Mental Illness and Spine Surgery — What Now?

The CORRelations post “Mental Illness and Spine Surgery — You Have a Role” suggested that orthopaedic surgeons should play a more hands-on role in encouraging patients with emotional distress to access behavioral health resources that will improve recovery after major surgery. I wholeheartedly agree with the entreaty made in the post: “Don’t hit ‘delete.’ You can do something about this.”

Over my career in orthopaedic trauma, I have repeatedly been surprised by how often I’ve not recognized when patients were experiencing symptoms of anxiety, depression, or other coping issues. As left-brained problem-solvers, we may not be as sensitive as we think we are to the emotional distress that many of our patients are experiencing. And it’s not entirely an issue of surgeons lacking in empathy or sensitivity either; many patients demonstrate a tough, coping exterior while their partners in the other chair in the exam room will, if asked, describe the patient’s brokenness.

I would advocate doubling-down on the advice in the post. Spend the time to reiterate that:

• Depression and anxiety are common, all the more so among patients after trauma or who may be experiencing somatic pain (remember that the pain doesn’t cause the depression, though depression can worsen pain)
• Depression and anxiety are treatable medical conditions, not character flaws or weaknesses, and treating them can help the patient achieve the goal we all share: a full and speedy recovery from the surgery we’re discussing together
• Sometimes, it’s worth postponing the surgery to work on the depression or anxiety (assuming it’s discretionary and the delay itself isn’t harmful; obviously emergency surgery is another matter)

Take the time to empathize and say that you care about the whole person — including his or her emotional distress and emotional well-being — and not just the joint, bone, or spine. This is common enough that each of us should have a list of resources readily available; mental health services often are strained these days, and so patients’ internists and family physicians often are stepping into the breach. Encourage the patient to reach out, and then make sure that they’ve done so.

Most of us realize that this is essential for patients with schizophrenia and bipolar disorder, but results suggest it may be just as important (or nearly so) for patients with symptoms of anxiety or depression.