By Michael A. Sonkin, Esq. And Samantha E. Shaw, Esq.
Surgical indications can be divided into different categories.
Some procedures are urgent/emergent and may be required for treatment of acute or even life-threatening conditions. There are also elective surgeries that are necessary but can be scheduled at the patient’s convenience and which may be expected to improve the patient’s quality of life. Hip replacement surgery in particular can fall into either category depending on the patient and whether the procedure is secondary to a chronic condition, such as arthritis, or the result of an acute condition, such as fracture.
Hip replacement procedures, like many other surgeries, also result in different levels of patient satisfaction, from those whose expectations are completely met to those who experience difficulties potentially greater than the initial indications for the surgery. Regardless of the reason for the hip replacement, or any orthopedic surgery, an orthopedic surgeon should not only discuss the risks, benefits and alternatives of the proposed procedure, but also elicit and address patient expectations.
Managing a patient’s expectations should be prevalent across most medical fields, but it is particularly important in connection with non-emergent hip replacement procedures where patient dissatisfaction is more likely to arise. The word “dissatisfaction” is identified intentionally because we are not referring to complications arising during or after surgery. Rather, we are focusing on instances where the hip replacement surgery was performed within the standard of care, but the patient is still dissatisfied with the outcome, such as a resulting leg length discrepancy. While the goal of such a surgery would be to achieve equal leg lengths at the close of the procedure, it is not always feasible in the context of the overall surgical goals.
Start the Conversation Early
At the forefront, a patient’s expectations should be ascertained and assessed well in advance of surgery, if possible. Too often, patients become focused on pursuing a potential medical malpractice lawsuit because they experienced an outcome that did not meet with their preoperative expectations for recovery and restoration of function. These expectations and whether they will be attained or not are typically part of an informed consent discussion. It is recommended that particular focus be given to whether the patient is demonstrating unrealistic expectations for the outcome of their surgery, and taking steps to educate them as to the likely outcomes they will achieve.
When conducting a discussion of the proposed surgery, including the patient’s goals and realistic expectations, it is important for such discussions to be conversational. As the physician, it is beneficial to establish your expectations for the surgery, including the recovery phase, short-term restoration of function and long-term prognosis. To help manage your patient’s expectations, it is important to also allow the patient to verbalize what they expect and to provide feedback to address any misconceptions they may have.
In managing expectations, it is often important to remind the patient that of their impaired baseline condition that is leading to the surgery. While a fully restored level of function without pain or discomfort may be the patient’s goal, that patient must be educated on the range of potential outcomes, including those that will fall short of their expected and/or ideal result.
Since hip replacement procedures are commonly performed, nearly everyone knows a friend, family member, colleague or acquaintance who has undergone the procedure. While it may seem obvious for those in the medical field, it may be beneficial in managing a patient’s expectation to remind the patient that no two surgeries are the same and no two surgeries are guaranteed to yield the same outcome.
An informed consent discussion will include references to the reasonably foreseeable risks of the procedure, but eliciting the patient’s expectations and addressing any misconceptions is also an important aspect of this dialogue. Too often, a patient’s dissatisfaction with the outcome of their surgery results in the pursuit or commencement of a lawsuit. Certainly patient dissatisfaction is not in and of itself grounds for a lawsuit, but too often it is a motivating factor. Thorough patient expectation conversations can both help to strengthen the physician-patient relationship and hopefully prevent unnecessary malpractice litigation.
Michael A. Sonkin, Partner, and Samantha E. Shaw, Partner, are attorneys in the Medical Malpractice Defense Group at Martin Clearwater & Bell LLP. For more information, visit mcblaw.com.
Source: MD News April/May 2021, Lower Hudson/Bronx Edition