by Elizabeth Hofheinz, M.P.H., M.Ed., December 5, 2019
Sometimes, reality is overrated.
If you are a 47-year old with chronic back pain, then you
are really looking for a new reality. And in comes the highly recommended spine
surgeon in the authoritative-looking white coat who is going to solve
everything. 
But there is a downside to the traditional reverence that patients have for their physicians.
Having cared for thousands of patients, Alex Vaccaro, M.D., Ph.D., M.B.A., president of the Rothman Orthopaedic Institute, knows much about the labyrinthine world of patient expectations.
How do surgeons get into trouble when it comes to patient expectations? At what point does communication break down?
Dr. Vaccaro told OSN, “I have seen some orthopedic surgeons, especially young ones, try to be all things to all patients. This can occur when an anxious patient pushes the idea of surgery. But if your clinical instinct tells you that despite the presence of a surgical pathology, that person is not likely to get better for whatever reason then you should say, I’m sorry, but I with surgery cannot help you.” Always give them realistic hope that symptoms may improve with other nonsurgical strategies.
Are surgeons actually being bullied or belittled into doing surgery?
“It happens all the time,” says Dr. Vaccaro. “And if the patient is not satisfied with the surgical outcome then the surgeon is the culprit. Apart from trauma patients in the ER, if you do not connect well with someone and have good communication, then you should refer that person. A sense of rapport that lasts is vital.”
“Even when you are under the impression that you are communicating clearly with a patient, they could be missing what you are trying to convey. If there is a perceived lack of clarity on their part, then I often have patients repeat what I have told them. I actually on my consent have typed out what I say and think is vitally important and give it to them so that they can initial the important statements. I refer them to reputable online sites, my PA talks to them, etc. Basically, you need to do everything possible to ensure that you, the patient, and the family members are all on the same page.”
Don’t underestimate the value of rapport building in managing expectations, advises Dr. Vaccaro. “The literature indicates that patient expectations are an independent predictor of clinical outcomes. In order to get patients to where you want them to be as far as expectations, you must truly connect with them. If they believe that you care and you do, then they are more likely to get on the same page with you.”
And while surgeons have a cadre of powerful tools to work with, most of them are not psychic. “Sometimes,” notes Dr. Vaccaro, “despite the surgeon’s best efforts, patients hold onto the idea that they will be 100% in all areas following surgery.”
Dr. Vaccaro’s final advice?
Underpromise results and overemphasize the possibility of complications.