Episode 4: Top 5 Things Your Surgeon Wants You to Know

Today’s episode titled top 5 things your surgeon wants you to know features Dr. Scott Cowan, a cardiothoracic surgeon and associate professor at Thomas Jefferson University hospital and Dr. Matthew Philp a colorectal surgeon and associate professor of clinical surgery at Temple Health. Both Dr. Cowan and Dr. Philp also serve as clinical advisors for the PENNJ-SOS program. Today’s episode is also moderated by Pamela Braun, MSN, who currently serves as the Vice President for Clinical Improvement at the Health Care Improvement Foundation. Pamela Braun: Dr. Cowan and Dr. Philp, I want to begin by thanking you for joining me on today's podcast. As you know, you were each asked to come up with a list of the top things you want your patients to know about opioids and pain management when they need to have surgery. I have your lists, and I think you both provide some really great advice for patients. One of the things you both listed is the importance of having a conversation with your surgeon about pain management. Dr. Philp, we'll start with you - can you tell me why a conversation is so important? Dr. Matthew Philp:             Thanks, Pam. I'm really happy to be here and speak with you and Scott today. Having a conversation is huge, because it just sets all the expectations with you, and with your surgeon and the patient. There’s a wide range of operations that we do. We have the insight of what recovery will be like, what expectations are—because a lot of times we see that, where they say, “I've seen someone that's had that procedure”. And they have this set expectation of how things are going to be.             Especially if it's something that may have happened 15-20 years ago, when management was different. We had different options. We didn't do things the way we do today. We do things better, and recovery can often be faster. For example, using something like minimally invasive or laparoscopic surgery for major abdominal cases. The recovery is just so much different and better for patients, so they expect sometimes to have all this pain and it's not going to be like that.             Having that conversation is just so huge. Setting expectations from the get-go is really important. Answering the questions that patients have is really important. Pamela Braun:             Thank you. And perhaps also the question for you, Dr. Cowan, is that at what point should these conversations happen with the surgeon? Dr. Scott Cowan: Thank you for inviting us to participate in the podcast, Pam. It's great to be here today. I think it's always important to have those discussions about pain at the time that the patient's scheduling their surgery, really to help set those expectations that Dr Philp mentioned. And also to talk to and educate the patient's family members about what to expect in terms of potential side effects with the patient and any potential long term consequences of being on these medications.             One of the most important things a surgeon can do is to let their patients know that having some pain after surgery is completely normal and is to be expected. So, the goal isn't to completely eliminate their pain, but really to make it so that they can function and get through that acute phase, those usually two to three days after surgery, where the pain is the worst. And that's where opioids really play the largest role nowadays. Pamela Braun:  Really a great point. Thank you. Dr. Philp, you mentioned in your list that it's also really important to develop plan with your surgeon. I wonder if you can elaborate a little bit about that? Dr. Matthew Philp: Yeah. So I think having a good plan is important. We're talking about opioids here today, but opioids really should only be a part of a total pain management plan. I think one of the things we're doing—I mentioned things we do differently now than we did 10 or 15, even five years ago—is   incorporating other modalities of pain management. Nonsteroidal drugs, ice, elevation, even some cognitive therapies… there's a whole spectrum of things that you can do. And it's going to vary by surgeon, by procedure, by patient. The more information we know about the patients, their histories, their prior experiences, the better we can tailor a plan. It really shouldn't be a one size fits all approach to pain management. It's best when it's done with some thought and nuance to the particular patient. Pam: Great. That's really helpful, because postoperative pain is unique for every individual. So, I think that is nicely aligned with exactly what you were just saying: truly tailor that plan to the unique needs of the patients.             Dr. Cowan, for patients that have an opioid use disorder, or may have struggled with addiction in the past, should they bring that up with their surgeon before surgery? Dr. Scott Cowan: Great question. And absolutely. And it's important that the...