Hope for the Best and Be Prepared For The Worst is a quote by Maya Angelou that we must remember when entering the healthcare system.

Recently, I met a woman who had an elective knee replacement. The Orthopedic Surgeon is part of a bundled payment program, which means he has a stringent protocol to follow. Her rheumatologist referred her, so she thought she would be in good hands. Unfortunately, she had many challenges that were not addressed before the surgery, which made the post-op period challenging for her and the doctor and caused much anxiety and costs that might have been avoided with some preplanning.

The Bundled Payment program is designed to lower costs and improve outcomes for those who undergo elective hip and knee replacements. The goal is to have a process with doctors, nurses, and physical and occupational therapists to evaluate each person before they undergo the procedure to ensure they are in the best condition to have the surgery and recover. Most surgeons who participate in the bundled payment program screen their patients to make sure they are a good candidate for the program and, if not, recommend they take the time to get in the best shape or go to another orthopedic surgeon who is not part of a Bundled Payment Programs as they will have more options to offer.

Some of the challenges that anyone having surgery should consider are the following questions: People need to ask themselves the following questions when considering an elective procedure.

  • Are you in the best shape you can be to have surgery? If not, what can you do to address that before surgery?
  • Do you live alone?
  • Do you have a sound support system that can support you after the operation? This is important, as you cannot do many things you usually do for yourself for a few days/weeks, depending on your recovery.
  • Do you have a pet?
  • Do you smoke, drink, or use drugs? These habits can impact your recovery, so they should be addressed so your team is aware and decisions can be made about how to proceed.

Most doctors screen their patients as they want good outcomes. Questions like the above need to be discussed with your doctor and the team before the surgery so that a plan of care can be implemented to address your circumstances and ensure you are safe. Today, most people go home on the day of surgery, but those people have a sound support system in place that can meet the person’s needs.

Unfortunately, my patient did not fully understand what she was getting into till after the surgery was done. In her defense, her team did not assess her to determine her issues. As a result, she has had a challenging time postoperatively that could have been avoided with some preplanning.

The lessons I want you to take away from this example are:

  1. The team should take the time to explain every aspect of the process to you. Participate fully in this, as it will help you recuperate.
  2. When given paperwork, take time to read it carefully and ask questions of the team so you are clear on what you are getting into and how that will impact you personally.
  3. The team should also share how you can prepare for the procedure. Many programs provide rehabilitation, which lets you know what exercises you can do before and after the surgery to get ready.
  4. If you do not have a sound support system that will help you at home as you recuperate, ask if you can have a period in a rehabilitation facility postoperatively. If you still need help, you should work with the doctor’s team to set up home care before you have surgery so things are in place for you and you are safe when you do go home.
  5. There have been great strides in Hip and Knee replacement. Most patients do well with preplanning and support from their healthcare team, family, and friends.

When you are in pain and want to feel better, you might overlook some of these things. This is why you need a health advocate to help you understand what you are getting into and how to prepare to meet your needs after the procedure.

Planning will help you be safe, well cared for and give you the best chance of having a good outcome.

Thank you for reading this post. Please share with anyone you know who might be going into the hospital for an elective surgical procedure so they can be prepared!

If you have questions or an example of how you prepared for a medical event, please put your comments in the comment box or email me at allewellyn48@gmail.com


Have a good week!



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