![]() To demonstrate why improved postsurgical instructions might strengthen psychological well-being, allow us to introduce a typical patient. We believe that through minor changes in how patients are treated after surgery, physicians and other clinicians can strengthen, rather than damage, patients' psychological well-being and improve their recovery. In response, we propose a change in the content and delivery of activity guidelines, with the goal of getting patients back to their pre-surgical life as soon as possible. We have seen numerous examples, some tragic, of the consequences of inadequate postsurgical guidance. Most likely, they are unaware of the harm that can result from ill-considered comments. However, they may not have the training, the skill set, or the inclination to deal constructively with the patient's postsurgical psychological needs. They know how to give postsurgical instructions about medications and wound care, which are obviously important aspects of clinical care. Physicians, surgeons, and nurses are very busy at what many regard as their primary job-diagnosing and treating difficult illness. The reasons for these unfortunate interactions are varied. We suggest that in some cases medical professionals can unintentionally contribute to patients' anxiety and depression by giving postsurgical activity instructions that are inadequate, overly restrictive, or even flippant. The unaddressed question is this: Why do patients who have had a successful surgical procedure end up feeling depressed or anxious? In patients who had undergone coronary artery bypass grafting (CABG), depression and anxiety were associated with higher hospital readmission rates ( 1), and depression predicted an increased risk of death ( 2). The resulting studies have linked factors such as depression and anxiety to the observed suboptimal outcomes. When it became clear that the difference in outcomes was not always the result of the particular patient's illness or the quality of the medical care provided, researchers began to look at psychological causes. ![]() In the extreme case, the patient may die. The patient may recover more slowly, have trouble resuming the activities of daily living (ADL), and have trouble going back to his or her presurgical life and occupation. Suboptimal medical outcomes sometimes occur with patients who have had completely successful cardiac surgery. In this article, we explore possible reasons for these deficiencies and their consequences, provide examples of helpful and unhelpful advice, and offer suggestions for improving the content and delivery of postsurgical guidance. Through this unique combination of personal and professional experiences, we have seen that current activity guidelines often fall short. Adams, is an exercise physiologist and senior research associate we worked together on the design and analysis of an experiment to improve rehabilitation of cardiac surgery patients. Since my recovery, I have corresponded with other survivors of aortic events via a Web site. I (RDP) am an electrical engineer and physicist who in 2003 underwent an emergent repair of a Stanford type A dissection of the ascending aorta. These provocative questions are not merely theoretical to us they are deeply personal. The door to the cardiac rehabilitation facility in the same hospital requires a 14-pound pull to open, yet no patients have died or have even been injured from opening this door.ĭo the activity restrictions that patients are given after major surgery affect their recovery? Can the activity restrictions increase the risk of morbidity? Can bad advice kill a patient who has just had a successful surgical procedure? ![]() He now owns and rides horses again.Ĭardiac surgery patients at a major Texas hospital are told on discharge not to lift anything heavier than a half-gallon of milk (about 4 pounds). ![]() Fearful of jeopardizing his life and not knowing what else to do, the man complied, but doing so plunged him into a depression that lifted only when he was well enough to see that the physician's advice was wrong. One of his physicians told him that he could never ride again and that he should sell his horses. Then he had surgery to repair an aortic aneurysm. The Indiana man was a fine horseman who treasured his horses-they were almost like family to him.
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