Mr. Jones (obviously not his real name) recently came in with his wife to discuss treatment options for his arthritic shoulder. I hadn’t seen him since last winter. We used the initial time catching up on how he had spent the previous year (traveling and visiting his family around the country) and then discussing how his shoulder had been during that time (“the same, occasionally sore”).
When I first met him a year ago, Mr. Jone’s shoulder was painful and stiff and as a result, his shoulder function was limited. At that time, we had a thorough discussion about our options. I explained that treating his symptoms (anti-inflammatories, injections, physical therapy) might help around the margins. But I expressed concerns that due to the severity of his arthritis, a shoulder replacement was likely needed to make a dramatic difference.
He noted that he and his wife had a busy upcoming vacation schedule. They were planning to visit their extended family scattered throughout the US and although painful, his shoulder wasn’t holding him back. He admitted that he was not yet ready for a shoulder replacement… And that was ok…It was the right decision for him. I started him on an anti-inflammatory medication and we decided that he would call or return if his symptoms worsened or his thoughts changed.
Now he was back. His shoulder was still bothering him some and he wanted to discuss shoulder replacement again. He had some questions for me: Are there any new treatments available? (No). Would a shoulder replacement relieve his pain? (Most likely). Was success guaranteed? (No, unfortunately never is…but also likely). How long would he be in the hospital? (Overnight). When could he travel? (Several weeks after surgery), and so on.
Then I had some questions for him: How bad is your pain? (“Not so bad, only when I’m active”). Are there things you’d like to do that you can’t because of your shoulder? (No). What has changed that brings you back to see me? (“Nothing really, just worried that I am making it worse by not having surgery (Not the case) and so I’d like to do it before we travel to see our family later this year”).
After discussing the technical details of the procedure as well as its potential benefits, any alternatives and the risks of this surgery, I asked one final question: “Mr. Jones, do you want a shoulder replacement?” There was a long pause and he looked over at his wife as if he wished for her to answer for him.
This highlighted several things for me: The importance others have in our healthcare decisions, the impact our decisions have on those same people…and his ambivalence.
Sensing his ambivalence, I suggested that he take some time to think about whether having surgery now was right for him. This being Thursday, I recommended that he discuss things with his family over the weekend and call me the following week if they had made a decision or had any additional questions.
Mr. Jones called the very next day. He said that he was not ready for a shoulder replacement…He was right.
And that’s ok.
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