Something that I have noticed in orthopedic clinic is the importance of taking time to simply talk to patients. I find that most patients want to know that their doctor has considered all the options for their diagnosis and treatment.
For people with arthritis for example, there are really only three basic treatment options. Generally, you start with an NSAID like aspirin or ibuprofen. This will usually treat the pain of arthritis, but not the underlying cause so inevitably it will worsen. Therefore, the patient will often come back to the clinic, and you will then give them a corticosteroid injection into the joint. This will decrease some of the pain and lasts a lot longer (months instead of days/hours), but again the disease will inevitably worsen and they will come back. At this point, if their arthritis is still bothering them it is almost inevitable that they have end-stage arthritis. The doctor will take an x-ray, confirm this diagnosis, and recommend a total joint replacement surgery. And this is when the patients react in shock.
Medically, this progression of treatment for arthritis is acceptable, appropriate, and evidence based. However, from an outside point of view it may seem crazy to jump from taking over the counter pills to surgery. Surgery comes with many emotional biases and fears; patients often find it hard to accept that it is the best option for them because it seems so drastic.
This is why it is so important to present information in a digestible and logical way. It is important to spend time with patients and explain the thought process behind medical decisions. Many patients come into the orthopedic clinic for a second opinion, because a doctor told them that they needed a surgery and the patient did not believe it. They all generally echo similar sentiments – that they felt that the previous doctor did not spend enough time looking at their case, or that the doctor is just pushing them into an unnecessary surgery in order to make money. It is hard for anyone to trust a stranger; it is our responsibility as medical professionals to earn that trust.