If an employee you are assisting is considering surgery, you can make a difference to their recovery and return to work by discussing the decision-making process with them.

People who are better prepared and understand their options make better decisions and are more likely to have successful recovery.

Discussing surgery needs to be dealt with sensitively, so your intent behind advice is key. If a claims manager has an interest in helping a person, this will underpin constructive discussion.

Support positive approaches, avoiding denigrating their surgeon or a particular medical approach. Don’t leave the person with the impression your input is influenced by costs.

Considering surgery?

If a worker is considering having surgery, it is worth helping them consider possible outcomes and alternatives.

Here are some ways you might broach the topic:

• "We regularly see people having surgery and we want the best outcome for you.”

• “Some people have told us afterwards that they wished they had researched the decision about surgery more before they went ahead.”

• “Is there anything we can do to help you get a good understanding of the operation?”

• “These are the things that other people have told us were important to them (e.g. understanding the recovery period; what pain levels they would experience after surgery).”

• “Our internal doctors tell us that it is always sensible to get a second opinion if you are unsure. “

• “Have you talked to your general practitioner about what they recommend?”

• “Are you confident you understand the pros and cons of having such an operation?”

• “I can see you are really keen to get rid of this problem. Sometimes we see people who are at their end of their tether and they make a decision based on that. In those situations, sometimes we see people go ahead when it isn't necessarily the best thing. “

• “Have you explored the nonsurgical alternatives?”

Surgeons and second opinions

Different surgeons have a whole range of different approaches and outcomes, and it’s important that the patient understands this.

It’s important the employee feels comfortable with their choice of surgeon. You can help them assess this:

• “Are you comfortable with the surgeon?”

• “Do you feel that the surgeon listens to you? Do you feel that you can ask questions?”

• “Are you seeing a good-quality surgeon who generally gets good results?”

• “Have you had a second opinion?” Sometimes patients feel that getting a second opinion will be seen as undermining the first doctor. However, any doctor with a reasoned approach will encourage a second opinion. People who take an active role in their surgery will have the best outcomes.

There is variation in every trade and profession; surgeons are no different. Some surgeons have a terrible bedside manner but produce great surgical outcomes. Some are good with communication, but are more likely to have poor outcomes.

A good general practitioner will generally know who the good surgeons are.

Some surgeons avoid seeing workers’ compensation patients. Others will see compensation patients but charge the patient rather than directly bill a compensation system. This may leave the patient out of pocket to the tune of $50-$200 for a consultation and potentially even a few thousand dollars when it comes to surgery.

Patients deserve to understand this.

While some patients will advise they can't afford it - or don't wish to be out of pocket – a number will say they are prepared to pay the extra when they understand the potential longer term benefits of seeing a surgeon who consistently produces better outcomes. The cost of a few thousand dollars can be relatively small when compared to the problems that occur for people if they don't have a good outcome from surgery.

Sometimes it's worthwhile getting a second opinion from a specialist who deals with the condition but who doesn't operate. For example, a rheumatologist still sees shoulder problems regularly may be able to discuss other treatment options, as well as the likely pros and cons of surgery. An example of the value of a second opinion was the Victorian guidelines for back problems developed in the 90s. A second opinion regarding spinal surgery was mandatory for the surgery to be covered.

Surgery preparation

It’s important those undergoing surgery understand that outcomes of their surgery are never guaranteed.

Patients and specialists can both have expectations that may not be met. Ensure your worker understands all the risks of the surgery, as well as realistic timeframes and limitations for recovery.

You might ask:

• “Has the surgeon given you an assessment of the success rate, as well as the potential complications?” (For example, patients who have a full thickness shoulder tear operation have about 25 per cent chance of developing a frozen shoulder, particularly if they are over 50.)

• “Has the surgeon advised you on the usual recovery period?

• “How do you think you're going to manage in the recovery period? Is there something we can do to help you?”

• “Does your family understand how you are going to be in the post-operative period? Are they prepared and able to support you?”

• “Have you and your supervisor talked about what you might do when you first come back to work? It works really well when people understand how they going to recover, and return to work plans are put in place in advance.”

• “What sort of work restrictions has the surgeon recommended?”

Making decisions about surgery can be difficult. And in some situations the decision might be made too easily. Helping people make balanced and informed decisions can make a major difference to their long term well being.

In the next article, we give you tips for supporting employees once they’ve decided on surgery.