Have you you ever been in a situation where a friend was about to make a bad decision – and you knew it? The lactose intolerant friend who decided to buy ice cream on a day outing. The cousin who decided to finance a luxury car but could barely pay rent. The best friend who supposedly found ‘the one’ despite all of the red flags their significant other has. We’ve likely all been there in one way or another. They share their thoughts and desires with you, and you want to be a good friend and listen to show that you care, but you can’t help but think about the terrible consequences that come from their decision: enjoying the wonderful taste of the ice cream but being best friends with the toilet several hours later, the joy of showing off his new toy but later not being able to make rent, the initial happiness of the “honeymoon phase” but the rough divorce several years down the road. No one wants to see this happen to the people they care about. This also goes for my patients. For the most part, my patients, with some small guidance, tend to make good decisions concerning their health. However, there are times when a patient tells me something that almost makes me jump out of my seat in disbelief. This story is about a young patient who did just that.

Jack (whose name was changed for the sake of his privacy) is a 14 year old track and field athlete who specializes in the hundred yard dash. Jack came to me previously for knee pain and was rehabbed back to sprinting in no time. Several months later, just as track season came into full swing, I saw that he was coming back to see me for hip pain. We took a look at his sprinting, and after some small modifications, he was back to sprinting with a a lot less pain. At his next visit, things took an interesting turn. Upon chart-prepping, I noticed that he saw an orthopaedic surgeon for developmental hip dysplasia, a condition in which the hip bone does not grow just right and can be very painful and debilitating. I thought nothing of it initially, as I knew that there were many successful athletes with the same condition. He can be treated! And besides, he did well at the end of his last visit. However, he told me that he decided to undergo a periacetabular osteotomy – he spoke with enough conviction to make my eyes widen. In lay man’s terms, a periacetabular osteotomy (PAO for short) is usually performed on individuals whose hip pain significantly limits their daily function. It involves a series of cuts into the bone surrounding the hip socket, effectively cutting the pelvis into 3 sections, in order to rotate the socket into a more optimal position. I don’t know about you, but that surgery sounds pretty wild.

Here’s the kicker: Jack rated his hip pain as 2/10 even with sprinting. He had no pain with any other daily activities. Yet he (and most likely his surgeon) was pretty convinced that surgery was his best option!

Take a small step back here. If you were the friend in any of the situations I mentioned earlier, what would you have done? Many people’s gut reaction would be to exclaim “Don’t do it! Can’t you see what the consequences are?!” Now, don’t get me wrong – surgery has its place for individuals whose hip pain is so severe that they can barely function. But 2/10? I’m not so sure here.

Although my gut reaction was to tell him not to do the surgery (and I had a wonderful 5 minute extemporaneous speech prepared for him), I understood that if you want to elicit change in another individual, they must make that change themselves. Well, great. So I can’t do anything about that, right? Not so fast. I said they must make that change themselves, not on their own. As medical practitioners, we can certainly help them decide to change. If you can learn their underlying emotions contributing to their decision, you just might be able to channel those emotions to elicit change.

            Back to Jack. After a little more questioning, I learned that he was pushing for surgery so that he would have enough time to recover to get back to high level sprinting and vie for a coveted varsity spot on his high school track team. “It sounds like you’re an extremely motivated guy that wants to be at the top of his game, Jack,” I told him. “Yeah, that’s right,” he responded. Bingo: just like any other athlete who will dedicate hours to their craft, Jack wants so much to excel that he’ll do anything to get there. “You know, a PAO is a major surgery. What do you know about this surgery?” Jack said he didn’t know anything about it, other than that it would help with his pain. “All right. I’ve got some homework for you: go do some research on the surgery and watch video animations of it. Look up the rehab process. Learn about who’s gone through it in the past and who hasn’t. Report back to me with what you find.” In the mean time, we made sure to update his home exercise program, which focused on trunk and hip strength.

            At his next visit a few weeks later, Jack came back with his report. He was pretty shocked at how major of a surgery it was. And with the relatively high percentage of athletes that are able to return to sport after a PAO, that was no guarantee that Jack would get back to the highest level of track after surgery. Not to mention the long road that is rehab. Now Jack wasn’t so sure. What made his situation even more interesting was that he also reported being able to sprint with no hip pain. I did a double take: “Like, no pain? None??” “None,” he replied. 

Game changer. 

After Jack realized what could be done through rehab, he focused more on developing strength in areas that needed work – and in the process, was able to finish off the track season strong. Looking back, I effectively channeled his motivation to be an excellent athlete into putting in the work to conservatively rehabilitate himself. I’ll never forget what his father told me at the end of his last visit. “You know, we all thought he wouldn’t be able to run track this season. Thanks so much.”

As healthcare practitioners, we have to develop our listening skills. We listen to our patients’ symptoms, their aggs, their eases. We even listen to their stories to connect any psychosocial factors to their symptoms. What takes our practice to the next level is when we listen and empathize with their underlying motivations. When we can do that, and do it consistently with all our patients, we then unlock new tools that help us elicit change in our patients. So, the next time you encounter that friend who’s about to make a decision that could change their lives drastically, start the conversation and listen to them. You never know what you just might learn. Better yet, you just might discover the strategy to help them out for the better.

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