Doctors overly optimistic about back surgery

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Nearly 4 out of 10 patients told by surgeons that they could expect a “great improvement” from lower back surgery reported no abatement in their back pain one year after the procedure, a new survey has found.

Clearly, surgeons’ predictions “were not correlated with patient outcome,” the authors write. “This optimism may occasionally encourage patients to undergo surgery when they shouldn’t,” said Dr. Bertrand Graz.

“Often the surgeon is not aware of what happens to his or her patients one year later and may simply assume that ‘no news is good news’,” and therefore carry unrealistic expectations of the benefit of surgery, Graz explained.

But it’s also important for surgeons to be optimistic about the procedure, Graz added. “If surgeons don’t firmly believe in the benefit of what they are doing, they might as well close up shop,” he said.

Also, among people for whom surgery was not an “appropriate” option, those who surgeons predicted would greatly benefit from surgery did experience more improvements in their mental and general health after the procedure - a trend Graz and his colleagues call the “curabo effect” in the journal Spine.

“As some of our results show, this optimism on the part of the surgeon may even have unexpected beneficial effects on patient outcome, he said.

As part of the study, Graz—based at the University of Lausanne Medical Centre in Switzerland—and his team interviewed surgeons who operated on 197 people with low back pain, sciatica or both.

Surgeons predicted that 79 percent of patients would experience a “great improvement” in their quality of life from surgery, and 20 percent would see a “moderate improvement.” Doctors were more likely to predict significant improvements in younger patients.

However, one year after surgery, 39 percent of the patients said they experienced no “clinically important difference” in back pain.

“For both physicians and patients, we hope that this will reinforce what we might call a ‘healthy skepticism’ about the real possibilities and limits of the science and the art of medicine,” Graz noted.

SOURCE: Spine, June 15, 2005.

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