{"id":298,"date":"2016-09-09T06:52:24","date_gmt":"2016-09-09T10:52:24","guid":{"rendered":"http:\/\/www.orthopaediclist.com\/blog\/?p=298"},"modified":"2016-10-23T10:52:04","modified_gmt":"2016-10-23T14:52:04","slug":"its-ok-to-do-the-right-thing","status":"publish","type":"post","link":"https:\/\/www.orthopaediclist.com\/blog\/its-ok-to-do-the-right-thing\/","title":{"rendered":"It\u2019s (More Than) OK to Do the Right Thing"},"content":{"rendered":"

by James D. Hundley, MD<\/h3>\n
\n

\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 As a retired orthopaedic surgeon, I miss the hallway consultations where colleagues discuss cases while trying to determine the best course for our patients.\u00a0 Fortunately I am still consulted from time to time and get to enjoy sharing ideas and opinions.<\/p>\n

A few weeks ago I was called by a young surgeon who was perplexed by what would be best for his patient, an elderly, emaciated, osteoporotic woman with end-stage Parkinson\u2019s Disease.\u00a0 She had suffered a displaced, four-part fracture of her proximal humerus from a fall.\u00a0 He had been taught that these need open reduction and internal fixation (ORIF) if the patient is to regain good function and felt obligated to offer that as a choice.\u00a0 When so offered, she had stated that she did not want surgery but would think about it.\u00a0 When he called me, he was dreading that she would call him in the next day or two saying she wished to proceed with ORIF.\u00a0 How should he respond?<\/p>\n

For me the answer was easy.\u00a0 Treat her with a sling and swathe until the acute pain had subsided and then begin gentle range of motion exercises.\u00a0 Sure, she would never regain function anywhere near normal but she could still use her elbow and hand to eat and for other similar activities.\u00a0 Even better, she could bypass the possibility of anesthetic complications and surgical ones such as infection, blood loss, loss of fixation, nerve injury, and so on.<\/p>\n

Being the one \u201cin the trenches\u201d, however, and having been taught that the proper treatment was operative, the decision-making for him was more stressful.\u00a0 He felt that the right thing to do was non-surgical, but feared that that would not be acceptable morally and could put him at risk for a lawsuit.\u00a0 That\u2019s when I reassured him by saying, \u201cIt\u2019s OK to do the right thing.\u201d<\/p>\n

I\u2019ve always felt that decision-making is the most difficult part of orthopaedic surgery.\u00a0 Sure, you must have a significant degree of core knowledge to understand the disorder and have an array of treatments at your disposal.\u00a0 Probably the biggest decision is whether or not to operate and when if ever to do it.\u00a0 If you don\u2019t do surgery, how else would you best treat the patient?\u00a0 If you do surgery, what is the best procedure?\u00a0 If you run into surprises during surgery, what do you do then?\u00a0 In every instance, the best decision is what is best for that particular patient at that particular time.\u00a0 Sometimes, \u201cdoing the right thing\u201d requires you to swim against the tide of current opinion and\/or what you learned during your training years.\u00a0 Over time, however, with personal experience and through seeing a variety of perfectly acceptable ways that our colleagues manage similar problems, we can and must learn to trust our judgment as to what is best for our patients.\u00a0 Thus, no matter which way the fads are pointing at the time, when you include the patient\u2019s wishes and do the right thing, it is always OK.\u00a0 In fact, it\u2019s more than OK.\u00a0 It\u2019s what should be done.<\/p>\n

Epilogue:\u00a0 In case you\u2019re wondering, the patient remained steadfast and decided to not have surgery.\u00a0 Had she requested it, I don\u2019t know what he would have done, but I\u2019ll bet he would have declined to do it.\u00a0 Thus, although the whole conversation was moot it was interesting and will hopefully help him the next time he is conflicted by what he thinks he should do vs. what he thinks others would have him do.<\/p>\n

Dr. Hundley is a retired orthopaedic surgeon with forty years of experience.\u00a0 He is also a founder and the president of\u00a0OrthopaedicLIST.com<\/a>, a free and open-access directory of orthopaedic products and services that was established in 2003 and currently lists over 10,000 products and services for orthopaedic surgeons and related professionals.<\/em><\/p>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

by James D. Hundley, MD \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 As a retired orthopaedic surgeon, I miss the hallway consultations where colleagues discuss cases while trying to determine the best course for our patients.\u00a0 Fortunately I am still consulted from time to time and get to enjoy sharing ideas and opinions. A few weeks […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5],"tags":[],"yoast_head":"\nIt\u2019s (More Than) OK to Do the Right Thing - OrthopaedicLIST.com Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.orthopaediclist.com\/blog\/its-ok-to-do-the-right-thing\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"It\u2019s (More Than) OK to Do the Right Thing - OrthopaedicLIST.com Blog\" \/>\n<meta property=\"og:description\" content=\"by James D. 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