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Treating Patients in the Context of Their Own Stories

Op-Med is a collection of original articles contributed by Doximity members.

Dr. Lisa Friedman is a 2020–2021 Doximity Research Review Fellow. Nothing in this article is intended nor implied to constitute professional medical advice or endorsement. The views expressed in this article are those of the author and do not necessarily reflect the views/position of Doximity. 

Joint arthroplasty is a reliable surgery that has a high rate of relieving pain and restoring function. However, even given a technically well-performed surgery, sometimes a patient continues to have significant problems post-op. In a randomized controlled trial, Geng et al. compared clinical outcomes and patient satisfaction (at six months and two years post-op) in patients with depression who underwent total knee arthroplasty. The patient population was divided into two groups: intervention (patients received perioperative psychological intervention) and control (patients did not receive intervention).

At six months, the investigators found that 88% of patients in the intervention group were satisfied versus 62.5% in the control group. Clinical outcomes also showed greater improvement in the intervention group than in the control group, with zero patients in either group experiencing any complications.  

This is an elegantly designed study that investigates an often-overlooked possibility for why patients may have a poor outcome despite a technically well-performed surgery. With trends in medicine toward value-based care and an increased emphasis on satisfaction, such findings are important. We cannot afford to overlook any external contributing factor that may impact outcomes, particularly if they are modifiable. 

 Too often, we see our patients as a collection of body parts. Surgeons are often so subspecialized that it can be challenging to see patients’ needs beyond the exact problem for which they are being treated. Patients can be reduced to their procedures — as in, “I’m doing three knees today.” Such thought processes can be helpful for communication purposes (e.g., deidentification reinforces patient confidentiality), but also risk dehumanizing patients. 

The reality is that the specific medical condition for which a patient seeks care cannot be separated from who that patient is as an individual, as a member of a larger community, and as a person with a unique set of medical comorbidities. With this study, Geng et al. demonstrate that these factors contribute to the success of our orthopaedic interventions. It is my hope that this research inspires a team approach to orthopaedic care, utilizing the expertise of many health care professionals to maximize outcomes for patients. Our goal must be to empower patients and treat them in the context of their unique stories. 

Lisa G. M. Friedman graduated from Case Western Reserve University with a medical degree and a master's degree in bioethics. She is currently the orthopaedic trauma research fellow at Geisinger Medical Center. Her interests include shoulder and trauma surgery, and she enjoys creative writing and playing sports in her free time. Dr. Friedman can be found on Twitter, @Shoulder2LeanOn. She is a 2020–2021 Doximity Research Review Fellow.

Illustration Collage by Jennifer Bogartz / GoodStudio / shutterstock

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