Often the problems the patient is encountering were set in motion prior to surgery and sometimes prior to injury. We have discussed before the mounting financial concerns, lack of preparedness for the future, marital strife and complicating general medical conditions (diabetes, hypertension, etc) that pre-date the surgery and often the injury itself.
While surgery can successfully manage the mechanical/physical problem, it may be a successful procedure on a patient with an unsuccessful life. The patient has no impetus for recovery, as we would define it. If you define surgery as ameliorating most of the tissue damage, then surgery has an objective goal.
If, however, you define recovery as the patient’s re-entering the workforce and productivity, then there may be numerous complications that are chiefly psychosocial. For many patients, they simply do not know “what am I to do next with life.” They have no contingency/backup plan and often no resources, financial, family or educational.
Much can be gained by determining that for which the patient hopes to mobilize. Even two years after surgery, in response to the question “if you do not go back to your old job, what will you do?” The most common reply I receive is “I have no idea.”
To complete our role, we must help them find that direction.