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The Internet and news media: friend or foe of the orthopaedic patient?
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For several years, I saw patients in my practice who were “educated” via the Internet about their disease and possible treatments. Following an open dialogue, patients nearly always agreed with me, based on my scientific approach and arguments for doing the procedure “my way.”
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However, in the past 2 to 3 years, a potential conflict between the patient and the surgeon has become more and more explicit. We are now faced with patients who not only ask for a particular procedure and a specific implant, but also demand it, otherwise, they will “doctor-shop” until they find a surgeon willing to carry out their demands.
Only half of the story
Now, nearly every day, I see patients in my outpatient clinic who sift through information from newspapers, TV and/or advertisements about how their hip should be done.
Recently, a hardworking, muscular, 38-year-old man argued in detail with me about having resurfacing performed using a mini-anterior muscle-sparing approach. He had learned from two different media sources that: resurfacing is a lifelong replacement that can allow him to do “everything” (as “advertised” in the TV news), and the mini-anterior approach, according to a local Danish newspaper, is a true advance in upcoming hip replacement procedures.
Science comes first
It is evident that we orthopaedic surgeons must be prepared to discuss with our patients what procedures and implants are relevant in each single case, but based on science and years of experience.
We must be critical when the media, colleagues or industry promote new implants, techniques or procedures as “the new and best way of doing a hip replacement,” without, at the same time, stressing that the new tools are still experimental and not scientifically proven.
We cannot blame our patients for arguing for “the best possible treatment,” but we can always criticize the media, our colleagues and industry for not informing patients on all aspects of care.
Today, I have patients who leave my office after I tell them that, besides believing that the new procedures are still experimental, I also lack the experience to perform them. These patients will inevitably “shop” until they find a doctor who will fulfill their demands.
Going down the wrong path
If these trends continue, orthopaedic clinics may be persuaded or pressured to shift their emphasis away from evidence and science as the basis for surgery, to what is “new” and what patients demand. In that regard, the orthopaedic market is similar to the automotive industry, offering us the newest and most fancy equipment. And who would not love to have this included in their new car?
We must start an open discussion on how we can curb this new trend and prevent our patients from shopping for a surgeon or implant based on nonscientific knowledge adapted from the media.
Flirting with higher risk
Some surgeons in question, who may or may not have the necessary experience, might be willing to perform a certain procedure or use a specific implant without the necessary clinical proof, thus increasing the risk of not only early complications, but also poor short- and long-term results.
For more information:
- Per Kjaersgaard-Andersen, MD, is an assistant professor of orthopaedic surgery at Veijle Hospital, South Danish University, Odense, Denmark, and is an editor of Orthopaedics Today International.