When is Shoulder Surgery Truly Necessary? Insights from a Central Texas Orthopedic Surgeon

Layla [00:00:00]:

Welcome to Shoulder Wise, the podcast where clarity, strength and care come together for every shoulder journey. Today we’re going right at one of the biggest questions patients ask, especially ask Dr. Szerlip on a regular basis, do I really need surgery? So today he’s here and has had these conversations every day, and today he’ll share not only the medical side of it, but the human stories that make these decisions so personal. So, Dr. Szerlip, thanks for being here. I. I know a lot of people are listening, eager to hear about your experience and how you handle this question and deal with people’s nerves essentially around this. So I’m excited to chat today.

Dr. Ben Szerlip [00:00:39]:

Yeah, thanks, Layla. I’m excited, too. And I really think that this is one of the most important topics. It’s one of the hardest ones to deal with from an emotional standpoint, from an intellectual standpoint, and how we tie it all together to help each other make decisions in life. It’s cool. And it’s a secret that we all have to crack. So the question is, do I really need surgery? And it’s the most common one. I had it today, actually.

Dr. Ben Szerlip [00:01:08]:

A super, super nice patient, and we had a great 20 minute conversation, and we still then decided to start and say, hey, we’re going to meet again. We’re going to talk some more. So I think that this whole myth about, you know, you have to decide right now is. Is completely, you know, bogus. I’d say 95% of the time, you. You have the time to process this information, to wait to. To learn more and to ask more thoughtful questions, because our brains are. Are usually trying to intake all this information and then we can’t process the decision quick enough.

Dr. Ben Szerlip [00:01:46]:

So I think it’s totally fine to get more info into weight as well. I think it makes patients feel more comfortable. But, you know, do I really need surgery? To answer your question directly is, I think that this is an opportunity to help somebody. I think that when somebody says, do I need something? And they come to you in your office, it’s saying, I need help from somebody I consider an authority on the issue and somebody that I can trust to give me advice based on my best interest, what’s best for me, and we need to investigate what that is. We need to talk and learn and know, you know, to kind of tailor that treatment plan towards each patient. So we all got into medicine, I think, to some degree to help others, right. And then empowering them to make their medical decisions with the critical information that we have, not only based on the research and the studies that are out there, but also years of experience or training. It’s a huge reward for the patient, for the doctor, for everybody involved.

Dr. Ben Szerlip [00:02:45]:

So I think that some of these other questions we’re going to talk about will help dig into how we actually process the information and how we do that.

Layla [00:02:53]:

Absolutely. And I’m sure from your end it’s a lot to process and also not maybe, you know, the easiest thing to convey to someone because it can be, you know, scary thing. I think it’s surgery. I get a little nervous. So when a patient is sitting across from you and they nervously ask you, do I really need surgery? What runs through your mind right away?

Dr. Ben Szerlip [00:03:18]:

So we have to gather the information and it’s by criteria. So does the patient need a surgery? It’s really, are they gaining value from it? You know, needing something? It could be, hey, you may have cancer. That’s a more extreme on one side of the spectrum where if you don’t get a surgery, it could be life threatening. Right. And so that is more of a more clear cut, more black and white answer. Do I need surgery? Will it benefit me? And then so when we do, you know, musculoskeletal treatments or injuries, a lot of times it’s saying, hey, I’m having increased pain or I have problems with a performance or I know it’s going to get worse or I may do more damage. So if we consider a surgery on those factors, pain is a little bit subjective. Right.

Dr. Ben Szerlip [00:04:06]:

And you know, function, I could, it depends on the patient’s age. So I just had a patient in their 30s, they’re a professional wakeboarder here in Austin, Texas. So there are professional athletes in essence. And then I have other people who are, you know, in their 50s and 60s and say, hey, I work at a desk and I, I really enjoy, you know, putt putt golf and you know, other types of more low demand leisure activities. So I think that you have to take each patient’s age, their functional levels, their symptomatic treatments and the act actual diagnoses. So I think that those are all factors that go into that decision making process. So needing a surgery, it’s pretty rare, honestly. Most of the surgery is considered an elective.

Dr. Ben Szerlip [00:04:52]:

So when I say elective, meaning they elect to get it after we have gone through a trial of conservative treatments that don’t entail surgery and they’re still having significant symptoms, limitations in their function or it’s not getting any better with those other treatments.

Layla [00:05:08]:

Absolutely. And when patients are thinking about needing a surgery or potentially having to have one. What do you think the most common fears that they have are when they hear the word surgery?

Dr. Ben Szerlip [00:05:23]:

Yeah, for sure. And I’m one of them. So I will talk about more about personal experience, but it’s good to put yourself in that patient’s shoes. But common fears, and we have that every day. And I think that, you know, one of the major keys to well being is the perception of control. Not that we know that we have control because a lot of life is out of our control, but the perception that we have control. And a more popular term in the mental health field right now is a sense of agency. And some people are like, what is that? It’s essentially a belief that your choices in action matter in shaping your life.

Dr. Ben Szerlip [00:06:01]:

So the multiple studies and scientific data out there consistently showed better mental health in resilience and life satisfaction in participants who felt they were able to influence their circumstances, relationships, or responses to how they did something. And surgery is absolutely no different. So if we’re saying, hey, what are people scared of when they think of surgery? And why are you talking about agency? A strong argument could be made that the fear of having a complete lack of control and surgery is one of those things. It’s literally fear of the unknown. In most cases, you’re going to sleep, you’re completely unconscious, and somebody’s doing something you’re probably not familiar with, you probably don’t understand that well, and you’re trying to get more information, but that’s almost the definition of being out of control. So I think that that’s what the stem from fear is. As soon as we understand that, we can then take the fear and the emotion out of the equation. Right, because then we have to process this information to make the best decision for ourselves.

Dr. Ben Szerlip [00:07:01]:

Right. And then ask questions that will help us in our recovery or optimize our goals or our outcomes. So I think that, you know, oftentimes there are specific concerns about recovery time. I think that’s probably the most common, like, hey, when can I do X, Y or Z? When can I type at a desk again to maybe do my job? When can I pick up my kid again? When can I drive a car? When can I go skiing? This winter in October, which we’re in right now. I have people already planning ski trips, weddings. So that’s really helpful to help them understand their timeline, potential pain that might be from the procedure and how can they expect that and how they can control it. There could be financial cost barriers. I think now more than ever, insurance is varied and different.

Dr. Ben Szerlip [00:07:46]:

And some people think it’s even crazy. But help them understanding what costs they’re going to have or if they have to take time off work, I think that’s a big deal. Or if they’re having to care for somebody else, like a child or a parent, they need to know that, too. So helping fill in all these blanks and the fear of the unknown and some of those other factors we mentioned are part of our jobs to fill in those blanks when we help patients or counselor them out of surgery.

Layla [00:08:13]:

Absolutely. Those are all very valid, I think, concerns from someone who is going to have surgery, especially when they have to take care of other people as well and they have important hobbies that they love and work and finances and all of those things. So I know from their end there’s probably a lot of decisions and again, a little bit of fear, but decisions and different thought process and things to figure out. But when it comes to you and your decision making in terms of whether or not someone would be a candidate for surgery, can you walk us through your decision making a little? When you evaluate a shoulder injury, what key factors really determine whether you recommend a surgery or not?

Dr. Ben Szerlip [00:08:55]:

Yeah, and I think that’s the key. Right. So we’ve talked about some of the fear and some. Do I need one or not? Does it provide value? And it’s the different criteria for, you know, considering an urgent or emergent surgery versus an elective one when we elect to get to improve the quality of our lives. But it really does come down to some of the criteria and would hopefully make it easier for patients to digest and then make the decision for themselves. But first of all, you kind of need to know that you’re kind of at the right place with the right person, with the right training and experience. But really it’s understanding and confirming the diagnosis. Right.

Dr. Ben Szerlip [00:09:31]:

Do I have X rays or is this diagnosis made on clinical exam and a patient history? Is the diagnosis made on an imaging like an X ray or an mri? It’s usually a combination of all those things. But do we have an accurate, almost firmer, guaranteed understanding that we know that this is the problem? Right. And so not all the time we’re coming in and trying to find some. We’re doing some detective work, as we had talked about in previous podcasts, to find out what that is. And then once we do have a firm lock on that diagnosis, or it could be multiple ones, do we have data that actually makes us confident that if that diagnosis is the problem, that this potential surgery will provide the best solution, right? So if we have this problem, will this, you know, surgery provide us pain relief? Will it provide us preventing, you know, future damage? Will it improve our function or allow us to do x, Y or Z better at our job or the hobby that we enjoy? So I think that those criteria are critical. And then there are several other things. So if somebody has a diagnosis, and this is more subjective on this third category, but do we have significant symptoms that bother us, like on an everyday basis or a consistent basis, however people would define that? Some people say, it doesn’t bother me at all when I’m not doing anything. And you’re like, hey, there’s no problem.

Dr. Ben Szerlip [00:10:48]:

But every time I try to exercise, every time I go to my job, which requires that I have to lift something over my head, then I’m in pain, or I can’t sleep at night because it wakes me up and I can’t get more than three hours of sleep. If people have experienced that or they have small kids, getting three hours of sleep each night can have a huge impact on the rest of your life. So some people like how much do the symptoms bother you? And I think that people can kind of rate that on their own severity scale. So there’s other things too. So if we go off those three things, so do we have a diagnosis, do we have evidence that shows that that surgery would improve that diagnosis or help relieve or solve the problem? How bad are the symptoms? Right? And really, have we tried other non operative treatments? Have we tried giving it time? Have we tried medications? Have we tried physical therapy, which is we talked about the last other podcasts, is critical to most people’s treatments in the musculoskeletal field. So you can say, hey, have we tried these non operative modalities and is it getting any better? And if they say, you know, I’ve tried all those things and no, it’s not getting better, it does bother me consistently every day. And it’s also, you know, affecting my quality of life in terms of I can’t do the things that I need to do for my activities of daily living or I enjoy with my hobbies, there are even more factors to help dissect this out. And it’s not to overwhelm the patient.

Dr. Ben Szerlip [00:12:09]:

It’s really just a. They can plug this into their own algorithm or scoring system and then help them make their decision. So take the subjectivity out of it and make it more objective. But do these patients have realistic expectations on what they need to do or want to do? I think it was my mistake. I had an older patient who, he could barely lift his arm up and we did a shoulder replacement, but he was somewhat frustrated that he couldn’t throw a football over 20 yards. He could throw it up to 20 yards, but he couldn’t throw it over. So he was a little bit disappointed on his outcome. So I think that it’s important that we talk about what we can expect from the surgery and what we cannot to get.

Dr. Ben Szerlip [00:12:50]:

And there is a bell curve on that. I think the other things are medical optimization. So when we talk about like, is the patient a smoker? Do they, are they having a problem with drugs or do they have diabetes or a certain problem with obesity that maybe this surgery is a potentially, you know, this diagnosis. The surgery could potentially benefit, but we need to have the patient make sure that their, their sugars are under control or that maybe a weight loss program before that would be helpful and, and knowing that we can decrease that patient’s risk for a complication after we medically optimize those issues.

Layla [00:13:30]:

Definitely sounds like there’s so much that goes into the decision making process way more than I would have even ever assumed or considered. But it makes a lot of sense in terms of their everyday life too, of how much is this injury, this pain, really preventing or stopping from your everyday life and then also being able to look at the potential outcome and kind of gauge what their life would be like post surgery. But I know that you’ve said this before about not being a scalpel first surgeon, and you definitely take a lot of into consideration and these decisions. So like for example, physical therapy and thinking of other things as well before just jumping to surgery. So being that you consider yourself not to be a scalpel for a surgeon, where did that philosophy come from? And was it a mentor or was it something you came up with yourself, one of your own values?

Dr. Ben Szerlip [00:14:29]:

Yeah, I, I definitely would credit my mentors and a lot of the people that I work with, I worked with, you know, my uncle and his, he used to be a plumber and help other people get water in rural areas. He, you know, like, there’s other people who worked in construction and like we talked about earlier. And if really if you, you know, if a person or organization prioritizes honesty and integrity, they will succeed. They will get people’s, you know, trust and respect. And I think that if we just give the impression that we’re trying to push them into a surgery or recommend something, I think that people are very good at quickly realizing that. And one of my favorite authors and somebody who I’m to have dinner with someday. But Malcolm Gladwell kind of talks about in his book Blink that we all have this ability to kind of gauge people and say, hey, are they looking out for my best interest? Do they understand my values and what I want? And then will they help me get there? So I think the other per, you know, so the best thing that a surgeon can do is really saying, hey, I’m gonna talk you out of a surgery. I think the best people, I’ve seen some of the best people in the country operate, and they used to come from all over the country, all over the world, so they could get their surgery from that person and they get the best results.

Dr. Ben Szerlip [00:15:57]:

Because saying, hey, this surgery will not help you. It won’t accomplish the goals that you want it to, and therefore we shouldn’t do it. And that seems surprising. But if you have the right patient selection of telling the patient whether they’re a good candidate or not, that’s the best thing. Because if you don’t have a plan or if you have the wrong plan before you get in the operating room, you’ll fail before you even start. I think an even easier way to say it, and one of my mentors, huge Kenny Rogers fan. So if you listeners out there familiar with the song let’s see from the Gambler, you have to know when to hold them, know when to fold them, know when to walk away and know when to run. And I think we as doctors and we as patients need to understand that as well.

Layla [00:16:44]:

Absolutely. And it’s interesting because we were just even talking about patients and their fears of surgery and a lot of people not wanting surgery, but I didn’t even think about it. There’s probably patients who are like, yeah, I do want a surgery and it will fix everything and let’s do it. And like you’re saying, it’s not always the best approach. So can you share an example of someone like that? Maybe a patient who came in and was convinced that surgery was inevitable and maybe the best thing for them, but you guided them through a non surgical path that worked maybe even better. Well, better than the surgery?

Dr. Ben Szerlip [00:17:23]:

Yeah. So I think that. Let’s see. Sorry, I lost my train of thought, but yeah, no, it’s good. So let’s see. I’ll start over at one.

Layla [00:17:33]:

I can say it again from question five if you want.

Dr. Ben Szerlip [00:17:35]:

Yeah, fine. So we’re on question five.

Layla [00:17:38]:

Yeah. So can you, can you share an example of a patient who came in convinced that surgery was inevitable, but you guided them to a non surgical path that worked.

Dr. Ben Szerlip [00:17:49]:

Yes. I had this patient who was unrealistic expectations, you know, relatively impatient. He wanted a quick fix and didn’t have time. Felt very inconvenienced by having an injury or dealing with your recovery times. And it was me, right? And that was the best thing to do. It was the best thing that ever happened to me because. So when you finish residency, you know, and you’re, you’re, you’re kind of in your 30s, right? And I’d been for. I’m very fortunate, very, you know, lucky and healthy.

Dr. Ben Szerlip [00:18:23]:

But then I, you know, so it is hard to identify with patients. But then I did have an injury. I was still a competitive athlete and I tore a ligament in my foot and I had a hard time. I was walking around in a boot for six weeks and I had a hard time running. And it really kind of got to me when I couldn’t, you know, run along with my kids. I was trying to. My kids were even younger than we were, trying to teach them how to ride a bike. And, you know, running or getting any kind of activity was really difficult.

Dr. Ben Szerlip [00:18:50]:

So I was convinced that I needed a surgery. I wanted to be done, I wanted to move on. And so the best way that some of my mentors and some other doctors, some other colleagues that I talked to throughout the country, they’re like, hey, this isn’t the best surgery for you. You need to treat it with. Without surgery. You need to treat it with therapy. And I said, hey, I’ve tried therapy for a whole two weeks. And you know, they were laughing because I say, hey, this isn’t working.

Dr. Ben Szerlip [00:19:17]:

You know, essentially we, as Americans, I think we’re conditioned. And I like to make fun of myself because it can happen to every one of us that I am frustrated when I don’t get my Amazon package in two days, right? And so we, we do have this like, you know, quick fix, get it done. I don’t have time for this. But I actually worked with a therapist who had dealt with the same problem. And so we were, we were doing the therapy in a wrong way, and I saw a different therapist and so trying to tweak different things. And a lot of coaches and success stories in business or athletics, they’ll say, hey, if you can change three variables, that will change things even 5%, well, that’s 15% different. And so the same therapist had actually dealt with the problem because one of my legs is actually rotated considerably more than my other. And so they kind of had to reteach me how to run and even do certain sports or activities in order to take pressure off that area where the bone was stressed and the ligament was torn.

Dr. Ben Szerlip [00:20:19]:

And so it took me probably four to six months to learn how to run and rework my gait. But it made all the difference in the world. And it taught me such a valuable lesson on to be more patient, to be more understanding, not try to seek that quick fix. And I’m eternally grateful for the doctors who kind of stuck by my side and said, hey, surgery is not the right answer.

Layla [00:20:43]:

Absolutely. Yeah. And it’s great that you had that particular surgeon and providers to give you that insight and not just say, hey, let’s, let’s go through with the surgery. But as a surgeon now, and on the flip side of this, can you tell us about a time that you had to tell someone, yes, surgery is the best option. And even when the patient may have been hesitant, so how did you build trust in that moment?

Dr. Ben Szerlip [00:21:10]:

Yeah, I think that that’s a, that’s a great question that I, I still, my answer still evolves every year that I treat patients. And I think in some ways that we have to counsel the patients the same way. Right. And if we as scientists, as engineers, it’s different than salesmen. Engineers seek the truth. They will give it to you black and white. And sometimes, you know, your accountant will just tell you how it is and not really care about how you feel about it. It’s just, it is what it is.

Dr. Ben Szerlip [00:21:44]:

Right. And I think that somebody who’s trying to sell you on something will change their approach or try to take a different pathway to get, to appeal to something. So if we believe that surgery is the right answer, we’ll give that recommendation and you present it in a way that it’s, it’s an evidence based answer. So, hey, this is the diagnosis, this is what the evidence shows that you would improve. But it really does come down to a quality of life. And so if, if those patients make the decision saying, hey, it, it does bother me consistently, you know, or, hey, it would improve my functional outcome. Or I tell them sometimes that this is a problem that would do more damage in the future. And, and then we, we say, hey, do you don’t have to make any decisions, just take the time, process, ask more questions.

Dr. Ben Szerlip [00:22:31]:

And some of them even want to get a second opinion. And I think that’s totally reasonable, making a big decision. So I think that allowing them to make decisions at their own pace, at their own time with the information is key. But I think one of the things that I’ve learned in the past couple years are, you know, I tell them, how would you treat your spouse? Or how would you treat your kid? And I say that because oftentimes we tend to punish ourselves or neglect ourselves when deep down it’s that fear or lack of emotional regulation that this thing is holding us back. But we know, like, I know my kid should get an injection when they need it, or I know my, my family member should get a certain treatment. And I wouldn’t withhold that. But sometimes you tend to procrastinate when, when it comes to our own healthcare.

Layla [00:23:20]:

Yeah, absolutely. No, for sure. But even in, in those situations where you know or you think to yourself, surgery is the smartest step. Right. What’s a common sign or a common situation that really does point that out to you?

Dr. Ben Szerlip [00:23:39]:

Yeah, I think that, you know, the previous question, we went over a couple criteria and I think those are all really helpful. But oh my gosh, it’s overwhelming. So I tell people and my wife we came up with this solution. She only gives me three things to remember when I walk out the door because if it’s more, I’ll probably forget. And I will admit that. And she’s usually right almost all the time. But I don’t tell her all the time. But I even forgot our, to pick up our kids.

Dr. Ben Szerlip [00:24:07]:

I got the groceries, but I forgot the kids. It’s cool. So long story short, the kids got picked up. But I think to get back to your, to get back to your question, I tell them. So the rule of three, three basic things. And you know, we can elaborate on that. But does it bother me on a consistent basis or every day? Right. Does it stop me from doing the things that I need to do or, you know, through my everyday life or my job or that I enjoy doing? And three, have I tried other things that, you know, non operative treatments and are those working for me? Um, I think if you kind of boil it down to those three things, I think you could address 80% of the questions and problems.

Dr. Ben Szerlip [00:24:48]:

We also talked about, am I a good surgical candidate for, you know, other medical optimization? But those three things, and I would say sometimes it, you know, I’d ask the surgeon, is this going to do more damage or can we watch this over time? So if we can keep it simple, I think that’s going to help all of us in the long run, not just the people who don’t know about medicine.

Layla [00:25:09]:

Absolutely.

Dr. Ben Szerlip [00:25:10]:

And maybe I’ll pick up my kids more often. That only happened one time by the way.

Layla [00:25:14]:

So I mean, I don’t have kids, but I couldn’t see that happening to me too.

Dr. Ben Szerlip [00:25:19]:

So I get it.

Layla [00:25:21]:

Yeah, I got it the other day I walked my dogs and I came out of the house and I was like, why is it so quiet?

Dr. Ben Szerlip [00:25:27]:

Yes, why is it so quiet? Okay.

Layla [00:25:29]:

Of the door.

Dr. Ben Szerlip [00:25:30]:

So, you know. Yeah, quiet can be dangerous.

Layla [00:25:34]:

Yeah, absolutely. But talking about indicators of needing a surgery or the decision making that goes into whether or not it really is the best idea. Are there any myths about shoulder surgery that come to mind that you wish you could erase? I’m sure you hear all kinds of different things and I’m sure when you make these decision, these decisions, patients probably come to you with some of these myths that they’ve heard. So what’s a myth that you really wish you could just erase? You know, for example, kind of what you said earlier, surgery is this long year long recovery process. It’s miserable. So are any of these myths that you hear even true?

Dr. Ben Szerlip [00:26:24]:

Yeah, I, that’s, you know, we talked about myths in the last top being that hey, that physical therapy can address a lot of things and that we don’t always need surgery, we don’t always need the quick fix. Like I told myself I did. I think that what I would say, hey, the myth for surgery or what we could erase or kind of not a race. It’s. But, but undo or processes. It doesn’t. It’s not a year factor. And to start, I think that the answer, my two word answer to you is negativity bias.

Dr. Ben Szerlip [00:26:58]:

And it’s something that it’s not that just negative people have. It’s not something that, you know, pessimistic people have and optimistic people don’t. Negativity bias is what our brains were evolutionarily adapted to do. For example, if somebody scowls at us versus smiles at us, we’re going to remember that scowl. It could mean danger. You know, when we were in the hunter gatherer phase, if somebody got eaten by a saber toothed tiger or you saw somebody get sick after they eat a mushroom, you would never go around tigers, you would never eat a mushroom. And you know, if you believe in all that, you know, or not. But I bet people, if they swatch the movie Jaws that they may not get in the ocean the next day.

Dr. Ben Szerlip [00:27:39]:

Right. And so that is an evolutionary adaptatious, you know, thing. But now in, in modern day society, if 20 people give us a compliment, but one person on social media tells us that our idea is stupid or we look funny, how many People are going to think about that all day or they’re going to ruminate about that, or lack, you know, if somebody at work tells you your project’s a bad idea, we have to be able to understand why our brains think that and then process it. So the myth is that if we see somebody or hear a problem, that one patient had problems for a year after their surgery, then we’re conditioned to think that that’s going to be our case. Right. And it’s perfectly natural. So I. I think that it’s not.

Dr. Ben Szerlip [00:28:26]:

The negativity bias is not to erase or eliminate the problems. It’s to understand that that’s probably the exception to the rule, that on a bell curve, that that is, you know, probably gonna be the 1 or 2%. And there’s a reason why we all think that, though. Another factor is it can. Patients can see improvements in their condition for up to one year. And so it doesn’t mean you’re gonna be out for a year. But I’ll give you an example. So if people watch ESPN or sports or football or baseball, the playoffs are on right now.

Dr. Ben Szerlip [00:28:59]:

So it’s. The fall is everyone’s favorite time to watch espn. Right. And so if you have an ACL injury or a rotator cuff tear, you don’t have to be a doctor. But most people understand those concepts. And that athlete is usually out or until the next season, and that can be a year. So these people who are paid millions of dollars to play sports, they’re 20 years old, they’re at the peak of their physical acumen, even. They take one year to get back to their level of play.

Dr. Ben Szerlip [00:29:29]:

So it is, you know, we’re gonna get back sooner, and patients do really well. But I think that we can expect to see improvements from a condition for six months to one year. It doesn’t mean that they’re out, if that makes sense.

Layla [00:29:45]:

And it doesn’t sound like they’ll be in misery for a year either. Particularly. I know that that’s something like the sentence is a big. A big mess. They think that that whole year afterwards, they’ll be in pain and agony and. And have to go through it for the entirety of a year.

Dr. Ben Szerlip [00:30:06]:

Yeah, yeah, I think. And I didn’t touch on that point too, even. So, I started residency. Let’s see, I started in 2004, man, 21 years ago. And so in general, the process, the procedures, everything had changed. The technology has changed. I mean, at that time, cell phones, computers, TV screens, cars, every technology has changed. So we have to used to have to cut the shoulder open to do some of these procedures.

Dr. Ben Szerlip [00:30:38]:

Now it’s done through a small, small camera, almost the size of a needle. And the hardware has changed, the technology’s changed. Uh, the surgeries are becoming less invasive. The fixation or the anchors or anything else in the implants are stronger, lighter, better, longer lasting. So I think that over time those things are evolved. So patients are getting back to work, you know, within a week. Um, I have contact athletes who are full go without restrictions at three months. But I also warn people that, you know, like, there is a bell curve, and everybody fits on that bell curve.

Dr. Ben Szerlip [00:31:20]:

So I have a question for you and all the audience. You know, I. Certainly having a baby is something beyond a guy’s even comprehension. But how do some women have their baby at home in a bathtub and think it’s the most beautiful miracle ever, and other women, you know, it sounds like a very big process in ordeal where, you know, going to the hospital and requiring all the drugs in the hospital would be ideal.

Layla [00:31:45]:

Yeah, yeah. I mean, I, I. The whole concept of having a baby still terrifies me in my older, older age. So, like, I cannot even imagine. But I know I would want to be in a hospital with all the anesthesia and drugs possible. Kudos to anyone with advocates, especially if they do it in a bathtub. But I just, yeah, that would, you know, completely, completely. The thought alone scares me.

Dr. Ben Szerlip [00:32:15]:

But yeah, but on second thought, too, I. We may want to tell Vivek and we can cut this small part out. If we compare surgery to having a baby, it may, that may be a bad comparison. So. But yes.

Layla [00:32:29]:

Oh, yeah, we could ask him if he wants to cut it out. But yeah, anything, anything related to like, the hospital personally scares me.

Dr. Ben Szerlip [00:32:40]:

But I’ve.

Layla [00:32:42]:

Since I would be like, I’m scared.

Dr. Ben Szerlip [00:32:43]:

I don’t want it.

Layla [00:32:44]:

What can you do? That would be, that would be my, my person for sure.

Dr. Ben Szerlip [00:32:49]:

It truly is hard to, to understand how some patients perceive pain. And they’re like, that doesn’t bother me at all. And then other, you know, so it is one of those factors. I think it’s just, it’s part in the chemicals that are processed through our brain. Substance P, and a couple other factors, dopamine, norepinephrine. But how we each process pain is truly amazing. And I think that hopefully we understand that better as scientists in the future.

Layla [00:33:17]:

Absolutely. Yeah. And everyone is different. Like, for example, people’s pain tolerance, people’s comfortability around surgery, around even hospitals, for that matter. So I’m sure. That there’s so much that also goes into it, even from the patient’s decision as well, whether they want it or not. And you have probably worked with so many patients and some that want surgery, some that don’t. But can you share a story of a patient whose decision around surgery really changed their life in a way that is super memorable to you and you’ll never forget?

Dr. Ben Szerlip [00:33:52]:

Yes, several. And that’s what I. I think one of the things I appreciate the most is, is helping guide them or counsel them on whether or not to make decision and what our goals are. And. But the story comes to mind is there’s a patient that only had the use of one arm. That patient had lost the use of the other arm due to a stroke. And so really, I think Ben Franklin said this, but we realize the value of water only until the well is run dry. And that patient had a lot riding on, you know, they had used that one arm to compensate for everything in their life.

Dr. Ben Szerlip [00:34:35]:

And that was, you know, what they did for most of their activities of daily living. So the injury had come about because they were just using that one arm and having a decision to pursue a surgery if, if something had not worked well or had gone wrong, that would drastically change their life. So I think that them. We talked about the element of not being in control. That was a huge factor for that person, and the stakes were relatively high. So it did go well, and the patient was very happy with their activity and it allowed them to do so many more things, including drive a car, work at their job, take care of this, you know, take care of others. But if it hadn’t have worked, then it would have been a big change for their lives. We had a couple professional athletes who also had the same kind of stakes where if they hadn’t got back to their certain level of performance, that they would have lost the ability to provide for their families or they would have lost a certain identity that they had in their abilities or their personality.

Dr. Ben Szerlip [00:35:45]:

So I think that those. Getting those people back to their level. And I think we can put a link to one of my favorite just videos, and it’s about this older gentleman who’s, who’s. He’s working out and he’s. Everyone knows, you know, doesn’t understand why. But one of the surgeries was that so he could help take care of his grandkids because he had, you know, their, their kids needed help with childcare, so he wanted to be able to pick up his kid, his grandkid over his head, and he Showed me pictures, and he, you know, he was kind of crying about it. This video reminds me of that. So those are the kind of things that.

Dr. Ben Szerlip [00:36:24]:

That are really fun to see and really rewarding.

Layla [00:36:28]:

Absolutely. And that. Yeah, I can imagine that being super rewarding and have clearly a lasting impression. I mean, that, you know, you’re changing someone’s life. You know, you’re helping them. You know, you’re helping their whole family by giving them that experience to have their full mobility and. Or the mobility to the maximum extent that they can have. So that’s definitely super, super rewarding, for sure.

Layla [00:36:53]:

And, you know, you being able to not only do the surgery, but then also, again, being that pillar for them and that knowledgeable person that’s giving them advice and helping them make that decision or recommending what’s best for them. And, you know, even now, you’re looking back and remembering that client and that patient and that story that was impactful as well as other ones of athletes. But when you look back years from now, what do you want your patients to remember the most about their experience? Either the surgery itself or the way that you guided them through the entire decision.

Dr. Ben Szerlip [00:37:34]:

Yeah, I think that’s a. That’s a great question I still ask myself, or sometimes struggle with, and I want to be completely honest and transparent. It’s. It’s great to see patients get better. It’s great to specialize in a problem or help teach other people on how to. How to hone their skills or their practice. But, Layla, we’ve also had complications in our practice. If we’ve.

Dr. Ben Szerlip [00:37:58]:

If we treated thousands of patients. We’ve had patients get infections before. We’ve had them, you know, where the broken bone didn’t heal the way we wanted it to. We had problems with scar tissue or whatever that may be. And so I think you’re gonna get my answer. It’s. It’s the way we guide them through a decision. Right.

Dr. Ben Szerlip [00:38:20]:

And it’s not so, oh, that’s great. We helped that person, and the stakes were high, but it’s. I think, you know, we’re going to come back to agency and gratitude. Right. And I think that that’s the way I want to live my life. That’s the way I want my friends and family to know that that’s what I believe in. And I think that even, you know, those of us who. I’m a believer, but even those of us who are not religious or believe in God, I think they’re familiar with the Serenity prayer.

Dr. Ben Szerlip [00:38:49]:

And that is to say, God Grant me the serenity to accept things I cannot change, the courage to change the things that I can, and the wisdom to know the difference. Right. I mean, they even use that in aa. Right. So. And most people are familiar with that, but it’s changed a lot of people’s lives and essentially the ability to make these decisions based on the information they have at hand and understand that they are not in control of everything, but they do have the knowledge that what they can control, they will process. And so if we can, as practitioners or friends or family members, help each other, you know, guide them through the decision process, I think that that’s, you know, all we can ask for.

Layla [00:39:35]:

Yeah, absolutely. Absolutely. And I’m sure that. That even from the patient’s side, is what would be more memorable to them, especially the surgery. Especially if you’re nervous, you’re probably not even fully thinking clearly or your nerves are there. And then once it’s done, it’s over. And it’s essentially, it’s done. The scary part is over.

Layla [00:39:58]:

And then, you know, you look back on the process and remember the conversations with you and the lead up to the surgery and having that confidence. And of course, again, nothing’s perfect. Like you said, there are things that come up, and it’s unfortunate, but it is. You know, I’m sure everyone has done everything that they can to make sure that doesn’t happen, but sometimes these things do happen. But still, being able to give your patients the best experience possible and being their guide and guiding them through the decision and the process, I’m sure is something that they will remember years, years from now, for sure. But definitely, you know, I think we learned a lot about basically the whole process of surgery today and really how you’re able to help patients with guiding them through fear and guiding them through the best. The best decision for them, whether it’s surgery or not, and really taking the time to learn their life and learn their lifestyle and their habits and their goals, to really be able to decide the best decision for them. Especially, like you said, not being a scalpel for a surgeon.

Layla [00:41:15]:

So helping them go through that process and even going back to your example of how some people like yourself at one point just wanted surgery, whether it’s the best decision for them or not. So taking that time to really learn them and guide them through is super important. So I know if I ever need it, a surgery, I would want you to be my provider for sure and help me go through that decision process.

Dr. Ben Szerlip [00:41:42]:

I appreciate that. I think it’s also a responsibility Right. And if we have. If we’re advising a friend or colleague or something in our line of work, and I think most people do, I think that that’s going to make us better. It’s also going to be harder if there is a problem or mistake, we have to hold ourselves accountable and responsible. So I think that, too, I’m obsessed with a couple authors to help me, to help guide me make decisions in my life and then to help others make those decisions for their lives, too, is apparent. Right. That’s one of our mission statements.

Dr. Ben Szerlip [00:42:19]:

But they kind of said, you know, Arthur Brooks kind of said that there’s three elements of making a decision that each person can kind of dig into. And it doesn’t take a degree. It doesn’t take, you know, rocket science. But it’s, you know, what’s your level of excitement? What’s your level of, you know, fear, and what’s your level of emptiness? Right. And so whether you’re, you know, deciding about picking a job, picking a significant other or a spouse, or, you know, pursuing a surgery. Right. It’s the. The level of excitement would kind of be around, like, hey, do I really think that this is the right decision for me? Will it improve my quality of life? Will it be the best on the things that I want to do? Will it make me be fulfilling or have a purpose or be meaningful? That’s kind of an initial gut reaction, the level of fear.

Dr. Ben Szerlip [00:43:15]:

I think it’s okay to have some fear. Expectations of the unknown. Fear of the unknown, or trying to achieve something that. That possibly has a failure. I think that we will all experience that. But some of the biggest forms of meaning and purpose have that there’s no guarantees in your job or the spouse that you date or the house that you buy or whatever that may be, or the surgery that you pursue. There’s probably no guarantees. And then the level of emptiness is saying, that’s another gut feeling of saying, hey, something is not right for me.

Dr. Ben Szerlip [00:43:50]:

Either I don’t understand this, or it just does not make sense to me on a fundamental level. And I think that those three levels, you can. I want to help me choose whether, you know, again, a job, you know, that’s. I think that’s great advice for those looking for dating or. Or many things you could apply when we all have to make these important decisions.

Layla [00:44:11]:

Absolutely. No, that’s a really good comparison. Something I wouldn’t have even thought about, but it’s true. And there is a little bit of unknown in everything, too. Right. Like you said, so definitely definitely. I think a good point. And a new perspective on how.

Layla [00:44:29]:

How much really goes into that thought process. Right. So, yeah. Well, thank you so much for sharing all of that. And that’s it for today’s episode of Shoulder Wise, the end of episode three. So thank you again, Dr. Szerlip. I think we’ve tackled a lot today.

Layla [00:44:45]:

We tackled one of the most important questions in orthopedics, do I really need shoulder surgery? And you showed us that the answer isn’t always yes. It’s about clarity, honesty, and the right timing. So make sure everyone listening, subscribe so you don’t miss the rest of these episodes, because better movement starts with better understanding. Thank you so much, Dr. Zula.

Dr. Ben Szerlip [00:45:06]:

Thank you.