Dr. Ryan P. Calfee, a renowned orthopedic surgeon and expert in hand and microsurgery, delivered a powerful presentation during Grand Rounds as the Duke Orthopaedics Hand Society Visiting Professor. His talk, "The Intersection of Mental, Social, and Physical Health," illuminated the complex relationship between psychological well-being and musculoskeletal outcomes and urged orthopaedic professionals to integrate a more holistic approach to patient care.
The Dreaded Scenario: When Surgery Doesn’t Deliver
Dr. Calfee began by posing a scenario many surgeons have faced: "The surgery went perfectly, but the patient’s recovery doesn’t go as expected. They experience anxiety, depression, and dysfunction. But why should we care?" The answer, he explained, is that mental and emotional health significantly impacts the success of musculoskeletal treatments.
Research indicates that 40% of orthopaedic surgeons report encountering patients with anxiety and depression that adversely affects recovery. These pre-existing emotional conditions are often overlooked in the postoperative process, yet they play a pivotal role in a patient's overall recovery.
The Importance of Addressing Mental Health
Dr. Calfee pointed to troubling statistics that highlight the critical need for addressing mental health in orthopaedic care. For instance, only 5% of patients experience mechanical failure after total knee arthroplasty, while 35% report unexplained pain. While the physical surgery might go according to plan, mental health challenges such as anxiety and depression can exacerbate feelings of distress, complicating recovery.
Incorporating tools like the PROMIS (Patient-Reported Outcomes Measurement Information System) group measures can help bridge this gap. PROMIS measures assess social, mental, and physical health, providing valuable insight into the patient's well-being. Dr. Calfee advocates using technology, such as PROMIS integrated into an iPad check-in system, to facilitate patient conversations about their emotional health. This simple but effective tool can prompt meaningful discussions on how patients cope, allowing clinicians to address issues that may go unnoticed.
Holistic Treatment for Better Outcomes
Dr. Calfee stressed that the future of orthopaedic care must shift toward more holistic treatments. "Our goal should be to help these individuals through comprehensive, patient-centered approaches," he said. Physical interventions do not solely determine successful outcomes but are also influenced by social and psychological factors. For example, the social determinants of health, such as where a person is born and raised, significantly affect their overall health trajectory.
In an ideal world, patients can access integrated care that addresses their physical needs and emotional and social well-being. Dr. Calfee encouraged orthopaedic professionals to advocate for these multidisciplinary care models at their institutions, which could improve the quality of care across the board.
Positive Feedback from Patients
One of the most compelling aspects of Dr. Calfee’s presentation was the patients' feedback in a study using PROMIS measures. "Patients appreciated simple actions like the doctor asking, 'How are you doing?'" he explained. "They felt that their doctor truly cared about their well-being." This feedback underscores the power of empathy and patient-provider communication in fostering trust and improving recovery outcomes.
Leveraging Technology for Mental Health Integration
Technology plays an essential role in integrating mental health care into orthopaedic practice. Dr. Calfee discussed how using the PROMIS system can flag critical mental health data—such as anxiety or depression—that can be displayed on a clinician’s screen before entering the examination room. After the appointment, providers can print out a sheet summarizing the patient's responses and offer online resources for counseling or mental health support. For example, apps like Headspace provide accessible mental health tools, allowing patients to continue their recovery journey outside of the clinic.
However, Dr. Calfee cautioned that digital interventions are not a one-size-fits-all solution. Instead, they should be part of a more extensive, personalized approach to care. “Addressing mental health in orthopaedics requires flexibility and individualized treatment,” he said.
Practical Steps for Clinicians
Dr. Calfee closed his talk with several actionable steps that orthopaedic surgeons can implement immediately to improve patient outcomes:
- Be flexible with clinical arrival times: If a patient struggles to make it to their appointment, allow them the flexibility to arrive late. The effort it takes for some patients to attend appointments may be significant, and showing empathy in this area can go a long way.
- Provide in-office therapy instructions: Where appropriate, offer therapeutic guidance during the same appointment to optimize recovery and reduce barriers to care.
- Utilize telehealth: If a patient cannot make it in person, consider using telehealth options to ensure they have access to care.
- Listen and show empathy: Simple actions like maintaining eye contact, listening attentively, and acknowledging emotional struggles can help build trust and strengthen the patient-provider relationship.
Dr. Calfee’s advice culminated in a powerful reminder: "Be the physician that you would want your family to see." By embracing a more comprehensive approach to care that integrates physical, social, and mental health, orthopaedic professionals can significantly enhance patient outcomes and ensure more holistic, sustainable recoveries.