clear," says Dr. Al-Mahroos. "Patient counseling is always key. They
need to know what you are going to do, what are the available options
and what affects your options."
Your patients need to hear from you about your rationale for care.
Dr. Al-Mahroos stresses that it's not just about the technique, but the
factors that can impact patient outcomes, such as the size and site of
the hernia and patient characteristics like BMI, diabetes and smoking.
You'll need to cite the available data to support your recommenda-
tions while warning patients about the chances for complications with
each approach.
2. The pros and cons
Patients look to their doctors for recommendations, but they should
still be involved in their own care, says Bruce Ramshaw, MD, FACS. In
an era of information overload, decisions should be a shared responsi-
bility. Patients have several different approaches to consider for hernia
repair, says Dr. Ramshaw, professor and chair of the department of sur-
gery at the University of Tennessee Graduate School of Medicine in
Knoxville. "We want them engaged so we can help figure out what's
best," says Dr. Ramshaw.
Sometimes, so-called "watchful waiting" is the best approach to
make sure the hernia isn't changing. Laparoscopic and open repairs
(with or without mesh) need to be discussed, as well. Patients should
learn about the different types of mesh that are available before they
settle on a treatment plan.
"Because of the awareness on the internet and through social
media, patients are learning about this, and sometimes learning misin-
formation," says Dr. Ramshaw. "It's going to be up to us to try to bet-
ter describe this with our patients."
If a patient wants a non-mesh approach, says Dr. Ramshaw, physi-
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