Gregory C. Mallo, MD, is a board-certified orthopedic surgeon specializing in complex shoulder reconstruction, shoulder arthroscopy and revision surgery. He serves as co-chief of the shoulder service at St. Charles Hospital in Port Jefferson, N.Y.
Question: You served as a Lieutenant Commander and orthopedic surgeon in the U.S. Navy and cared for active duty sailors and members of the Elite Special Forces Community. How has your military experience influenced your practice?
Dr. Gregory C. Mallo: After 9/11 I was eager to start the long process that began with medical school, continued with residency and culminated with my duty assignment as orthopedic surgeon at Naval Hospital Camp Lejeune. While I was there, I had the privilege of caring for our active duty sailors, marines, and some members of [Marine Corps Special Forces].
This high-demand population needed a comprehensive treatment plan. These men and women were expected to deploy to the highest-risk combat situations. I had to be very careful when discussing surgical and non-surgical options. These motivated patients often saw surgery as a quick fix, and underestimated the potential risks, complication, and recovery time.
In my practice now, I first identify if surgery is an imperative first-line option, like with a displaced fracture which will not heal correctly if it is not fixed immediately.
In other cases, the quickest way to return to sport or combat is to avoid surgery if possible. Most shoulder surgeries require a four to six month recovery period, which can be even longer if there are any setbacks.
That is why I advocate for conservative treatment whenever possible, and recommend surgery only when I know it is the only option and will actually make a patient better.
Given the nature of their work, Special Forces operators and military patients in general expect 100 percent pain relief and return to function. This is often possible, but other times the injury is so severe that a complete recovery is not possible. These are some of the most difficult conversations to have and it is important to help manage expectations prior to surgery. This experience now directly translates into my current community practice and has helped me prepare for day-to-day discussions with patients and how to manage their expectations.
Q: How do you manage patient expectations?
GM: First I speak with patients about their personal goals. Are they expecting pain relief, better range of motion, better strength, or improved overall function? Then I show patients their MRI or X-ray images, and explain if I believe there is a surgical option to help them reach their goal. I also lay out the recovery process including the need for sling/brace use and the specific physical therapy protocol.
If they don't have reasonable recovery goals or are not willing to complete the post-surgical therapy, surgery is not offered. I try to use scientific evidence to explain to patients why such precautions are necessary.
I find that using everyday analogies and personal anecdotes goes a long way to helping patients feel at ease with their treatment plan, and it bridges the gap between scientific explanation and day-to-day experiences.
Q: How do you use personal experience in your interactions with patients?
GM: In terms of personal anecdotes — most orthopedic surgeons have a story about an athletic injury, and in a lot of cases that's how we got started on the path toward orthopedics. Personally, as pitcher on a very competitive high school team, I began having severe pain and weakness in my dominant elbow.
I ended up getting arthroscopic surgery and I was told to rest. Unfortunately, I was a stubborn teen, and I continued to push the envelope during my recovery and ultimately needed a second, more invasive procedure. Surgeons extracted stem cells from my pelvis and transplanted them into my elbow to help the bone and cartilage heal.
As a result, I missed two complete years of high school athletics and any chance of playing baseball at the college level. I often relay this story to help convince patients to follow post-surgical protocols.
I also had a shoulder surgery as a result of an injury that occurred during deployment with the Marines to Afghanistan in 2013. I am able to relate to patients' experiences with cortisone injections, pain medication use and outcome expectations. It is a comfort knowing that their physician has been there and is speaking from firsthand experience.
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