The Most Important Decision You Can Make
How do you Make Your Big Decisions?
Almost daily we make choices that could change our lives or the lives of those around us. Sometimes it’s taking a different way to work and ending up in an accident, buying a car that ends up costing a fortune in repairs, or for the very few, stopping and picking up a winning lottery ticket on the way home.
Most of us do not like making big decisions. Weighing the odds and the possible outcomes has kept even the strongest of us awake at night. Healthcare decisions especially can be insomnia producing.
The first thing one does when buying a house or a car (two of our biggest purchases) is research. We look up “comparables” on houses and talk to friends to find the best agents in the area. An official inspection is done and we make sure everything is completed before we actually sign the papers.
When we buy a car, we go online, we compare prices and consumer reports. Most people make sure a used car has not been in an accident or a flood and get their own mechanic to check it out.
We are very good at doing our homework when money is concerned. Safety is a generally a secondary concern unless your children or pets are being considered. Unfortunately, we are not as careful with ourselves.
Why do we not “shop” for elective surgery? It is more important than a new car. We go to one surgeon, take their advice and make a decision that can affect the rest of our lives. Most people do minimal research and feel that if the doctor recommended it, it must be done. Only a small percentage of people look for alternative treatments, get second opinions, or research their physicians.
It’s a big decision to undergo any surgery, but especially spine surgery. It not only affects you now but has a permanent effect on your future. Do your homework! Check out your alternatives. Get a second, or even a third, opinion. Make sure all conservative measures have been taken. You get one body. You can’t trade it in. You can’t buy a new one.
Remember, it will be the biggest purchase you will ever make.
- Kim CH, Chung CK, Choi Y, Kim MJ, Kim MJ, Shin S, Yang SH, Hwang SH, Kim DH, Park SB, Lee JH. Increased Proportion of Fusion Surgery for Degenerative Lumbar Spondylolisthesis and Changes in Reoperation Rate: A Nationwide Cohort Study With a Minimum 5-Year Follow-up. Spine (Phila Pa 1976). 2019 Mar 1;44(5):346-354. PubMed PMID: 30028778
Hi, I'm Dr. John Shim, and today I want to play the role of a patient. The truth is doctors and doctors' families have the same medical complaints like everyone else. On a weekly basis I have family members or friends approached me about spinal issues and inevitably some have been given the status of candidate for surgery, but what does that exactly mean? How would I as a spinal specialist approach that status for either myself or my family? This might be a complicated discussion, but I want to try to let the audience the viewers understand my thought processes on how I, as a spinal specialist and a spinal surgeon, would decide major medical decisions for myself, my family, or my closest friends. First of all if you have a life-threatening or limb-threatening problem get yourself to an emergency room and call your doctor. Now is not the time to be surfing the web or calling around for information. Full stop - go call your doctor. Go to the emergency room. Do it now. For the rest of the viewers let me tell you how i will make the decisions for myself or how I would advise my family members. I always start with this question: what makes me a candidate for surgery? Understand the term candidate is often used when a patient has some complaints and some testing results that indicate a surgery might be performed or may be performed. It really doesn't define anything more. It doesn't mean you need the surgery or that the surgery will always be beneficial. To give you some examples it's an accepted principle that up to 80% of people will have significant episodes of spine pain sometime in their life. After age 40 about half the population has MRI findings that can make them the quote candidate for surgery. In reality less than 1% of the US population has surgery each year. So, for me and my family elective spinal surgery has always been a very difficult choice for me I need to determine if the complaints matched my physical exam findings. I need to know and confirm that the diagnostic testing identified are also consistent with my complaints. Then I need to be convinced that I exhausted all non-surgical options. The final and most difficult part is to basically guess how many other factors have contributed to my complaints and would those factors diminish the chance of a successful outcome. I need to know what would be the best case scenario after surgery and I need to know what is considered success for the recommended operation. If I decided to pursue surgery I have to also understand that the benefits would outweigh any potential risks. These are very hard things for anyone in pain to truly assess. I need to understand if my goals as a patient was actually the same goal as the surgeon. May seem very strange but many times the goals may be different. If my goal was to be active but I define active as being able to do things like when I was 25 I'm gonna be very disappointed. I will be 58 this year - I cannot expect that the operation will allow me to act like I'm 25. If the goal of the surgeon was to fuse my spine and it fuses then the surgeon achieved his goals but if my goal was to be pain-free and my goal was not to have any discomfort, then my goal may be disconnected from the goal of the surgeon. The surgeon may say he'd get a successful fusion, but I'm gonna complain that I'm not really pain free. So, there'll be dissatisfaction. When I'm in pain I really also cannot assess the risks properly. Let's be totally frank, the larger spinal operations have the higher complication rates and a smaller chance of success. Even the smaller operations cannot be a 100% guarantee. If I'm going to consider surgery I have to ask myself do I understand the risks and am I prepared to accept complications? Am I prepared to be even worse after the operation? While I need to be confident things will improve I must also accept that there is a possibility it may not turn out that way. That's why if I was going to have surgery I will do everything else first before deciding to have an operation. I will have a deep conversation with myself before committing to the operation. I really need to take desperation out of the decision process. I know - this is all very hard, but in the end I'm the one getting the operation, I must be confident the diagnosis is right, I must be certain that the surgical procedure is the best for my situation, and I must be also confident that I've tried everything else. I must also understand that I have to be realistic with my goals, and I need to accept that there are complications or potential that the outcome may not be as good as I thought. I need to understand that this is an exercise of what's called risk management. You have to weigh the benefits to the potential risks. This is a discussion of transparency. If I'm the patient I have to be transparent with myself. I need to understand what I'm trying to achieve, and I need to understand if it's realistic and can the surgeon get me a reasonable chance to get to that goal. I have to have a long discussion with myself and my family before I pursue the surgery because it's very very important that we all understand it. I hope I didn't scare anyone from making the decision to have surgery. I just wanted to share what I would do if I had to make a surgical decision for myself or my family. This is Dr. John Shim, discussing how I would approach surgical decisions for myself or my family. Thank you for listening.