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Letters to the Editor to:

Scientific Articles:
Pamela L. Hudak, Kristy Armstrong, Clarence Braddock, III, Richard M. Frankel, and Wendy Levinson
Older Patients' Unexpressed Concerns About Orthopaedic Surgery
J Bone Joint Surg Am 2008; 90: 1427-1435 [Abstract] [Full text] [PDF]
*Letters to the Editor: Submit a response to this article

Electronic letters published:

[Read Letter to the Editor] Unexpressed concerns: time constraints, informed consent and surgeon grade
Ziad Harb, Koushik Ghosh and Quamar Bismil   (26 August 2008)
[Read Letter to the Editor] Addressing the Unexpressed Needs of Older Patients: Making it Multidisciplinary
Dorothea Z. Lack   (28 July 2008)

Unexpressed concerns: time constraints, informed consent and surgeon grade 26 August 2008
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Ziad Harb,
Senior House Officer in Trauma & Orthopaedics
St George's Hospital, London,
Koushik Ghosh and Quamar Bismil

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Re: Unexpressed concerns: time constraints, informed consent and surgeon grade

ziadharb{at}doctors.net.uk Ziad Harb, et al.

To the Editor:

We read with interest the article by Hudak et al.(1). In our experience it is difficult to fully address patients' concerns because of time constraints,particularly during busy fracture clinics and business ward rounds.

In a recent study that assessed the ability of orthopaedic surgeons to counsel patients and obtain informed consent, orthopaedic residents were found to be better than consultants in performing this task; presumably because of their immediate need to focus on decision making, preoperative planning, and the planning for post-operative care(2).

The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.

References:

1.Pamela L. Hudak, Kristy Armstrong, Clarence Braddock, III, Richard M. Frankel, and Wendy Levinson Older Patients' Unexpressed Concerns About Orthopaedic Surgery J Bone Joint Surg Am 2008; 90: 1427-1435

2. Hamilton P, Bismil Q, Ricketts DM. Knowledge of the laws of consent in surgical trainees. Ann R Coll Surg Engl. 2007 Jan;89(1):86;
Addressing the Unexpressed Needs of Older Patients: Making it Multidisciplinary 28 July 2008
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Dorothea Z. Lack,
Psychologist
Independent Practice

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Re: Addressing the Unexpressed Needs of Older Patients: Making it Multidisciplinary

dlack7{at}aol.com Dorothea Z. Lack

To the Editor:

As the demands for services increase with a growing population (1), it seems less and less efficient and/or effective to ask the orthopaedic surgeon to address yet another demand for communication. I find it interesting that patients were willing to disclose their concerns to a stranger in a telephone interview and not to the surgeon.

I am proposing a whole new approach to the necessary communication surrounding proposed surgery--add a communications expert, such as a psychologist to the orthopaedic team. I think it will still be necessary for an orthopaedic surgeon to discuss the procedure, risks and possible outcomes, but the psychosocial concerns can best be left to a separate expert in communication, one who is not directly involved the patient's care.

The concerns which lead to this suggestion are consideration for the surgeon's time and the demand characteristics of the situation, which may make it difficult for the patient to be fully open for fear of appearing to be a difficult patient, or fear of losing the respect of the surgeon.

The author did not receive any outside funding or grants in support of her research for or preparation of this work. Neither she nor a member of her immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of her immediate family, is affiliated or associated.

1. Richard Iorio, William J. Robb, William L. Healy, Daniel J. Berry, William J. Hozack, Richard F. Kyle, David G. Lewallen, Robert T. Trousdale, William A. Jiranek, Van P. Stamos, and Brian S. Parsley; Orthopaedic Surgeon Workforce and Volume Assessment for Total Hip and Knee Replacement in the United States: Preparing for an Epidemic J Bone Joint Surg Am. 2008;90:1598-1605.