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Omolola Fakunle, BS

AAOS Now

Published 11/1/2019
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Omolola Fakunle, BS

Considering the Whole Patient

Editor’s note: The following letter is in response to the article titled, “High Prevalence of Depression Found in Shoulder Surgery Patients,” which was published in the September issue of AAOS Now.

Equating surgery to the work of a butcher is the harshest remark I’ve heard made about the work that occurs in the operating room. Studies like the one discussed in the recent AAOS Now article combat misconceptions about the role of surgery in patient care. This brief commentary is a two-part response written to (1) praise the researchers’ choice to explore the relationship between depression and orthopaedic intervention and (2) expand on the potential utility of such research findings.

This study investigates how a nonsurgical condition like depression may influence the course of orthopaedic management. Astutely, the researchers link mental health care with functional outcomes, thus elucidating their importance in the surgical world. The researchers also demonstrate how surgical outcomes are not limited to one anatomic region. This study reminds surgeons to tend to the mental health of their patients and legitimizes the psychiatric struggles that may be associated with orthopaedic pathology.

The researchers suggest their findings may support screening patients for depression prior to shoulder surgery, with subsequent referral to a mental healthcare professional as necessary. Other studies have evaluated the mental health surrounding orthopaedic procedures. One study suggests examining the role of preoperative expectations in patients with depression, whereas another study takes a more pharmacologic approach in suggesting the administration of small-dose ketamine for clinically depressed patients to help with postoperative depression. Both tactics could be considered in addition to those already suggested by the authors. Lastly, this study challenges orthopaedic researchers to explore this trend in other orthopaedic procedures.

It is motivating to see a model of medicine in which subspecialty care is also concerned with patient issues “outside of its realm.” It sets a precedent for future generations to remain greatly concerned with developing surgical skill, while refusing to neglect a patient’s whole person. By learning how issues like depression interact with surgical care, more researchers will be motivated to assess these kinds of nuanced relationships.

Omolola Fakunle, BS, is a third-year medical student at Emory University School of Medicine. She is an orthopaedic surgery research assistant and has served as the vice president of Emory’s chapter of the Student National Multicultural Association and director of education for Emory Health Against Human Trafficking.

References

  1. Weekes DG, Campbell RE, Giunta NJ, et al: Prevalence of clinical depression among patients after shoulder stabilization repair: a prospective study. Orthop J Sports Med 2019;7:2325967119S00259.
  2. Kudoh A, Takahira Y, Katagai H, et al: Small-dose ketamine improves the postoperative state of depressed patients. Anesth Analg 2002;95:114-8.
  3. Yakushiji K, Fujita K, Matsunaga-Myoji Y, et al: Expectations and depression in patients who have undergone total hip arthroplasty in Japan: a prospective cohort study. Int J Orthop Trauma Nurs 2019:100708.