No, No, Not This Leg !

So what do you make of the photo above? Well, what if I tell you this was my patient in the pre-op area of Georgetown University Hospital who wanted to make sure I did the bunion correction on her correct foot? …and what if I told you she was in the healthcare professional world?

Well, first, I assume you might think this patient is a bit crazy, or perhaps even obnoxious. You might also be concerned that she is trying too hard to get into the middle of your business. In reality, this patient was an absolute riot and we had a lot of fun with her and the obvious pre-op antics that you see pictured. However, some in our profession are very offended or even intimidated by ‘involved’ or ‘overly-inquisitive’ patients. For example, in deciding on the appropriate bunion correction for your patient, many would say that it is your job to decide for the patient exactly which procedure they need. While I don’t totally disagree with that sentiment, I prefer the role of educating the patient on the top 2 or 3 procedure choices and then arriving at a treatment decision together. This allows several important benefits: 1. The patient takes an active role in their care and their decision making, 2. the patient will have a much better understanding of what you are planning and why, 3. it forces you to carefully review the pros and cons of each procedure option, and 4. it makes the patient less likely to blame you for a long post op course (they picked it).

This type of patient-involved decision making can certainly have its down sides, AND there are certainly many patients who really are not in a position to make a decision for themselves. In cases where the patient’s education level, maturity, or emotional status do not permit them to be as involved in the decision making, then I certainly feel comfortable informing them of the recommended treatment plan and they can agree or choose not to proceed. In most cases, however, I feel very strongly that our job is to educate patients on the various options for their particular pathology so that they can make an appropriate choice.

What is your take on this? Any nightmare stories on either side that you would like to share?  Ask your Residency Director and Attendings whether they TELL THE PATIENT what procedure they will do or INVOLVE THE PATIENT in the decision making...and write into us to let us know.  Let s start an online discussion about this important issue...

Any stories, feedback or questions about the experiences that you've had in your residency program?  Let's make this forum more interactive. We're not looking for gems here...just the sharing of your personal experiences.  Please share your comments by sending a note to jsteinberg@podiatry.com

John S. Steinberg, DPM
Editor, PRESENT