By that, I mean a doctor. Not that there's anything wrong with that. Being a doctor is a very good thing. But when you're advising a patient about medical choices with a doctor, and especially a surgeon, you must be venturing into the area of professional courtesy, one physician to another.
Most patients would not have the temerity to interview a doctor about available options. Or maybe it's just me. Once I committed to having knee replacement surgery, and selected a surgeon, I pretty much opted out of any decision making. It is true the surgeon I selected was not the first one I sought help from. Several years earlier, at my first visit to an orthopedist, I was totally surprised when he told me that the worst thing he could tell me was that I needed both knees replaced. That was what he was telling me, he said, and he could do that, in relatively short order. He said I needed him more than he needed me and to call his office to set up an appointment when I wished to. He never mentioned any options, and it never occurred to me to ask.
So, about 7 years later, when my knees were so painful to stand on, I could hardly cook Thanksgiving dinner, not to mention barely being able to walk across the lawn to the end of our yard, and having my own child tell me that it appalled him to watch me hobbling around on my crooked and bowed-out legs, I seriously contemplated the surgery. I called another surgeon, though, one who came highly recommended not only for his expertise in orthopedics, but also for his appearance. A woman poll inspector in Raymertown claimed he had enabled her to go from wheelchair-bound to being able to not only walk without a limp, but to skip. And to prove her point, she actually skipped around the room. She went on to say that her orthopedist was not only the best doctor she had ever seen, but also the best-looking man she had ever seen. Similar testimonials were given by our own librarian. I was ready to discount their glowing reviews, but when I mentioned the surgeon's name to my brother-in-law, his first comment was what a handsome man he was, in addition to his surgical skills.
At my appointment with him, he took a detailed history, stated that there was nothing that contra-indicated TKR, and told me he could fix the knee and straighten the leg. He suggested I go home and talk it over, but I said I'd schedule it right then. But, Dr. Komaroff, at no point did the discussion of surgical options arise. And it is true you write that your surgeon MAY discuss several choices. The surgeon I saw was careful to explain everything that could possibly go wrong, including the eventual deterioration of the "artificial materials." But he did not offer me a choice of materials, he did not ask if I wanted cemented or cementless implants. He did not let me choose between a fixed-bearing or rotating knee platform.
I think for most of us, who are not member of the medical profession, and who do not want to spend an eternity searching out every possible angle, the best we can do is pick a surgeon who we have heard good things about. I think it is true that most such surgeons have developed their skills using a certain protocol. If they use cement to glue the parts in place, they are not going to go cementless. They are not going to waver between fixed and rotating knee platforms. They will have made their choice of implant, from the lab they have chosen.
To summarize, in my case, and I suspect most, the surgeon informs you of what appliance he uses, such as "Signature." He does not ask the patient what procedure or materials or technique they want. I guess it may be different among the society of physicians, but, Dr. K., that's how it works out for mere mortals.
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