Hi, I'm Dr. John Shim, and today I want to play the role of a patient.
The truth is doctors and doctors' families have the same medical
complaints like everyone else. On a weekly basis I have family members or
friends approached me about spinal issues and inevitably some have been
given the status of candidate for surgery, but what does that exactly mean?
How would I as a spinal specialist approach that status for either myself
or my family? This might be a complicated discussion, but I want to try to let the
audience the viewers understand my thought processes on how I, as a spinal
specialist and a spinal surgeon, would decide major medical decisions for
myself, my family, or my closest friends. First of all if you have a
life-threatening or limb-threatening problem get yourself to an emergency
room and call your doctor. Now is not the time to be surfing the web or calling
around for information. Full stop - go call your doctor. Go to the
emergency room. Do it now. For the rest of the viewers let me tell you how i will
make the decisions for myself or how I would advise my family members. I always
start with this question: what makes me a candidate for surgery? Understand the
term candidate is often used when a patient has some complaints and some
testing results that indicate a surgery might be performed or may be performed.
It really doesn't define anything more. It doesn't mean you need the surgery or
that the surgery will always be beneficial. To give you some examples
it's an accepted principle that up to 80% of people will have significant
episodes of spine pain sometime in their life. After age 40 about half the
population has MRI findings that can make them the quote
candidate for surgery. In reality less than 1% of the US population has surgery
each year. So, for me and my family elective spinal surgery has always been
a very difficult choice for me I need to determine if the
complaints matched my physical exam findings. I need to know and confirm that
the diagnostic testing identified are also consistent with my complaints. Then
I need to be convinced that I exhausted all non-surgical options. The final and
most difficult part is to basically guess how many other factors have
contributed to my complaints and would those factors diminish the chance of a
successful outcome. I need to know what would be the best case scenario after
surgery and I need to know what is considered success for the recommended
operation. If I decided to pursue surgery I have to also understand that the
benefits would outweigh any potential risks. These are very hard things for
anyone in pain to truly assess. I need to understand if my goals as a patient was
actually the same goal as the surgeon. May seem very strange but many times the
goals may be different. If my goal was to be active but I define active as being
able to do things like when I was 25 I'm gonna be very disappointed. I will be 58
this year - I cannot expect that the operation will allow me to act like I'm
25. If the goal of the surgeon was to fuse my spine and it fuses then the
surgeon achieved his goals but if my goal was to be pain-free and my goal was
not to have any discomfort, then my goal may be disconnected from the goal of the
surgeon. The surgeon may say he'd get a successful fusion, but I'm gonna complain
that I'm not really pain free. So, there'll be dissatisfaction. When I'm in pain I
really also cannot assess the risks properly.
Let's be totally frank, the larger spinal operations have the higher
complication rates and a smaller chance of success. Even the smaller operations
cannot be a 100% guarantee. If I'm going to consider surgery I have to ask myself
do I understand the risks and am I prepared to accept complications? Am I
prepared to be even worse after the operation? While I need to be confident
things will improve I must also accept that there is a possibility it may not turn
out that way. That's why if I was going to have surgery I will do everything
else first before deciding to have an operation. I will have a deep
conversation with myself before committing to the operation. I really
need to take desperation out of the decision process. I know - this is all very
hard, but in the end I'm the one getting the operation, I must be confident the
diagnosis is right, I must be certain that the surgical procedure is the best
for my situation, and I must be also confident that I've tried everything
else. I must also understand that I have to be realistic with my goals, and I need
to accept that there are complications or potential that the outcome may not be
as good as I thought. I need to understand that this is an exercise of
what's called risk management. You have to weigh the benefits to the potential
risks. This is a discussion of transparency. If I'm the patient I have
to be transparent with myself. I need to understand what I'm trying to achieve,
and I need to understand if it's realistic and can the surgeon get me a
reasonable chance to get to that goal. I have to have a long discussion with
myself and my family before I pursue the surgery because it's very very important
that we all understand it. I hope I didn't scare anyone from making the
decision to have surgery. I just wanted to share what I would do if I had to
make a surgical decision for myself or my family.
This is Dr. John Shim, discussing how I would approach surgical decisions for
myself or my family. Thank you for listening.