Spinal Stenosis, The Older Patient, And "Need" To Refer To Surgery

[Paddington]

I tend to see a lot of older patients that have Spinal Stenosis. Many have tried various remedies including medications, PT, interventional spinal procedures already by the time I see them.

The ones that might benefit from surgery I discuss surgery as an option and refer to surgeon if they are interested.

But what about ones that are over 70, have history of MI's, carry around oxygen tanks, etc. I just don't see a surgeon wanting to operate on them and I don't want to waste the surgeon's time with a bad referral. So in that case I might not even discuss it during the visit (in this age of customer service surveys, why bring up something as a treatment option, only to tell them they can't have it because of X, Y, Z?). Is it then acceptable for me (as a non-surgeon) to write in the chart, "Doubt patient would be a candidate for surgery due to X, Y, Z" or is that something that can get me into trouble, because I made a presumption about how someone else might act whose in a different specialty?

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[emd123]

"Mr Jones has multiple co-morbidities that may limit his surgical options. Risks and benefits of surgical options were discussed, and although his surgical options may be limited, he requests a surgical consultation to discuss these options further. Will refer to..."

Done.

Get over worry about "wasting a surgeons time" with a referral, STAT. They get paid for a consult just like you do (and probably spend 1/4 of the time) and just think of how many referrals you've gotten from surgeons or whoever else where there wasn't much to do. Everybody has to take the good with the bad.

 

[Pacman27]

IMO it's a easy referral for them and they get paid. The bad news ends up being when the surgeon goes ahead does operate

 

[SSdoc33]

Don't refer to a surgeon unless the patient needs a surgery. You want to play second fiddle forever, go right ahead, but you should know better than a surgeon if a patient needs a surgery.

 

[ultm8frisbee]

Personally, as an Anesthesiology by training, I know much more about a patient's surgical risk than a surgeon. If I don't think a person is an acceptable SURGICAL candidate based on co-morbidities I will not refer.

 

[101N]

Tell the patient that they need a decompression, not a fusion. If the surgeon insists upon a fusion tell them to ask for a second opinion.