What can a patient expect when they have you as a doctor?
I am a firm believer in sharing information and educating the patient to help make an informed decision. The spine is very enigmatic, and people often have misconceptions regarding the causes of back or neck pain. More importantly, treatment for common back issues is often grounded in unsubstantiated claims. My job as a spine surgeon is to present the facts, make the data understandable and allow the patient to decide what is best for them.
Thankfully, most of the time spine surgery is elective based. Typical neck or back complaints are benign and get better with time, regardless of treatment. It is only after failure of conservative measures (time, therapy, medications, or injections) that any consideration is made for surgery. More often, simple reassurance regarding the complaints is all that is needed to help a patient learn to cope with their discomfort.
My approach to a patient with new onset back pain is to describe the spinal anatomy and how different painful spinal parts can present themselves. Once the patient has a general understanding what is causing pain……we then transition to what treatment options are available. Conservative options are the first line of treatment. Most of the time the patient gets better with time. If a person has continued symptoms, even after conservative intervention, then maybe a surgery is a possibility. The decision really boils down to where is the pain coming from, is there a surgery option that addresses that problem AND how comfortable are we (doctor and patient) that the surgery will make a positive difference.
My responsibility as a surgeon is to present realistic expectations of what a surgery can provide. Cure is never a possibility. The degenerative changes (arthritis) of the spine cannot be reversed. Spinal surgery, for the most part, either un-pinches nerves (decompression) or stops a painful part from moving (fusion). If I feel comfortable with the patient’s presentation AND the efficacy of a surgery; we then discuss the surgery.
Oftentimes, I do NOT feel surgery is an option. Either the pain generator is not clear, or the patient’s expectations are unrealistic; in those cases, I will recommend against surgery. Pain is multi-factorial and surgery is not always a valid treatment. Many patients do not like to hear my opinion regarding intervention but honesty as to what a procedure can offer is paramount.
Ultimately, presenting the facts and emphasizing the risks and benefits of interventions are important in developing a trust between patient and surgeon. Trust goes both ways in doctor-patient relationship. No surgery is without risk or complications. If as a surgeon, one of my patients has an unexpected result, it’s my commitment to resolve the issue as quickly and efficiently as possible. I in turn, also expect the patient to be follow my recommendations and be honest with me regarding their actions. Successful surgery is dependent on both doctor and patient!!!!
Paul Saiz
