Why It’s Important to Manage Surgical Patient Expectations
Unprofessional behavior contributes to poor postoperative outcome
Informed consent is one of the most talked-about aspects of medical care, especially in a surgical practice. An important component of an effective informed consent process is managing patient postoperative expectations. When an injury or medical condition limits a person’s daily activities, patients often pursue surgical intervention with the intent of improving or returning to their pre-injury or pre-condition status regarding physical activity, strength and range of motion. These may or may not be realistic expectations.
Unmet postoperative expectations can create the illusion that the procedure was performed below the standard of care, especially if the patient is not satisfied with their postoperative recovery. Informing the patient before any procedure that they may not return to their previous activity level or abilities can help mitigate potential dissatisfaction with surgical results.
Some injuries, conditions and subsequent surgical repair can permanently affect a patient’s abilities, pain level and daily life. An orthopedic procedure that results in 65% improvement to the patient’s range of motion, for example, may be considered a success in the surgeon’s eyes. However, the patient may have expected that they would be back to their pre-injury abilities, so they viewed the surgical treatment as a failure. Even when the outcome is successful, and the standard of care is met, the patient may still perceive the surgery as unsuccessful, because they did not have reasonable postoperative expectations.
A successful surgery to repair cartilage tear …
In one case, a 25-year-old woman, who was an avid runner, lifted weights four times a week, played recreational softball and volleyball, and participated in many 5ks and half marathons, sustained a tear in her knee cartilage. The orthopedist recommended arthroscopic surgery as her best option to shave off the damaged cartilage and smooth out the head of the tibia to relieve her pain. Anxious to return to her prior level of activity, the patient quickly agreed to the procedure. The arthroscopy was performed without complication and the patient had no recurring symptoms upon recovery.
… leads to patient disappointment and dissatisfaction
At her final surgical follow-up appointment, the orthopedist gave her a pamphlet on walking groups in her community and told her she might enjoy participating in one of them, now that running was out of the question. The patient was startled and confused, and immediately thought something had been done wrong in the performance of her arthroscopy. She questioned the orthopedist, who informed her that this was the outcome they discussed. The young woman had no recollection of this discussion, as it would have struck a chord with her desire to remain active.
She left the appointment feeling angry and dissatisfied. She did not understand that her injury and need for surgery had left her unable to run. She sought a second opinion at her own expense. The second orthopedist echoed the first orthopedist’s assessment of her abilities postoperatively. The patient stated she would not have had the surgery if she knew this was the potential outcome.
Upon review of her medical records, there was no documentation of the reduced ability to run after the procedure and recovery. No malpractice claim was ever filed, but the woman was very vocal in her dissatisfaction with the surgical care and the permanent consequences that she felt were not effectively communicated prior to the procedure.
Our review of Constellation surgical malpractice claims indicates that 79% of surgical allegation claims have a contributing factor of technical performance issues, including known risks and complications of a procedure and almost a quarter of claims (23%) also have a contributing factor of patient dissatisfaction with care. That means even though a known risk or complication of a surgical procedure occurred, a patient still felt that the care was negligent and filed a malpractice claim. This indicates an opportunity to improve the informed consent process.
Improving the informed consent process to effectively manage patient expectations
The cornerstone of informed consent is effective communication between the treating clinician and the patient. This communication should include:
- Information on the proposed treatment or procedure and the related risks, benefits and complications
- Potential alternative treatment options and the associated risks, benefits and complications
- Risks arising as a result of no treatment
Important items to address when discussing proposed surgical procedures and managing patient postoperative expectations are:
- Postoperative pain or discomfort level
- Activity restrictions, and for how long
- Physical therapy expectations for the best recovery
- Projected improvement in physical symptoms, such as:
- Range of motion
“Informed consent goes far beyond a signature on a consent form; it is a process of ongoing conversations that are held at critical points in the surgical care process.”Traci Poore, Constellation Sr. Risk Consultant
By including reasonable expectation management into your informed consent process, patients can realistically anticipate pain, discomfort, time for healing, and abilities during and after the recovery process. By letting patients know what to expect prior to surgery, you avoid creating an illusion of failure or wrongdoing when the patient is faced with symptoms or limitations they did not expect.
Documenting these conversations allows for easy reference to the original conversation with the patient if they come to you with questions. You can gently remind them that what they are experiencing is normal and expected with the procedure they had. By taking the time to give patients a realistic picture of what their life may look like after a surgical procedure, you foster a relationship of trust and open communication. Not only can you reduce the risk of patient dissatisfaction from surprise or disappointment, but you also help the patient see that even when improvement isn’t 100%, treatment can still be considered successful.
Sign in or register at ConstellationMutual.com and navigate to Risk Resources > Bundled Solutions > Surgery and Anesthesia to access the Informed Consent Risk Management Guide and other tools to help improve surgical processes in your organization.
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