiting is Spine Surgeon “Tough Love”. Frankly, most of my negative social media comments have come from patients that have been asked to wait before having surgery. Somehow, there is the belief that the surgeon was not caring, or taking the pain seriously. Patients may not understand that it would be easier, and financially more beneficial, if the Surgeon would just offer that early surgery. But as a Surgeon, my code of Professionalism, and my Hippocratic Oath directs me to provide the best information, and the least risky solution for my patients. Early surgery is not the best option in the above scenario.
Without Professionalism and the Code of Medical Ethics, it would be an easy decision to just “provide the customer what he wants”. Early surgery for the customer, and more revenue for the practice would definitely be the better business decision. That is why the Field of Medicine cannot be just a pure business. That is why Spine Surgeons must demonstrate “Tough Love” for their patients.
- Madkouri R, Grelat M, Vidon-Buthion A, Lleu M, Beaurain J, Mourier KL. Assessment of the effectiveness of SFCR patient information sheets before scheduled spinal surgery. Orthop Traumatol Surg Res. 2016 Jun;102(4):479-83. PubMed PMID: 27108260