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Expectation Management

Lessons Learned from a trip to the ER

Proceed With Caution

I have to admit that for the last few years I have used an interesting tactic with my children to get Them to stop roughhousing. Anytime the kids getting out of hand and I feel that somebody might get hurt at any moment, I asked excitedly “Who wants to go to the ER!?” or “Who wants to get staples/stitches?” I’m sure that it was inevitable that the children that had been to the urgent care for staples and/or stitches before would find their way back again. The other day my son Evan found himself in such predicament. He was playing around the minivan and hit his head on the latch for the back door. Sure enough, he comes into the house saying that he needs to go to the ER to get staples! After cleaning him up and preparing him to be seen in the emergency room, we drove to the ER and had the following conversation:

Me: “Evan, you know that the staples are going to hurt, right?”
Evan: “yes,” said with hesitation.
Me:“Evan, why are we going to the ER?”
Evan: “to feel better”
Me: “You’re NOT going to feel better! This is going to hurt! This will help your head heal, but you may not feel better, because it is going to hurt just as much as it did when you hit your head”

Once we arrived at the ER, I feel that Evan was fully prepared for treatment, knowing what to expect and fearing that it would be worse. It is standard protocol to numb the area with a topical cream. Yet, I knew there was a chance that this may not work, having repaired many head lacerations in children while on my emergency medicine rotation, and having had Evan’s older brother already have a poor experience with this medicine and staples to the head. When I put the two small staples to repair Evans head laceration, he didn’t even flinch or cry or express any pain! I was shocked!

Expectation management

Often in medicine, we hope for the best. Yet, we don’t always prepare patients for the worst, or even reality. From my experience with Evan and other recent experiences at the hospital I learned that we should be meeting somewhere in the middle in building proper expectations. An example: the cardiothoracic surgeon shared with me his dislike for the pain goal for his patients in the intensive care unit. ”On the board in the patient’s room it says, ‘Today’s pain goal: 0 out of 10’ but that is unrealistic! The patient had their chest cracked open the day before, they’re not gonna have ‘0 out of 10’ pain. They will have 5 out of 10 pain, even with morphine-like medicine.”

How does this apply to foot and ankle surgery?

Just like with Evan, and the patients in the ICU, proper expectations will lead to better outcomes. If you require surgery of the foot or ankle, an incision has to be made somewhere! Even with excellent anesthesia before, during, and after the surgery it is unlikely to be a pain-free experience. Set a reasonable goal with your surgeon! You are not their first patient to undergo surgery. Your surgeon will be held to help guide you and set appropriate expectations. Remember, you wouldn’t undergo the surgery in the first place if it wasn’t going to alleviate symptoms.