It is not enough to save the patient’s life or to carry out a successful operation for a benign condition: whenever possible, the patient should be restored to full social and work capacity. This aim demands more than surgical ‘cure’:rehabilitation will be required in many cases. The importance of this can be judged by the well-documented fact that a patient who suffers a severe and incapacitating injury or accident that keeps him or her from returning to work for 12 months is unlikely ever to return to full employment, however good his or her recovery from the injury appears to be. While orthopaedic and neurosurgical centres provide the bulk of surgical patients requiring a programme of active physical rehabilitation, such centres should be equipped toassist patients recovering from medical disorders as well, e.g. cardiac and ‘stroke’ patients. With the steadily enlarging proportion of elderly patients surviving, there is an increasing demand for facilities for vascular patients (amputees) and patients with gastrointestinal diseases, principally cancer of the lower bowel (colostomised cases).
Motivation is an important element in rehabilitation. In the USA, a company employee or union-supported victim of trauma takes five times longer to resume his or her normal work than a self-employed person. Therefore, rehabilitation should include a programme of psychological and emotional readjustment in which the family should play an active supportive role. Although rehabilitation can involve the surgeon, pastor, marriage counsellor, occupational therapist, physio therapist, vocational training assistance scheme, prosthetic counsellor, psychiatrist, health visitor and the family doctor, in many cases practical guidance and effective support should emanate from the surgeon who carried out the primary care. Nothing is more important than the timely recall by the surgeon at the time of the initial surgical procedure that his or her patient will require appropriate rehabilitation to achieve the best result.
While maintaining a caring and human approach, the surgeon must be prepared to be firm with patients who play for sympathy as they try to avoid achieving independent status during their rehabilitation programme.
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