Doc… “Do I need Surgery ?” #InformedChoice #PM #WhyPM

Saw a fairly active middle aged patient this weekend in the office…

Fairly straight forward case, went to push off, felt a pop around the ankle.  Looked back to see who shot them (typical story). 

Diagnosis… Achilles Tendon rupture.

We discussed the alternatives available…. plenty of research supports both non-operative as well as operative management of these injuries. We used a few decision making aids.  But It boils down to :  Surgical group has higher risk of infection (which can be a nightmare in this area) and the non-surgical group has a higher risk of late re-ruptures.  It doesn’t get more exciting…that’s it.    Both groups share certain risks… blood clots, etc.

20 minutes after discussion began…. the questions was put to me.  “Do I need surgery?”  I don’t know, do you? “Doc, I need you to make the decision for me.”  Let’s go over the facts again.  So we did… and in the end the patient opted for non-operative management.  Is this an informed choice success?  I think so.  I’m sure there are those who will disagree…. but the patient had the facts (evidence based), they took into account their lifestyle and values… and came to what I thought was an appropriate choice. 

The patient spent the rest of the weekend talking to their friends who ALL had surgery for their achilles ruptures (most were not offered non-operative mgmt)… so now the patient is re-thinking their decision.    

 

Oh well…. to be continued

 

Advertisements

About hjluks

A busy Academic Orthopedic Surgeon, Digital Strategist, Chief Medical Officer and father... intently and efficiently navigating the intersection of Social Media and Health Care.
This entry was posted in Uncategorized and tagged , . Bookmark the permalink.

2 Responses to Doc… “Do I need Surgery ?” #InformedChoice #PM #WhyPM

  1. rbalboajrmd says:

    I admire the way you practice medicine. I visited your website and agree with your philosophy of informed consent, evidence-based care.Would you be willing to serve as a consultant for my HelloHealth-powered practice?

  2. Howard Luks says:

    It would be an honor to serve as your consultant…. feel free to email me at luksh AT wcmc DOT com if you like.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s