I’m honoured to have been included in the May edition of Essential Marbella Magazine. You can read my article in print and also in the Essential Marbella Magazine online edition here:
How to get the most out of your Orthopaedic Surgeon?
By Dr. Thomas Boerger, MD FRCSI (Tr&Orth) Consultant Orthopaedic Surgeon in Marbella & Gibraltar
First, avoid the need to see an Orthopaedic Surgeon
This is possible when you do all the right and necessary things to achieve optimal bone and joint health from as early an age as possible. You can make good lifestyle choices by aiming for good nutrition and maintaining a healthy weight, cuttting down on or stop smoking altogether and drinking responsibly. Excess weight is a major cause of wear and tear of important joints such as the hip, knee and ankle. Adequate physical activity, together with times enjoyed in the sunny outdoors, help to promote good bone density, growth and repair, as well as reducing the severity of osteoporosis which can lead to fragility fractures of the hip, wrist and spine.
Once we move past the middle age mark, and sometimes even despite our best efforts to live healthily, we begin to experience age-related stiffness and generalised aches and pains. Modern day pharmacies are able to reliably advise and safely recommend over the counter topical and oral pain-relief medication and support bracing options, once you start to find the need to seek out help for your joint symptoms. Modifying your exercise routines may sometimes be necessary to minimise stress and strain on the affected joints and muscles.
How do you know when you really need an Orthopaedic Surgeon
You attend your primary care physician’s office to discuss your acute/chronic difficulties. The doctor would comprehensively assess you for relevant degenerative and inflammatory joint conditions such as osteoarthritis and rheumatoid arthritis respectively. Inflammatory joint diseases are typically managed with disease modifying medication, not surgery. If the joint problem is one of osteoarthritic joint, your GP can often prescribe physiotherapy and painkillers and sometimes inject anti-inflammatory medication directly into the affected joint to offer symptom relief and improvement in the condition.
You need to see a specialist Orthopaedic Surgeon to consider definitive treatment options when you have done all of the above and continue to be troubled by persistent symptoms and the painful joints are beginning to get you down because you find yourself no longer able to join your friends for a game of golf, or even just to go for a quiet walk after dinner; when you are not sleeping comfortably any more or when the situation is causing you distress and you want to make things better again.
Before, during and after seeing an Orthopaedic Surgeon
Before making and attending the appointment:
Identify a good Orthopaedic Surgeon by speaking to your primary care doctor, family and friends. Make sure that the Orthopaedic Surgeon’s specialty areas are relevant to your needs. Familiarise yourself with the Surgeon’s professional training and clinical experience. Find out as much as you can about the Surgeon’s practice set-up. Be as clear and specific about what you wish to know and hope to achieve by engaging with the Orthopaedic Surgeon.
During the first consultation:
Above all else, from the outset, the Orthopaedic Surgeon you see should be professional, caring and interested in you as a person, not just a patient. The initial interview with you should be comprehensive and you should feel free to tell your story. You should expect a thorough examination of all relevant physical systems. Based on the medical history information you will have been asked to share, you should in some cases be referred to other physicians (such as a Cardiologist or Haematologist) within the same specialist team for further assessment.
Your personal circumstances permitting, you can expect to have high quality radio-images such as joint X-rays taken there and then. The images should then be available to your Orthopaedic Surgeon to be able to view them with you directly and explain the findings to you clearly. He/she should also, by then, have sufficient clinical information to be able to explore a range of management options, from conservative to surgical treatment plans, and be in a position to counsel you adequately on everything each option entails.
After the consultation:
You are now in possession of multiple options. You should have some initial understanding of what has been recommended. You should be given further opportunities to ask more questions, including those of your surgeon’s specific professional experience with any specific operative procedure on offer. As a minimum standard, your Orthopaedic Surgeon who has offered you joint replacement surgery should be fellowship-trained in Arthroplasty (joint replacement surgery) in reputable clinical centres of excellence, and should have a specialised expertise in the procedure recommended to you.
If you have carefully considered and now wish to proceed with joint replacement surgery, you should be given an explanation of what happens next, starting with any tests to be completed before surgery in order to plan the surgery, the type of implant chosen for you, the projected life-span of the implant, the preferred mode of anaesthesia, other relevant aspects of post-surgery rehabilitation time frame, expected and managed outcome and any associated follow-up schedules. There must be an open and full discussion about potential risks and complications of the specific type of surgical option, along with information about any relevant alternatives to the proposed procedure.
Most importantly, you should never be rushed or feel pressured into any decision. Your Orthopaedic Surgeon should offer you another appointment to discuss any queries you may have, if you wish. You should also receive a comprehensive letter/report from you Orthopaedic Surgeon soon after this first consultation which allows you a review of your clinic experience and a reminder of management recommendations.
Once you have decided to go ahead with surgery
Before surgery:
You may wish to ask the team for testimonials or even contact other patients who had completed the clinical journey before you.
It is never too late to do a last bit of homework; ask yourself if you know enough and are happy with the following added considerations of your chosen specialist Orthopaedic Surgeon and his/her team:
- Is your Orthopaedic Surgeon’s immediate clinical team complete with dedicated teams of anaesthetists and ring-fenced operating theatre staff, working within a dedicated lamina flow environment suitable for joint replacement?
- Does he/she possess a broad and mature professional network around him/her?
- Has he/she been annually appraised and regularly revalidated by his/her professional regulatory body?
- Does he/she keep up-to-date with his/her clinical practice? And how?
- Has he/she maintained Continuous Professional Development (CPD) by attending or presenting at international conferences?
After surgery:
You are fully informed about the intra-operative process. You are offered adequate pain management and associated therapy towards your discharge from hospital. You and your family are given opportunities to ask questions. Clear post-operative care and post-discharge review plans are offered. You know who to contact in the immediate post-operative period for any concerns arising upon returning home.
Finally, any questions?
This article has been written by Dr Thomas O. Boerger, MD FRCSI (Tr&Orth) Consultant Orthopaedic Surgeon, who obtained his primary medical qualification from Berlin, Germany, and who is fully post-graduate Surgical and Orthopaedic sub-specialty trained and qualified in London, UK. Dr Boerger led in, and completed, Orthopaedic research projects, and successfully published with the Department of Biomechanical Engineering, Imperial College, London and University of Leeds, UK. He has also specific Arthroplasty (Hips and Knees) and Soft tissue/Ligamentous reconstruction fellowship experiences in Florence, Italy and Canberra and Sydney, Australia. Dr Boerger is currently operating in St Bernard’s Hospital, Gibraltar, and High Care International Hospital, Marbella, Costa del Sol, Spain.