When a Knee Replacement Specialist Needs His Own New Knee

Ira H. Kirschenbaum, MD


September 07, 2016

In This Article

Preoperative Preparation

August 17, 2016

No matter how many patients I prepared for surgery as a surgeon, from a patient's perspective, I see how complex it is. There are so many pieces to the puzzle. The major issue: Everyone who has to prepare for surgery had a life before having to prepare for surgery. Now you need to take time out for the preparation.

No matter how many patients I prepared for surgery as a surgeon, from a patient's perspective, I see how complex it is. There are so many pieces to the puzzle.

There are quite a few categories of preparation: your mindset, your professional life, your medical life, your health and personal finances, your personal life, and your surgery education.

It's not as easy as it looks. A whole bunch of people have to do a whole bunch of things separately and distinctly from each other to make everything come together on a particular day so that afterward the patient can feel a whole bunch better.

It starts with preparing your mindset. I needed to wrap my brain around the enormity of the concept of having surgery—the pain, the time off from work, and the change in my daily lifestyle, just to mention a few things. Early on, this knee surgery needed to be placed high on my priority list.

Organizing my professional life was no small feat. Patients who have surgery when they are younger are typically working, and I was no different. When you are going to be out of work for 6-12 weeks, figuring out how to turn work down is a challenge. I decided it would take 3 months to get things in order, so I scheduled my surgery appropriately.

Truth be told, a week before my surgery, I was still scrambling around. So much for a plan. I was glad that I told a lot of people at the hospital that I was having surgery so that my preparations were not seen as being out of context. I needed a plan for leaving and a plan for returning. I planned to recuperate for all of September, have office hours only in October, return to 50%-75% of my normal surgery schedule in November, and then return to work full time in December.

I was curious to see if I could stay on course.

You never really know how sick you are until your primary care doctor prepares you for surgery. As a surgeon, I always thought that I saved people's lives just by sending them to a primary care doctor for preoperative preparation. At that meeting, the primary care doctor would often find a host of illnesses unrelated to their surgeries and put the patients on a treatment plan. Fortunately, in my surgical pre-op visit, there were no surprises. My internist recommended some cardiac testing, and the chairman of medicine at my hospital reviewed my excruciatingly normal tests. My medical life was in order.

Health finances are harder to understand than an algebra question. There are a million deductibles and fine-print rules; none are really advantageous to patients. For me, there was an interesting twist: Financially, my surgery was being performed under one of the first commercial bundled (ie, a global flat fee) payment programs for outpatient joint replacement. By having the surgery done as a bundle, there are no billing surprises.

I had more than enough sick leave, short-term disability, and a plan to return to work within a reasonable time, so personal finances would not be a problem. Still, this was something I needed to calculate.

My personal life, however—from my mobility to how I would spend my time—would be upended by the surgery. At this point, I am not even close to anticipating how much time I will need to devote to healing. This is likely to be a challenge.

I have an advantage over most patients when it comes to surgery education. But even for an orthopedic surgeon, there is a lot to learn. My operation is taking place in an unfamiliar hospital, and the protocols to be used are also a bit unfamiliar. I want to try my best to be a good patient through the process.


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