When Susan first came to see me, I was taken aback by her regal, patrician looks. An elegant woman in her late eighties, she had a younger woman’s trim figure, but the aching back more characteristic of her age. She had been referred to me by an orthopedist who, uncharacteristically, called me before her appointment to brief me on her case and make sure that I would “take good care of her.”
He had diagnosed her a few years earlier with spinal stenosis, and now all conservative measures were no longer effective. Susan had been accustomed to traveling extensively to remote areas of the world, but now found that impossible due to her back pain. Susan lived up to the reputation that her referring doctor described to me. Indeed, she had an independent-minded spirit and didn’t want to be seen as an old woman. It was quite clear on our first meeting that she was having difficulty walking from the waiting room to the consultation room. She made every effort not to bend forward for relief because, as she told me later, “that is what old folks do.” Her orthopedist was indeed correct that she had severe spinal stenosis. I presented her with options, and because of her age, I advised against surgery.
“Young man, I will decide what treatment is best for me,” she stated. Her surgery went superbly and I still receive her postcards from exotic places. I learned my lesson again: Patients are still my best teachers.
I also must add that I have had many patients, including young ones, who have failed conservative therapy yet braved onward without opting for surgery—even when I recommended surgery. These people choose instead to continue modifying their activity levels and seeking new conservative treatments. Some do eventually change their minds if they don’t find adequate relief. But many lead highly productive lives without any invasive intervention and make peace with any restrictions that they have to bear.
It is important to remember that not all patients who undergo surgery do as well as others. As I teach and advise routinely, surgery is never a guarantee. It might help you, but it might not—and it could even leave you worse off than before. Which is why the decision to go down that road should be carefully thought out in partnership with your doctor.
And above all, your personal values matter. If you have a doctor who doesn’t appreciate your values, it’s time to find another doctor. And if you ever doubt the recommendations of your treating physician, seek a second opinion.