Editorial: Introducing CORR®’s Newest Column: What I Wish My Surgeon Knew

We’ve both been patients. You have, too. Have all of those encounters gone exactly as you had hoped they would? Us, neither.

One of us (SSL) is also a surgeon, and some of his patients have left his office disappointed, whether because of a clinical result that fell short or a missed moment of connection. Like you, he’s hoping to continue raising his game so as to let fewer patients down because of his empathy lapses.

The other of us (SLS) is the full-time managing editor of our journal. Busy job. She’s also the mother of a young child. She understands, intimately, that humans crave routines, but also that there is more work to be done every day than can fit into the hours allotted. When it comes to the need for pace, she gets it. She understands how getting through a clinic roster can feel like a long to-do list—but with real, live people as the “items” on that list.

That said, nobody wants be an item on anybody’s list.

One solution is to find ways to listen more closely to the patients whose health we’re charged with improving, to keep their voices in our ears. In this month’s issue of Clinical Orthopaedics and Related Research®, we introduce our newest column, “What I Wish My Surgeon Knew” [2], which seeks to do exactly that. In this occasional section, patients or carers will reflect on an interaction they had with their orthopaedic surgeon and describe how that moment—which may have been a moment of missed opportunity, misunderstanding, close connection, or something else—influenced the patient’s recovery or shaped the patient’s view of our specialty or medicine more broadly.

By doing this, we hope to reclaim a bit of humanity in what usually is, but isn’t always, a humane profession. We’re throwing no shade here. Surgeons work in a system that incentivizes turning people into items on a list—a process that dehumanizes both patients and their surgeons—and that dehumanization of surgeons starts early in training [3]. Those who would become surgeons enter medical school animated by a desire to cure, and when that isn’t on the menu, at least to help people heal. But that training involves faceless body parts from the first day of gross anatomy. Moments where medical students and residents are asked to consider patients’ feelings are sporadic, if not incidental. The work is intense and the hours long.

After training, surgeons are asked suddenly to flip the humanity switch back on [3]. But the responsibilities and burdens are, if anything, more intense than before. The same system that demands ever-increasing throughput says that it values connection, communication, and a high-quality experience for each individual encounter, not just the surgical skills surgeons spend five or more years trying to learn. It’s a small wonder that one survey found that while 75% of orthopaedic surgeons believed they were communicating effectively with patients, only 21% of those patients agreed [4]. Diving deeper, it appears that even objective ratings of communication effectiveness made by trained communication scholars have little or no association with patient-rated clinician empathy [1].

It feels like we’re lost at sea, but it doesn’t have to be this way. We just need to slow down. To listen. To be receptive to honest feedback from patients.

Which brings us back to this new column. Missing from CORR® up until now—and indeed, missing from most journals—is the voice of those whom all physician-readers are committed to serve. That changes today. “What I Wish My Surgeon Knew” will not answer the questions you have about that patient who gave you a one-star rating after a slam-dunk surgery and a smooth recovery. We also realize that these columns will be anecdotes, and that the plural of anecdote isn’t data. Still, we believe these narratives will offer a glimpse into a moment that mattered. We hope you’ll take the time to read each story.

The opening installment in this month’s CORR [2] shares the observations of Nadine Korab, who underwent limb-salvage surgery and chemotherapy while pregnant during the COVID-19 pandemic. Perhaps the worst part of her harrowing journey is that she had to endure every appointment alone, and the end result was nothing like what she’d hoped it would be. It’s one thing to hear our summary, but as you’ll see, quite another to hear it in her voice.

We welcome your contributions to this section, but you won’t be writing them. If you know of any patients or carers whose journeys were especially tough—or especially uplifting—please reach out to Samantha League Smith, CORR’s Managing Editor, directly at sleague@clinorthop.org for more information on how to get those stories covered. Your patient doesn’t have to be a great writer (we’re happy to run these as interviews, too); he or she just needs to have a story worth sharing, and be willing to share it with people who want to learn.