A neurosurgeon will base his work upon objective diagnostic findings. He will objectively communicate those findings to the patient. He then operates based upon those objective findings and gauges success based upon post-surgical objective findings.
Surgical outcome is still not always predictable. Even when excluding those who are malingering, there are a number of patients who do not respond as preducted.
Objective findings are necessary, but they are not sufficient to account for a patient_s response.
I suspect that even though the surgeon feels that he knows his patient well, the patient keeps private significant information regarding their family, finances, future, fears and expectancies.
The patient often hears only that surgery is needed and that _there is a high degree of success._ Most patients interpret the latter to mean that after surgery there will be no limitations_and there will be no pain.
The conduit to the patient_s family is the patient, most often not the surgeon. The patient miscommunicates the findings and the surgical plan to his/her family. The family then repeatedly discusses these misinformtation it in the home, and information regarding the surgery and its probable outcome become increasingly distorted.
When the patient enters surgery, he/she then carries not what has been carefully explained but the shared distortion held within the family. This can be combined with comments made by nurses, staff, and even those in the waiting room.
Not surprisingly, the patient_s subjective outcome to surgery is not as expected.
It is far easier to have someone outside this inner circle of communication evaluate the patient and his/her family_s perception of what is to occur and what outcome to expect. Issues such as dependency, resentment, lack of alternatives, fear of anesthesia and/or pain, and a myriad of other concerns can come to light, be resolved, and increase the probability of positive surgical outcome.