INTRODUCTION
“Rome is not built in a day”. Just like that, successful practice in joint replacement surgery cannot be achieved in days or months. It takes meticulous planning, hard work, and a bit of luck to reach the peak. We will discuss some guidelines which are given by the successful surgeons over the decades. Arthroplasty is different from other subspecialties in orthopedics in the sense that once the patient is operated upon, you are wedded to him for a life time. Hence, one has to be very judicious in selection of patient, counseling, and the execution of treatment.
ADEQUATE TRAINING IS FIRST PRIORITY
One has to spend minimum time of 6 months to 1 year in a high-volume centre. Pay close attention to the overall management and in particular how the chief surgeon is dealing with the complications. Spend reasonable time in outpatient clinics as well to acquire communication skills in dealing with the patients. Many young surgeons feel that outpatient clinics are a waste of time, but this cannot be further from the truth. You can master a surgical technique even by seeing a video, but the communication skills have to be acquired hands on.
UTILIZE THE MEDIA TO THE HILT
In the initial days, you should be able to use the services of the media, both television and print to drive your point across the society about the expertise and facilities. Conducting public awareness programs on different platforms addressing to different target groups is useful.
USE THE PATIENT INFORMATION MATERIAL FOR GOOD EFFECT
Before starting the practice, you should spend time in acquiring the patient information material brochures, models, dry bones, and demonstration implants. One model of a knee replacement is worth hundred brochures. It is good practice to show the patients videos of the old patients, preoperative and postoperative.
BUILD UP A GOOD OUTPATIENT TEAM
The team should consist of a receptionist, secretary, patient counselor, and patient care manager. Job description should be clear and they should be trained with your personal inputs. Patient counselor is the lynchpin of the team and will be guiding and helping the patient in all aspects. Every patient will have hundreds of queries and you will not be having enough time and opportunity to address them. The counselor, adequately equipped with patient information booklets, should fill this void.
ESTABLISH RAPPORT WITH THE PATIENT
A warm welcome, eye contact, firm handshake, complimentary remarks, empathy, patient hearing of the complaints, sharing their fears and concerns, frankness, and a right dose of humor are vital ingredients for a rewarding practice. Always involve the relatives of patients in your discussions, because majority of times, they swing the final decision of patient in choosing the surgeon.
DO NOT SELL THE OPERATION—LET THEM BUY
There is lot of difference. Do not give a sales talk like that of car salesman. Explain the diagnosis and the modalities of treatment and discuss pros and cons. Do not force him or suffocate him to take a decision about surgery, when he is still in your consultation room. Encourage him to go home, discuss the issue with his people in the comfort of his home, and then come back. In my experience, 90% of patients will come back. Never subscribe to the cynical comment, “Out of clinic—out of operating list”.4
DEVELOP ROUTE MAPS AND PROTOCOLS
Patients will have many questions and concerns about what happens next. Address them proactively by supplying them with booklets containing information ranging from blood transfusions to postoperative constipation. Remember, a well-informed patient is a well-treated patient. Supply them with route maps of events that take place during their hospital stay.
Protocols should be displayed in the wards and there should not be any deviation, and if there is one, should be backed up by explanation. Regular review of protocols is mandatory for good clinical governance.
PATIENT CARE MANAGER—ANOTHER IMPORTANT MEMBER OF THE TEAM
Patient care manager should chaperone the patient from admission to discharge. If you are practicing in a multispecialty hospital, even a simple event like postoperative X-ray might involve hours of waiting which will add to the discomfiture of the patient. A friendly patient care manager, by simply being with them during such episodes, will lessen the hardship significantly.
SPEND MONEY AND TIME IN BUILDING UP GOOD OPERATING ROOMS
Operating rooms, well planned and well built, will go a long way in preventing complications. Laminar air flow is mandatory in joint replacement surgeries, according to me. Another important issue is strict theatre discipline.
ASSEMBLE A GOOD OPERATING ROOM TEAM
It is very important that your nurse and your theatre technician should know what you are doing and this comes only by you training them personally, imparting them with the philosophy, and the objective of your surgical practice. It pays well to send them on regular update training courses to higher centers.
A GOOD PHYSICAL THERAPY DEPARTMENT IS VERY IMPORTANT
Another vital area, almost contributing to half of your success, is physical therapy unit. Spend time occasionally with physical therapists assessing their approach to the patient. Remember they spend a lot more time with the patients than you and, many a time, their inputs will heavily influence the outcomes.
BE PROACTIVE IN DEALING WITH POSTOPERATIVE ISSUES
The patient comes to postoperative follow-up with minor problem, but they feel that those are the issues which are of paramount importance. Be proactive and explain to them beforehand. A very useful trick is to run the list of all the likely postoperative problems, even before they mention any of them. Then go on to add that these are minor and settle down eventually. Never trivialize their problems, however petty they look to be.
THE ONLY WAY TO DEAL WITH A COMPLICATION IS THROUGH IT
Complications are a way of life—do not run away from them. Proper explanation and sympathetic approach will win over many a patient, even in the backdrop of complications.
NEVER CRITICIZE COLLEAGUES
It is unethical practice to foul mouth a colleague and to comment on his shortcomings in front of patients. Many a time, patients will push you to comment on previous surgical mishaps. Resist from this temptation and be diplomatic by saying that let us look into the future course of action than dwell on the past.
REGULARLY UPDATE YOUR KNOWLEDGE
It is a must to attend conferences and visit higher centers periodically. As you know, science is dynamic and things keep changing. Be open to accept changes for the better.
Finally, one golden rule is to be patient.
Remember, Rome was not built in a day!