Do we know too much?

[ajj1001]

Interesting to read a surgeons perspective on "educated" patients. I wonder what the way forward of having so much information available to lay people is?

Self-educated patients: A problem facing the medical community
By Per Kjaersgaard-Andersen, MD
ORTHOPAEDICS TODAY EUROPE 2010; 13:3
Per Kjaersgaard-Andersen
Many patients who come in to our offices today are frequently well-educated on the diseases and conditions that affect them. It would have been a rare occurrence 2 decades ago for a patient to come to the outpatient clinic with an acquired knowledge about treatments and outcomes and expect to have a frank debate with the physician on the suggested course of treatment. These new, self-educated patients are clearly a result of widespread Internet access and the routine availability of scientific knowledge and medical news. However, along with that accessible wisdom is the availability of a plethora of false and/or misleading information.
Being a hip surgeon, I recently had a patient who saw a televised report of a new “sports hip replacement.” He then found information on the Internet about hip resurfacing and all of its benefits. He even had read promotional materials from local private hospitals on how hip surgery “should be done” and, therefore, asked me to perform his surgery with a minimally invasive technique, even through a specific approach.

Experimental procedure

The patient is a physically active 46-year-old farmer, who suffers from severe coxarthrosis and certainly a candidate for hip replacement.
However, in my clinic we still consider hip replacement with the resurfacing technique as partly experimental compared to the standard total hip replacement. This also is the position of the National Health Institute, therefore The Danish Hip Arthroplasty Register must be provided with detailed annual reports on the outcome and survival for this implant. I provided all of this information to my farmer patient and gave him the recognized risk factors of undergoing hip resurfacing arthroplasty.
I told him that due his body mass index it was impossible for me to promise to perform the surgery through a small, muscle-sparing approach as he wished. Although I gave him detailed and specific information on all aspects of the surgery and why it may not be best for him, he was convinced by what he had read on various Web sites and decided to look for another hip surgeon who would fulfill his requirements.
New challenge

We have to learn how to interact with and educate our patients about the information they gather from the Internet. As we see greater numbers of younger and more demanding patients, we should never give up our professionalism and offer our patients a menu-item list of the currently most popular procedures.
The complexity of orthopaedic surgery allows it to be, at the same time, standardized to follow strict techniques and protocols and individually tailored to suit each patient’s needs as when a single joint, or portion of a joint, needs to be replaced. Therefore, our clinics’ Web sites should not only provide information on diseases, techniques and implants, but also on results, complications and the potential risks of having surgery performed.
We must be ready and able to teach our patients through our Web sites, before they even enter our outpatient clinics. By using this method of information sharing, our patients will know what we can do for them and, maybe of more importance, what we cannot do for them. This may potentially direct patients away from your clinic, but will also keep you from the dilemma of having to convince a patient against his or her wishes of having an operation that may not be a primary choice, and one that may give him or her a reason to pursue legal actions for their unfulfilled expectations.

http://www.orthosupersite.com/view.asp?rID=59932

[Katie]

Interesting article, Alison. Thanks. I wonder just how much education he would give his patients if they came in knowing nothing. "We must be ready and able to teach our patients through our Web sites, before they even enter our outpatient clinics"

I guess I am somewhat cynical, having run into so many surgeons who did not want to spend any time explaining my options, and instead just telling me what was best without any room for questions of any kind. Any inquiries have been met with anger...how dare I question their expertise.

My first surgeon told me to go home and just take more drugs, that he saw half a dozen patients like me every day and there was no other treatment available. When I finally discovered ADR and excitedly asked his opinion, he told me that it was the most ludicrous thing he had ever heard, and that I was not a car and able to get new parts.

When I pointed out that people were also getting hip and knee replacements, he paused and said that yes, they were 'somewhat successful'. That's when I knew I was talking to a dinosaur, someone who would never want to learn anything new.

Strangely, except for one other, it has only happened here on my home turf. When I drove six hours south to NY, I was able to have an intelligent conversation about my options with a very well educated surgeon. The same with every other out-of-country specialist. When I asked the last surgeon here at home why that was, I was told that the 'foreign' doctors were overly aggressive and took too many risks.

In my opinion and experience, overly conservative surgeons give us too few options and seem to have more fragile egos. I don't go into an office knowing I'm right, only knowing that there is more than one way to skin a cat and would like to be able to discuss what is best for me.

Sorry for the mini rant. It just brought back memories, years of frustration. Without the internet and our new ability to learn about our options, I never would have known about spine surgery that has been commonly used in Europe for over a decade, mainly with great success

This article is right; we might travel elsewhere and get treatment that may be more risky, but at least we now have a choice.

[Justin]

Thanks, Alison. I saw this article yesterday. Providing quality, peer-reviewed information for Spine Patients is important to the Spine Patient Society and is, in fact, part of our Mission. There is a lot of "misinformation" on the Internet, especially regarding new procedures. We hope that our Patient Education resources here at the Spine Patient Society provides Spine Patients with reliable, timely information.

See the Spine Patient Society Education Section, which includes educational resources in written and video formats: Spine Patient Society Educational Resources.

[Katie]

I have to add that I do see both sides of this article. There always will be those for who a little bit of knowledge is dangerous, and I'm sure I fall into that category myself at times.

"we should never give up our professionalism and offer our patients a menu-item list of the currently most popular procedures"

Of course this would be wrong. There is no way that every surgeon has the skills to address each and every problem. What I hope the specialists could learn to do is direct the patient to the best doctor possible for their specific case, if they are unable to do it themselves. There are more than enough patients to go round after all, to fill their schedules.

Justin you are so right. Finding the right sources of information is the key, and you are doing a wonderful job at providing one. Thanks again.

[ajj1001]

It did make me think about whether I consider myself too much of an expert when deciding on the best treatment. However in the UK's healthcare system there is very little choice and access to exactly what you want. This means that being informed and demanding seems to help redress the balance. You can then try to find a way to a consultant who might possibly offer you what you think might be the best option. Not an ideal system . My general practitioner has conceded that I probably do know more than him so takes my recommendations into account when treating me !

[dalhousie]

On balance, I don't think we do know too much . Unfortunately I think you have to educate yourself & research in order to get a good long term outcome. In my immediate local area there is only fusion available not ADR. From what I can gather recently, they mainly do fusions for leg pain & not back pain. Different consultants offer different technologies & it's only as an informed patient that you can ask about the feasibility of other options plus some specialists are more open with the information they give than others.

At 34 the first spine specialist I saw & 2 pain consultants told me never to have my spine fused & didn't seem pro surgery at all so what was I supposed to do when conservative management was failing - just spend the rest of my life lying in bed at home getting over flare up after flare up. I did nothing for a while as I didn't know what to do or who to go & see but all in all I wasted 7 years of my 30's with no quality of life, just existing.

I agree with you Katie I don't reckon to know it all by any means but would like to discuss the best options available to date. It's too risky not educating yourself - your health is your responsibility.