How do Orthopedic Surgeons Address Psychological Aspects of Illness?

Document Type: RESEARCH PAPER

Authors

1 Department of Psychiatry, Behavioral Medicine Service, Massachusetts General Hospital, Harvard Medical School, Boston, USA

2 Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, USA

3 Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

Abstract

 
Background:
Orthopaedic surgeons have a pivotal role in transitioning the care of orthopedic patients from a biomedical to a biopsychosocial model. In an effort to foster this transition, we designed a study aimed to determine surgeons’ attitudes and practice of noticing, screening, discussing psychological illness with patients, as well as making referrals to address psychosocial issues in patients in need. Additionally, we asked surgeons to rank order potential barriers to and reasons for referrals to psychosocial treatment.
 
Methods:
Orthopaedic surgeons members of the Science and Variation Group and Ankle Platform (N =350) completed demographics, and a 4-part survey assessing the degree to which surgeons notice, assess, screen and refer for psychological treatments, as well ranked ordered barriers to engaging in these processes.
Results:
As a group surgeons were neutral to referral for psychological treatment and formal screening of psychological factors, and somewhat likely to notice and discuss psychological factors. Surgeons were more likely to refer for psychological treatment if they engaged in research, or if they reside in South America as opposed to North America. The highest ranked barriers to screening, noticing, discussing and referring for psychological treatment were lack of time, stigma and feeling uncomfortable.
Conclusion:
Overall surgeons are likely to notice and discuss psychological factors, but less likely to formally screen or refer for psychological treatment. Transition to biopsychosocial models should focus on problem solving these barriers by teaching surgeons communication skills to increase comfort with discussing psychoemotional factors associated with orthopedic problems. The use of empathic communication can be very helpful in normalizing the difficulty of coping with an orthopedic condition, and may facilitate referral.

Keywords


1. Ayers DC, Franklin PD, Ploutz-Snyder R, Boisvert
CB. Total knee replacement outcome and coexisting
physical and emotional illness. Clinical orthopaedics
and related research. 2005;40:157-61.
2. Ayers DC, Franklin PD, Trief PM, Ploutz-Snyder R,
Freund D. Psychological attributes of preoperative
total joint replacement patients: implications for
optimal physical outcome. The Journal of arthroplasty.
2004;19(7 Suppl 2):125-30.
3. Melzack R. Pain--an overview. Acta anaesthesiologica
Scandinavica. 1999;43(9):880-4.
4. Atlas SJ, Tosteson TD, Blood EA, Skinner JS, Pransky GS,
Weinstein JN. The impact of workers’ compensation
on outcomes of surgical and nonoperative therapy for
patients with a lumbar disc herniation: SPORT. Spine.
2010;35(1):89-97.
5. Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic
MT, Malkasian D, Ross JS. Magnetic resonance imaging
of the lumbar spine in people without back pain. The
New England journal of medicine. 1994;331(2):69-73.
6. Mechanic D. Sociological dimensions of illness behavior.
Social science & medicine. 1995;41(9):1207-16.
7. Vranceanu AM, Bachoura A, Weening A, Vrahas M,
Smith RM, Ring D. Psychological factors predict
disability and pain intensity after skeletal trauma. The
Journal of bone and joint surgery American volume.
2014;96(3):e20.
8. Vranceanu AM, Safren S, Zhao M, Cowan J, Ring D.
Disability and psychologic distress in patients with
nonspecific and specific arm pain. Clinical orthopaedics
and related research. 2008;466(11):2820-6.
9. Janssen SJ, Ter Meulen DP, Nota SP, Hageman MG,
Ring D. Does Verbal and Nonverbal Communication
of Pain Correlate With Disability? Psychosomatics.
2015;56(4):338-44.
10. Janssen SJ, Teunis T, Guitton TG, Ring D, Herndon
JH. Orthopaedic Surgeons’ View on Strategies for
Improving Patient Safety. The Journal of bone and joint
surgery American volume. 2015;97(14):1173-86.
11. Vranceanu AM, Hageman M, Strooker J, ter Meulen D,
Vrahas M, Ring D. A preliminary RCT of a mind body
skills based intervention addressing mood and coping
strategies in patients with acute orthopaedic trauma.
Injury. 2015;46(4):552-7.
12. Riediger W, Doering S, Krismer M. Depression and
somatization influence the outcome of total hip
replacement. Int Orthop. 2010; 34(1):13-8.
13. Rolfson O, Dahlberg LE, Nilsson JA, Malchau H,
Garellick G. Variables determining outome in total
hip replacement surgery. J BOne Joint Surg Br 2009;
91(2):157-61.
14. Bruinsma WE, Becker SJ, Guitton TG, Kadzielski J,
Ring D. How prevalent are hazardous attitudes among
orthopaedic surgeons? Clinical orthopaedics and
related research. 2015;473(5):1582-9.
15. Tosti R, Ilyas AM, Mellema JJ, Guitton TG, Ring D,
Science of Variation G. Interobserver variability in the
treatment of little finger metacarpal neck fractures.
The Journal of hand surgery. 2014;39(9):1722-7.
16. Teunis T, Janssen SJ, Guitton TG, Parisien R, Ring D.
Do orthopedic surgeons acknowledge uncertainty?
CORR 2015; ahead of print.
17. Teunis T, Janssen SJ, Guitton TG, Vranceanu AM, Goos
B, Ring D. Surgeon personality is associated with
recommendations for operative treatment. Hand
2015; 10(4);35-39.
18. Vranceanu AM, Safren SA, Cowan J, Ring DC. Health
concerns and somatic symptoms explain perceived
disability and idiopathic hand and arm pain in an
orthopedics surgical practice: a path-analysis model.
Psychosomatics. 2010;51(4):330-7.

19. Vranceanu AM, Jupiter JB, Mudgal CS, Ring D.
Predictors of pain intensity and disability after
minor hand surgery. The Journal of hand surgery.
2010;35(6):956-60.
20. Farzad M, Asgari A, Dashab F, Layeghi F, Karimlou
M, Hosseini SA, et al. Does Disability Correlate With
Impairment After Hand Injury? Clinical orthopaedics
and related research. 2015; 473(11):3470-
6.29(10):e414-20.
21. Teunis T, Bot AG, Thornton ER, Ring D. Catastrophic
Thinking is Associated with Finger Stiffness After
Distal Radius Fracture Surgery. Journal of orthopaedic
trauma. 2015; 29(10):e 414-20.
22. Borrell-Carrio F, Suchman AL, Epstein RM. The
biopsychosocial model 25 years later: principles,
practice, and scientific inquiry. Annals of family
medicine. 2004;2(6):576-82.
23. Novy DM, Aigner CJ. The biopsychosocial model
in cancer pain. Current opinion in supportive and
palliative care. 2014;8(2):117-23.
24. Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets
RJ, Ostelo RW, Guzman J, et al. Multidisciplinary
biopsychosocial rehabilitation for chronic low back
pain: Cochrane systematic review and meta-analysis.
Bmj. 2015;350:h444.

25. Masi AT, Vincent A. A Historical and Clinical
Perspective Endorsing Person-centered Management
of Fibromyalgia Syndrome. Current rheumatology
reviews. 2015;11(2):86-95.
26. Dugdale DC, Epstein R, Pantilat SZ. Time and the
patient-physician relationship. Journal of general
internal medicine. 1999;14 Suppl 1:S34-40.
27. Menendez ME, Chen NE, Mudgal CS, Jupiter JB, Ring D.
Physician empathy as a driver of hand surgery patient
satiasfaction. JHS 2015; 40(9).
28. Ahrweiler F, Scheffer C, Roling G, Goldblatt H, Hahn
EG, Neumann M. Clinical practice and self-awareness
as determinants of empathy in undergraduate
education: a qualitative short survey at three medical
schools in Germany. GMS Zeitschrift fur medizinische
Ausbildung. 2014;31(4):Doc46.
29. Neumann M, Edelhauser F, Tauschel D, Fischer MR,
Wirtz M, Woopen C, et al. Empathy decline and its
reasons: a systematic review of studies with medical
students and residents. Academic medicine : journal
of the Association of American Medical Colleges.
2011;86(8):996-1009.
30. Lim BT, Moriarty H, Huthwaite M. “Being-inrole”:
A teaching innovation to enhance empathic
communication skills in medical students. Medical
teacher. 2011;33(12):e663-9.
31. Riess H. Empathy in medicine--a neurobiological
perspective. Jama. 2010;304(14):1604-5.
32. Vranceanu AM, Cooper C, Ring D. Integrating patient
values into evidence-based practice: effective
communication for shared decision-making. Hand
clinics. 2009;25(1):83-96, vii.
33. Riess H. In reply to Ho. Academic medicine : journal
of the Association of American Medical Colleges.
2015;90(2):128.