“This relationship is valuable to spine surgeons because patients need to be confident in their decision to undergo surgery and they gain confidence by getting to know their treating physician,” says Bryan Massoud, MD, a board certified orthopedic spine surgeon with Spine Centers of America in Fair Lawn, N.J. Here are seven advantages to operating surgeons conducting the pre- and postoperative visits with their patients.
1. Knowing the patient’s expectations before surgery. Becoming familiar with patients includes knowing their postsurgical expectations. If patients lead an active lifestyle before back pain slows them down, they need to know how much activity they can return to after surgery. In other instances, a patient’s job may require physical activity or strain, and understanding their condition can help them meet reasonable expectations.
“It’s important for the surgeon to understand what the physical expectations of the patients are following surgery,” says Dr. Massoud. “Then, they can guide these patients to find the particular procedure that is best for them. All this information is gleaned through preoperative, intraoperative and postoperative relationships with the patient.”
Most patients will have a prior history of failed surgery or interventions, and they have specific goals in mind for their postsurgical lifestyle. Surgeons should know what their patients have been through and where they would like to be in order to make the appropriate decisions before, during and after surgery. “By identifying the patients’ expectations from surgery, you have a better chance of meeting those expectations and having a better outcome,” he says.
2. Making accurate diagnoses. Much emphasis is placed on finding the back pain patient’s pain generator before beginning treatment, which means locating the disc, annulus or facet joint that is causing pain. If the patient is suffering from stenosis, the surgeon must know whether it is foraminally or centrally located, and whether the patient might have scar tissue from prior surgeries. “All of these different potential sites of pain can be the pain generator,” says Dr. Massoud. “To distinguish which is the actual cause, we think it’s important to have an intimate knowledge of the patient’s individual complaints and history.”
The operative surgeon should take the patient’s history, do physical examinations and review the diagnostic tests personally to develop a keen sense of the patient’s situation. “By personally taking the history, doing the examination and reviewing the diagnostic tests, the surgeon can form an opinion about what the pain generator is and design the appropriate procedure for surgery,” he says.
3. Creating a treatment plan. If the operative surgeon collects the patient’s history and has access to their diagnostic tests at the time of their visit, the surgeon is able to efficiently conduct the preoperative visit and create a plan for care. “When the operative surgeon has all the tools at their fingertips, it saves a great amount of time and allows the surgeon to have the ability to perform complex preoperative evaluations,” says Dr. Massoud. “And it’s also better from a medical standpoint for the surgeon to see the whole story unfold in one setting while the patient is there.”
In order to have all the information, surgeons must depend on a strong ancillary staff to schedule and prepare patients well before the visit occurs. Dr. Massoud also utilizes patient liaisons who have one-on-one contact with the patient to gather previous diagnostic results, general patient information and guide them through the treatment process.
4. Dealing with intraoperative abnormalities. All surgeons go into surgery with an intraoperative plan, but there is always the possibility for abnormalities or complications to appear after the surgery has begun. It’s important for surgeons to know the patients’ goals before surgery so they can deal with potential complications during surgery in a way that will still provide the best outcomes for individual patients.
“The best knowledge of a patient’s abnormalities or pathology is obtained by direct visualization at the time of surgery,” says Dr. Massoud. “The surgeon’s intimate knowledge of the specific patient is necessary to make the best intraoperative decisions. During surgery, we have to make decisions as to how aggressive we might get in a particular situation.”
5. Correctly relaying operative information post-surgery. It’s extremely important for the operative surgeon to be involved in the patient’s postoperative report because only the operative surgeon knows exactly what was done and in what manner the surgery was done for each particular patient. Other physicians or medical professionals may not be able to relay this information accurately to patients, or answer all of the patients’ questions.
“Simply reading the name of a procedure many times does not give you the full depth of knowledge of everything that was performed and how it was performed,” says Dr. Massoud. “The surgical process affects the patients’ postoperative treatment, and I think only the operative surgeon and patient can judge the level of success of the surgery.”
6. Working with physicians’ assistants. Many specialists employ physicians’ assistants to assist them during parts of the preoperative and postoperative process, moving patients through the office quickly and efficiently. However, many patients still want to develop a good relationship with their surgeons.
“If you’re going to employ a PA or clinical nurse practitioner, allow them to participate in the care of the patient, but they shouldn’t be the only specialists involved in the crucial phases of the preoperative and postoperative assessments,” says Dr. Massoud. “Patients often say they don’t want to be just another number in the system. They want to develop a relationship with their surgeon.”
7. Promoting positive outcomes. Studies show that patients with low expectations or a pessimistic outlook on their condition often have worse outcomes than those with positive attitudes. One way to influence patients’ attitudes toward surgery is by becoming familiar with them individually and easing fears they have about the procedure.
“The idea of having surgery is scary, and it’s common for patients to be anxious prior to surgery,” says Dr. Massoud. “But by developing a strong bond with the actual surgeon who’s going to be doing the procedure, through meeting the surgeon and having their questions answered, they can alleviate their fears. Having that positive attitude will increase the likelihood for a positive outcome.”
Learn more about Dr. Bryan Massoud.
More Expertise From Dr. Bryan Massoud:
The Trend Toward Minimally Invasive Spine Surgery: Q&A With Dr. Bryan Massoud of Spine Centers of America
4 Critical Steps Physicians Must Take to Learn Endoscopic Spine Surgery
6 Things to Know About Endoscopic Cervical Spine Surgery
