O U T P A T I E N T S U R G E R Y M A G A Z I N E O N L I N E | J U LY
I Cannot Tell a Lie
Sometimes it hurts to tell patients the truth.
W
e should always tell patients the truth, even when, as in
these scenarios, the news isn't what they want to hear.
• 'More arthritis than we bargained for.' Sometimes even the
most sophisticated MRI unit misses appreciable arthritis. What initial-
ly looked like a reasonable shoulder really has less mileage left than
my 1964 Studebaker. A patient who may have aspired to pitch for the
Yankees may have to settle for a mixed softball league. Thankfully,
underhand throwing is not just for sissies.
• 'We couldn't fix it all.' Many patients put off rotator cuff surgery until
their tissue quality approaches that of Kleenex. At surgery, at best we
can accomplish a partial repair and not fully restore native anatomy.
The patient needs to know that bench pressing is not in his future and
that his rehab is going to be longer than the turnover time at the
Veterans Administration OR. Patients usually find significant pain relief,
but when they return 6 months later and still can't lift a laun-
dry basket, they'll know why.
• 'We didn't really find much.' Some patients display many
signs and symptoms consistent with meniscus tear of the
knee, yet have equivocal imaging findings. After months of
rehab and exhaustion of every conservative
means possible, I'll sometimes recommend
arthroscopic evaluation just to be sure and
for closure. Sadly, on occasion, the findings at
surgery are meager at best. In surgeon parl-
ance, this is called a surgical "airball." The
presumed meniscus tear causing the medial
knee pain was simply not there and some
softening of the patella was the likely cul-
C U T T I N G R E M A R K S
John D. Kelly IV, MD
z SCOUT'S HONOR It's sometimes
easier said than done to come
clean with patients and families
after surgery.
