Keywords: trust, inconvenience, expense, functionality, Hippocratic oath, Responsibility, outcomes

29.1 Introduction

Everyone entering a surgical experience has expectations. Ideally, the expectations are identical, or at least very similar, for all parties involved—surgeon, nurses, patient, family, employers, attorneys, insurance carriers. At times, however, for whatever reason, outcomes of surgery do not match the expectations. Surgical treatment outcomes may exceed or fall short of expectations; or ultimate outcomes may be delayed or even substantially altered by complications.

No one expects complications, but they can occur unexpectedly. Even unexpected complications can have the same expected outcomes ultimately, but the course to that eventuality may be prolonged, and can entail additional or divergent treatments, additional surgeries, other specialty consultations, and often additional rehabilitation. If the ultimate outcome of the initial surgery is altered significantly by a complication of any nature, the impact for the patient may be profound.

Avoidance of complications, minimizing their risk, is the responsibility of every good surgical team. Each member of the team should assume that responsibility from the same page of protocol and benevolence. Hand patients—like any other patients—are consumers, usually contractual consumers, giving informed consent to the surgical intervention which guides their expectations. Emphasis on informed consent means more than just cataloging possible inadvertent tissue injuries on a preoperative signature form; it means educating a patient about the pros and cons of alternative treatment options and the rationale of selecting a surgical approach. Surgical preparation entails risk management—medication adjustment, diet, pre-habilitation conditioning, sanitation, arrangements for postoperative care, splinting, and many others.

Hand surgery outcomes that are delayed or significantly altered by complications can be considered in a variety of categories, from the patient’s perspective. For this chapter, we will divide them broadly into the issues of trust, inconvenience, cost, and functionality.

29.2 Trust

A hand surgery patient’s relationship with his surgeon may be brief and emergent, or it may be cultivated over a longer period of time. It may stem from the hand surgeon on call for an emergency department, or begin with an Internet search, referral from one’s primary care physician, or from the recommendation of a friend. In any event, the relationship is based in patient trust and confidence in the surgeon and his team. Why else would one lie down under anesthesia and entrust the future of his hand—his instrument of function, of expression, of productivity, of exploration—to someone else to do something surgical, something to alter his natural anatomy, about which he the patient has no familiarity, certainly no expertise and probably little or no personal experience? He must have trust; confidence in the ability of the surgeon to whom he entrusts his well-being. We surgeons are not mere technicians. We must be physicians first, dedicating ourselves to the benefit of our patients.