Family Physicians Recommend Surgery More Than Surgeons Do!!

Dr. Harriott's Comments:

Do MD's really expect or recommend that every patient referred to a surgeon should ultimately get surgery? Do they assume that I would consider every referral a good candidate for chiropractic manipulation? While every person would benefit from a chiropractic lifestyle I absolutely do not recommend manual spinal manipulation for every patient. My care plans are customized to the needs of the patient and most are but some are not candidates for manipulation. On the other hand, without the years of experience that I have as a chiropractor, MD's are the not the best persons to decide whether chiropractic care is appropriate for a given case. But then again, MD's typically think that unless you need their "cure", then you don't have a problem. At least there is one profession (Chiropractic) that understands where the need for "cure" comes from and is prepared to do something about it before that need manifests.

So, I think this article is misleading at best. If this were asked of me, I'd only be able to indicate my basis for recommendation for surgical consultation. I am not the professional best suited to recommend surgery, and neither is the family physician. The the article's premise makes it pretty worthless.
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Surgeons are less likely than family physicians to recommend lumbar spine surgery


1st on the web (February 1, 2010)
Surgeons are less likely than family physicians to recommend surgery as the preferred treatment option for patients with lumbar spine problems; and patients, surgeons and family physicians have different factors affecting their decision-making regarding surgery, according to the results of a study appearing in Spine.

S. Samuel Bederman, MD, PhD, FRCSC, and colleagues hope that their research will help better align the opinions of doctors and patients and improve the shared decision-making process.

“This can directly result in a significant improvement in patient satisfaction with the health care process and even overall health status following treatment,” Bederman stated in a press release.

The investigators surveyed orthopedic surgeons, neurosurgeons and family physicians, to determine the factors influencing their recommendations for lumbar spinal surgery. They also surveyed patients regarding their preferences for surgery and the factors influencing their decisions.

The investigators presented the participants with hypothetical scenarios involving the following key factors:

walking ability;
duration of pain;
severity of pain;
location of pain;
neurological symptoms; and
factors inducing pain.
The groups ranked their recommendations and preferences for surgery regarding each scenario, and the investigators noted the factors impacting the participants’ choices.

Among the three groups, the investigators discovered that family physicians would recommend surgery most often, while orthopedic and neurosurgeons would recommend surgical treatment the least. The study also revealed that the most important factor regarding decision-making for surgeons was the location of pain, and that most preferred surgery for patients with leg pain compared to back pain.

For family physicians, neurologic symptoms were the most important factor regarding their recommendations for surgery followed by patients’ walking ability and severity of pain, according to the study.

In addition, the investigators found that pain severity, walking ability and pain duration were the most important factors regarding patients’ preferences.

“All of these symptoms are highly related to quality of life and have little direct bearing on outcomes following surgery,” Bederman stated in the release.

Orthopedics Today Editorial Board Section Editor Scott D. Boden, MD, said that the results of the study match his experience with the different groups that were surveyed.

“Family practitioners do not have the detailed experience to sort out which patients actually need surgery, but can identify patients that may benefit from surgery,” Boden told OrthoSuperSite.com. “Thus, many patients referred to surgeons either do not need surgery or decide not to choose surgery once they learn more details and are seen by more of a specialist.” He noted that many different lumbar spine problems often present with a similar or overlapping set of symptoms. However, only a specific set of lumbar problems best treated with surgery.

He added, “It is my hope that well-educated surgeons and patients that go through a true shared-decision making process will together make the most appropriate decisions about surgery on a case-by-case basis.”

Reference:
Bederman SS, Mahomed NN, Kreder HJ, et al. In the eye of the beholder: preferences of patients, family physicians, and surgeons for lumbar spinal surgery. Spine. 2010.1;35(1):108-115.