Due to liability issues and coverage amounts, most personal injury patients that need surgery don’t have the option of having surgery. In those that do have the option to proceed, there are several factors that can make the difference between a patient having surgery and not having it.
Attorney reputation
The reputation of a plaintiff's attorney is important, especially in a surgical case. The patient will want to know that the attorney has handled these types of cases before and that he or she has the means, whether internal or external, to litigate these cases to the end. The surgeon will likewise want to work with an attorney that can take a case to its finish. Most surgeons will avoid attorneys that have a reputation for quick and low settlements because these settlements will often leave most medical bills unpaid. The surgeon will want an attorney with a reputation for reasonably paying most medical costs.
Physician reputation
Physician reputation is also important. Obviously, the patient will want a surgeon who is known for doing good work. The doctor should be experienced in his field and should have the appropriate board certifications pertaining to his specialty. For an attorney, it will be important to work with a surgeon that is known for communicating effectively. No one wants to have a complicated patient they are trying to help, only to find out that the doctor’s office is impossible to communicate with. Calls should be returned promptly and reports should be thorough and prompt. Lastly, since most large cases will be litigated, the appropriateness of using the surgeon as an expert or obtaining testimony as a treating physician should be considered.
Conservative care
It’s also important that patients undergo the appropriate degree of conservative care prior to having a surgical recommendation. No one wants to feel like they are being whisked off to the operating room. Patients have a very high regard for conservative measures, especially chiropractic care. In fact, patient satisfaction with chiropractic care is often higher than their satisfaction with their MD. No one is going to want surgery unless they have exhausted what they consider to be generally more potentially satisfying and less invasive options.
It has also been shown in studies that patients simply want to exhaust other measures before considering surgery. In one major study, it was shown that patients were more likely to consider surgery if they had undergone therapy, been prescribed narcotics and had injections, without significant benefit. This is not surprising. A reasonable person will want to try more conservative options first. In addition, patients that fail the gamut of conservative options are more likely to be severe enough as to consider surgery.
The most minimally invasive surgery
Lastly, a reasonable patient is going to want the least invasive procedure possible while still obtaining a good result. Patients today are well informed and have access to medical sites on the internet. It is common knowledge that surgery has changed and that younger doctors are being trained to perform smaller procedures. While some of the information available to patients is unsubstantiated hype, a lot is not. Small surgical retractors and microscopes have made outpatient discectomy a reality. Radiofrequency rhizotomy has made the treatment of 80% of whiplash injuries a no recovery period outpatient procedure. Endoscopic surgery, now a mature procedure backed up by scientific evidence, can miniaturize surgeries we already thought were miniaturized, while obtaining similar results.
Conclusion
It’s important to get the personal injury patient the surgery that they need. Liability and limits allowing, attorney and physician reputation, an appropriate course of conservative care and the least minimally invasive option will go a long way to helping patients get the surgery they need.
Wellington Yueh, MD
The views expressed are the personal views of the author and do not represent the views of The Brain, Spine and Joint Group, its managers, affiliates, partners, employees or its clients. Furthermore, the information provided by the author is not intended to be expert or legal advice.
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