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Topic Date User

Grade 3 AC Joint Dislocation (Separated Shoulder) 9-Sep-2009 At 9:40:34 AM dougal

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On 9/09/2009 Hugh wrote:
>i know this is somewhat of a hijacking.. But why is it that so many people
>are hesitant to have surgery? Just interested in thoughts..

Any responsible surgeon will say something like "I'm the port of last call." A collegue of mine estimated that 97% of people refered to him shouldn't have been in his office ie 3% warranted a surgical approach. (figures will vary - his practice handles quite specific problems with poor outcomes) so generally people leave a surgeons office without a booking. Surgery is still astoundingly overprescribed in health care and poorly researched but it's what our western system does well (ie a lot of) along with CT scans, MRI and chemotherapy for metastatic tumors.

The vast proportion of complaints not only do not require surgery but surgery (and medication) is actually contraindicated. This doesn't stop many people from performing thousands of proceedures with little or no evidence base (if you think surgery is wholly based on science/evidence you are mistaken - it is largely an art form like all the other health fields based mostly on empiricism (let's see what works and pass that on to the next student). Good outcomes are more to do with picking and choosing. Through experience you learn that one approach has good out comes and another doesn't (at least that's the idea). Mostly we keep doing what someone taught us with little or no real evidence base. Again that's accross the board in health care.

This question could and has generated volumes in health care lit.

Having said that - I'm curious as to why the surgeon advised against the proceedure - why the athlete and the tradesman and not you? I suspect he assumes you don't want to use your arm. This proceedure (reattaching the ac jt) can be very effective. You need to push him with questions. Be blunt. Also try calling Julian Saunders in Blackheath for advice. He's seen plenty of these in athletes and has a very good understanding of the pros and cons of having/not having it done taking into account how dysfunctional it is.