Affordable Access

deepdyve-link
Publisher Website

Surgical patient selection and counseling.

Authors
  • Ziegelmann, Matt1
  • Köhler, Tobias S1
  • Bailey, George C1
  • Miest, Tanner1
  • Alom, Manaf1
  • Trost, Landon1
  • 1 Department of Urology, Mayo Clinic, Rochester, MN, USA.
Type
Published Article
Journal
Translational andrology and urology
Publication Date
Aug 01, 2017
Volume
6
Issue
4
Pages
609–619
Identifiers
DOI: 10.21037/tau.2017.07.19
PMID: 28904893
Source
Medline
Keywords
License
Unknown

Abstract

The objectives of patient selection and counseling are ultimately to enhance successful outcomes. However, the definition for success is often narrowly defined in published literature (ability to complete surgery, complications, satisfaction) and fails to account for patient desires and expectations, temporal changes, natural history of underlying diseases, or independent validation. Factors associated with satisfaction and dissatisfaction are often surgery-specific, although correlation with pre-operative expectations, revisions, and complications are common with most procedures. The process of appropriate patient selection is determined by the integration of patient and surgeon factors, including psychological capacity to handle unsatisfactory results, baseline expectations, complexity of case, and surgeon volume and experience. Using this model, a high-risk scenario includes one in which a low-volume surgeon performs a complex case in a patient with limited psychological capacity and high expectations. In contrast, a high-volume surgeon performing a routine case in a male with low expectations and abundant psychiatric reserve is more likely to achieve a successful outcome. To further help identify patients who are at high risk for dissatisfaction, a previously published mnemonic is recommended: CURSED Patient (compulsive/obsessive, unrealistic, revision, surgeon shopping, entitled, denial, and psychiatric). Appropriate patient counseling includes setting appropriate expectations, reviewing the potential and anticipated risks of surgery, post-operative instruction to limit complications, and long-term follow-up. As thorough counseling is often a time-consuming endeavor, busy practices may elect to utilize various resources including educational materials, advanced practice providers, or group visits, among others. The consequences for poor patient selection and counseling may range from poor surgical outcomes and patient dissatisfaction to lawsuits, loss of credibility, or even significant patient or personal harm.

Report this publication

Statistics

Seen <100 times