Elizabeth Dennis, MD | Cory Smith, MD
May 5, 2021
You walk out and shut the door, exchanging pleasantries on the way. As the door shuts you panic. The patient on the other side of that door just heard you tell them that they will need surgery. The problem? You have never done that surgery!
There will be varying degrees of this scenario that play out throughout your career, so we may as well address it now. The procedure that you told the patient they need may be one that you have done hundreds of times in residency or fellowship, but never alone. Or perhaps it is one you have only seen, but never done. Either way, we will help you take the best care possible of this patient.
After an appropriate workup and failure of non-operative measures, surgery may be indicated. This is an important discussion with the patient after which he or she may have several questions. It is imperative at this point that we are honest with the patient while still maintaining their confidence and trust. Many patients will ask “how many times have you performed this procedure?” At this point, a response could be “During my training I have performed this procedure several (or X number of) times, however in practice I have not performed this procedure; I feel confident in my ability to provide you with the best care possible.” Depending on the relationship with the patient, patients may ask for a second opinion; however, considering the trust built into the relationship, patients may very well request you to do the procedure.
In anticipation of a case you have not done before, preparation is critical. The onus is on you at this point to make sure you understand the anatomy and pathology and make a plan for the case. All of the details from how much time you will need, equipment you will need and its availability, and staff you may want or need for the case must be accounted for and documented. Additionally, if you have partners who can help you with the case, make sure to coordinate schedules accordingly; be sure to make the patient aware of this. Finally, this process may take you some time, so maybe this case will need to be scheduled in a few weeks or more, and the patient and their problem can wait.
One of the most important caveats: ASK FOR HELP! Don’t let your pride get in the way of what the patient needs! Many of these scenarios will never reach the previous paragraph because the patient needs a very specific specialist – Oncology patients or Pediatric patients, or the more common option which is referral within your group to a subspecialized partner. Obviously, we want to take the best care of the patient first, and if this is not in your hands, then get the patient to the best hands you can find.
However, many cases will still end up on your schedule, so don’t be afraid to ask for help during your planning process. This may involve reaching out to colleagues within your group, residency, or fellowship faculty for advice, or even your colleagues from training. You may want to scrub or observe this case or a similar one with a partner or another physician who does this case frequently. You may even want to arrange for someone within your group to scrub this specific case or even the first few times you perform it. The orthopedic community is filled with brilliant physicians who want the best for patients but also for their colleagues and are happy to teach and assist whenever necessary.
Let’s flashback to the panicked surgeon standing outside the room. They pick up the phone and call their fellowship director who agrees with the diagnosis and indication for surgery. They give a few pointers on how to perform the case and what to avoid. The surgeon then reviews the anatomy and even watches videos such as those in the AAOS Orthopaedic Video Theatre and prepares a plan for the case. The day of surgery arrives, and the case is a success. Another patient is cared for, and the young surgeon’s confidence is soaring….at least until the office tomorrow.
DISCLOSURES: Dr. Dennis This individual reported nothing to disclose Dr. Smith This individual reported nothing to disclose.
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