Data Proves Correlation Between Depression, Anxiety, and Disability
By Howard J. Luks, MD
Most of my time as a surgeon is not spent in an operating room, or preparing for an operation. Most of my day is spent listening, teaching, examining, educating, and empathizing. From the information I gather, I determine whether surgery or any number of surgical alternatives are best for a client. As I’ve said for years, I treat patients and not MRI results.
We all have goals, values, and lifestyles that define us. Injuries have their own personality that define them. The same injury or medical issue manifests itself differently in every individual. An ACL tear in a very active 45-year-old triathlete is a different injury than an ACL tear in a 45-year-old obese diabetic.
Effects on quality of life are unique to the individual before me. Unless I dive into how the issue is affecting you I cannot come up with an effective, customized treatment plan. Your goals and lifestyle may be the difference between a treatment plan that calls for surgery versus one that calls for surgical alternatives.
My goal and job is to simply try and improve your quality of life. This can usually be accomplished if I listen, educate, and offer solutions with realistic achievable goals for your particular problem.
Patients are in our office because they are in pain. Many are also scared and worried. Because of pain, they will have loss of function and thus their injury becomes a quality of life issue. They are worried surgery might be the only answer, but that is not always the case, for there are numerous surgical alternatives. They are worried they are broken and will never be normal again.
Treatments Incorporate the Past, Present, and Future
- Past: Genetics. Degeneration or aging occurs and your DNA plays a large role. Together, we can move past it and work to find a solution.
- Present: I’m hurt now. What can we do to restore function and minimize the pain I have? Is this the new normal? Am I broken? Just because something is torn, does not mean there are no surgical alternatives.
- Future: How today’s choices affect my future? Can I get by with one of the surgical alternatives? Many people who choose to have surgery do so because they are afraid of what will happen if they do nothing. Many do not understand the natural history of degenerative or traumatic conditions. Education plays a HUGE role in your care. Surgery to prevent something which may or may not occur is often a poor choice.
Patients can’t help but ask, “Am I Damaged? Is my injury a normal consequence of aging? While I ever be normal again?” Many will need to get past the fact something is torn or wearing out, and for some, surgical alternatives may lead them to a long, active, and healthy life.
Treat People Not the MRI
Imaging technology is wonderful, but it is only a small part of the information put together to determine your most appropriate treatment. Imaging studies only provide us with a small piece of data from which we need to construct an appropriate treatment plan. Relying on imaging studies alone means far too many people will be over-treated for a condition that didn’t need anything but a brief education about the natural history of their orthopedic condition.
If I need an excuse to operate on someone, I just need to get an MRI. Almost no one has a “normal” MRI. MRI’s are used far too often. But it is much easier to order an MRI than it is to talk to someone about why they do not need one. If you see a physician who takes the time to explain why further tests are not needed you might have a great doc before you.
An MRI can possibly complicate the problem. We are an over-diagnosed society. More than half of all MRIs do not need to be obtained. If we MRI 100 people without knee pain, many MRIs will show tears or arthritis. If we MRI 100 people with no shoulder pain beyond 40 years of age, there is a substantial chance of having a rotator cuff issue. So … there is a good chance that the changes seen on your MRI were likely there before your “injury” and thus may not require aggressive surgical management.
Far too many of you will be treated for findings which were predictable simply because you were lucky enough to reach your age.
Often times, less is more.
Right Time, Right Person for Surgery or Surgical Alternatives
When your symptoms rise to the point that something needs to be done I will be there to offer you surgical alternatives if there is a realistic chance they will work and have the potential to meet your expectations.
Sure, there are orthopedic issues that will rise past the threshold of requiring surgery. Some conditions will not get better on their own. You never cease to amaze me in the ways you find to injure yourself.
The question to be asked is not can I operate to address your issue; the question is should I? Surgery is not always the answer and in some instances it can make your issue and quality of life worse. But if the right injury in the right person is addressed by the right surgeon in the right manner—a happy and satisfied patient should emerge from our interaction.
Often in medicine, and certainly in Orthopedic Surgery, less is more…
Sometimes it’s best to talk and do nothing more.
Howard J. Luks, MD
A Board Certified Orthopedic Surgeon in Hawthorne, NY. Dr. Luks specializes in the treatment of the shoulder, knee, elbow, and ankle. He has a very “social” patient centric approach and believes the more you understand about your issue, the more informed your decisions will be. Ultimately your treatments and his recommendations will be based on proper communication, proper understanding, and shared decision making principles—all geared to improve your quality of life.
A version of this article originally appeared on Howardluksmd.com.
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