The best strategies to discuss complicated information with spine patients


Six spine surgeons share their best practices for helping patients understand complex diagnoses and treatment plans.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses.

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Question: What are your top strategies for communicating complicated information with patients?

Mark M. Mikhael, MD. Spine Surgeon at NorthShore University HealthSystem's Orthopaedic Institute and Illinois Bone & Joint Institute (Chicago & Glenview, Ill.): I take a four-step approach to communicating complicated information with my patients. First, I allocate the appropriate amount of time to spend with them, even if it means extending clinic appointments to make sure they understand all the information they need to know. Second, I incorporate as many visuals as possible to explain their condition and the best treatment option. In a multimedia presentation, I not only show them their MRI and X-rays but also a 3D model of the spine to further illustrate the complexities of their anatomy.

Thirdly, I point them to websites that have animations and videos showing their pathology and suggested surgery, so they can review the information in their own time and at their own pace. Finally, I ask them to summarize what I just told them about their condition and treatment, so I understand how they will explain it to family and friends. This is a good indicator of how well they absorbed and retained the information given. If there is misinformation, I correct and clarify the original points discussed. It is the last checkpoint to make sure patients fully understand this complicated information.

Richard Kube, MD. Founder and CEO of Prairie Spine & Pain Institute (Peoria, Ill.): I am a believer in parable and analogy. I believe using analogies that patients can follow to enhance their understanding and follow my logic is important. Also, pictures are worth a thousand words. I spend time reviewing the images with patients and also use spine models. When all of those tools are utilized, there is a good chance that the patient will have a reasonable idea of what is happening. Finally, ask if they have questions. Let the patient tell you which blanks they need you to fill and then do your best to fill them.

Vladimir Sinkov, MD. Spine Surgeon at New Hampshire Orthopaedic Center (Nashua): First and foremost, a clinician needs to establish trust with a patient by exhibiting empathy, compassion and simply being friendly during the visit. I sit down to make sure that I am on the same eye level with the patient. After gathering all of the information I need, such as history, physical exam, review of diagnostic studies, I ask the patient what they already know about their diagnosis or proposed treatment. This helps me to know where to start with my explanations and allows me to dispel whatever misunderstandings they may have already had about their condition.

I speak slowly, maintain eye contact when possible, use common words and employ a lot of visual aids, including patient's own X-ray/MRI/CT images, 3D models of spines and instrumentation I have in the room and sometimes my own drawings. After I have finished explaining the diagnosis and the proposed treatments, I give the patient an opportunity to ask questions to clarify anything I said. At the end of the visit I usually summarize everything we talked about and give them a pamphlet describing their condition and the proposed treatment to take home. All of this makes for a long office visit but the benefits of having a fully informed patient that trusts you as a doctor are completely worth it and make the rest of the interactions with the patient much easier.

S. Samuel Bederman, MD, PhD. Spine Surgeon at St. Joseph Hospital (Orange, Calif.): Many spinal conditions can be complicated for patients to understand. While many people can be confused by spinal problems, they can often be explained in very simple terms that are meaningful to patients. Different problems such as nerve compression, instability or abnormal motion, degeneration, muscular weakness and abnormal alignment can be easily explained in simple terms when we spend the time with patients. Once informed about their problem, the solutions recommended often make more sense. The better our patients understand their problem, the better they are able to manage it.

Brian R. Gantwerker, MD. Founder of the Craniospinal Center of Los Angeles: Utilizing surgical models and metaphors are very helpful. It is critical to watch how the patients absorb, or don't [absorb], the information. Go back over salient points and make eye contact. I also use their own films to illustrate surgical indications and what the goals are of the surgical intervention. I project the films onto a large screen TV and use the mouse pointer to show them the problem areas.

Payam Farjoodi, MD. Orthopedic Spine Surgeon at Spine Health Center at MemorialCare Orange Coast Medical Center (Fountain Valley, Calif.): I use analogies to get my point across. For example, I relate a disc herniation to a jelly donut which has been stepped on. By giving them a familiar object, I find patients understand their condition better. Additionally, I try to use visual aids when possible, such as spine models and the patient X-ray or MRI studies.

Finally, I have a prescription pad with my website, that has videos of most common conditions and treatments. I refer patients to these videos when they are diagnosed and whenever we are discussing surgery.

More articles on spine surgery:
5 predictions on the future of spine surgery from Dr. Richard Wohns
The key trends for independent spine practices in the US
What spine surgeons can do to fight the opioid crisis 

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