Am I anti-surgery?

In this episode of the Talking Rehab Podcast, I reflect on a recent patient encounter that made me pause—am I seen as anti-surgery just because I don’t perform it? Join me as I explore the importance of balanced care, why I advocate for all treatment options (including surgery), and why long-term patient follow-up matters more than the label of being “non-surgical.”

Key Topics Covered:

• [00:00 – 00:27] Introduction: Who I am and my mission with this podcast.
• [00:32 – 01:15] A patient’s casual comment sparks deep reflection on my role as a non-surgical specialist.
• [01:50 – 02:42] Why I avoid labeling myself as “non-surgical” and focus on solutions instead.
• [03:07 – 03:43] Marketing in spine and sports medicine: non-surgical vs. surgical biases.
• [05:29 – 06:07] Can you get a second opinion from a surgeon if you don’t want surgery? My take on biases and public perceptions.
• [07:32 – 08:19] The complexity of residency training and why surgical and non-surgical specialties differ.
• [09:32 – 10:49] Preparing patients for surgical consultations and managing expectations.
• [11:56 – 13:06] Why I always see patients post-surgery: the importance of long-term follow-up.
• [14:27 – 15:56] My philosophy: Pro-movement, pro-health, and walking with patients through life’s challenges.
• [16:05 – 16:17] A call to all providers: Follow your patients long-term, because they deserve it.

Whether you’re a patient wondering about your treatment options or a clinician reflecting on your practice, I hope this episode encourages thoughtful care that goes beyond procedures. Thanks for tuning in to the Talking Rehab Podcast! Don’t forget to like, subscribe, and follow me on social media for more insights into musculoskeletal and sports medicine.

Enjoy a movement-filled day!

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Transcript

0:00

What is rehab or rehabilitation? My name is Fred Begaris, a board certified sports and spine medicine physician in Virginia beach, Virginia. After 10 years of practice, I still find musculoskeletal medicine, both fascinating and challenging. This podcast is about the lingering thoughts and questions I've had after residency and fellowship. My hope is to spark discussion, challenge dogma, and share my experiences in musculoskeletal medicine. Welcome to the Talking Rehab Podcast. In my practice, I do a lot of second opinions, and I had a recent encounter where the patient was weighing out their options between, essentially they were having spine problems, and they wanted to know, what their treatment options were after seeing a couple different surgeons a couple pain specialists it was a very productive discussion and we had a really good rapport and they said something kind of on the side in terms of like, well, I really respect your opinion and I know you're anti surgery but and she proceeded to kind of go on past that and she just kind of skipped over it and I, I was, it kind of caught me off guard a little bit. It was very casual. I know you're anti surgery. And, it's true. I'm, I'm not a surgeon. I'm a sports and spine medicine specialist. But I guess the fact that I am not a surgeon, does that necessarily make me anti surgery? And, I've been doing this for 10 plus years. And I had never really thought that people assumed that because I chose not to do surgery that I might be anti surgery, it's actually, quite the opposite. I don't consider myself to be anti surgery or pro surgery. I'm pro movement, I'm pro health, and, maybe I took it the wrong way, but it did get me thinking about, is this what people actually, I guess, really think about what I do? It is part of the reason why. From a marketing standpoint, I don't call myself a non surgical specialist because I don't like comparing myself to another specialty. That being said, marketing what I do, which is a lot of problem solving, looking for solutions. Some of them are conservative treatment options. Some of them are surgical options. that is essentially what I do, but at the same time it's now making me wonder if I'm giving the consumer i. e the patients, the wrong idea of what I do again, this is one particular person that made an kind of innocent comment but it does make me wonder now is that what people really think is that when the when they come and see me that they're Getting a biased. I guess we all are biased, but are they, expecting me to not advocate for surgery? from my standpoint, my goal again is to be pro movement, pro health and come up with whatever solution is best for my patients. I can't obviously speak for everybody. I've definitely seen some marketing of surgeons. Obviously they market for surgery. That's that's kind of a no brainer, but I have definitely seen sports medicine specialists, pain specialists, market saying that this is a non surgical approach to your problem or why get an unnecessary surgery when you can. Do this non surgical solution. You know, I'm not a huge fan of that marketing. Again, that's not to say that you shouldn't do that. It's just not really, I guess, my particular style. That being said, I can only imagine, how the conversations go. I do a lot of. second opinions. I do a lot of medical record review, medical legal stuff. So I do read the notes, and I, can tell that certain practices do have that bias. not just, non surgical specialists saying that, these are non surgical options that have been proven to work and that surgery is unlikely, that's from a marketing standpoint I think there is it's quite appealing to people at the same time I've also seen surgeons say that conservative treatment options are not going to work based off of their experience, which again I understand that they are seeing a subset of people where of people that are wanting to have surgery, the people who do not want to have surgery, they're obviously not seeing. But I do take a little bit of issue with that, where I have heard surgeons basically tell patients that nothing is going to help them and that everything that a non surgical specialist is going to do is going to be moot until they actually have surgery. But again, I, I choose to market my. my practice the way that I do. I look at all solutions including surgery, non surgical, even some non medical solutions. I do a lot of health coaching as well. But the other question that came up is kind of along the same lines of, the whole second opinion discussion is can I get a second opinion from a surgeon if I'm not entirely sure that I even want a surgery? And this is a hundred percent my opinion. I, from a physician standpoint. if you want to see a surgeon You are asking them if they are a good candidate for surgery That being said i've explained that to people in the past And even though they don't want surgery. They still want their opinion so again my opinion, I think that there is a little bit of a kind of a bias a superiority bias where I believe the lay public believes that conservative treatment and we're talking about medications, injections, physical therapy things like that, are an important but, a limited arm of the medical treatment spectrum. And surgery is something that I am not experienced in or I don't have credible experience in. And I believe that they think that medical school and residency training is training of all modalities, all treatment options, all conserved treatment options. And if you go to a surgical residency, then you learn all of that plus surgery. So in a way, they have essentially, I think, a belief that They have a knowledge from A to Z, conservative to surgical outcomes. And that's just not true. I mean, I, I understand why, why if you're not in the medical field, why you would believe that. But it's not true. you do a surgical residency to learn about surgeries. And there's a lot to learn about that. That being said, to do what I do, conservative treatment options, understanding biomechanics, understanding how to design a rehabilitation program, as a residency, plus a fellowship, so it's, to squeeze all that, plus learn all the surgical techniques, it doesn't necessarily make sense. That being said, while I might not have direct surgical experience, I do have experience working with surgeons, both orthopedic and spine surgeons for over 10 years and I've had a lot of conversations in the conference rooms and some, you know, just on the side. So I do have a pretty good sense of what surgeries. They tend to offer and some of their beliefs and, I do have a working knowledge of how they rationalize one type of procedure versus another. So, that does give me some experience to help counsel my patients. But, if someone wanted to come to me and ask very specific questions about surgery, I'd say, this is where my knowledge base ends, and this is where you need to actually talk to a surgeon. But I definitely have people still wanting to see a surgeon, even though they don't want to. to have surgery just to get their opinion and, I still send them off. I don't have, I don't have any issues referring people to see a surgeon. Some people just want to get their opinion and who am I to stop them from getting a surgeon's opinion when they clearly don't have a surgical problem. do have to add a little bit of an asterisk behind this comment because in my experience, surgeons typically like to see people that is going to end up with a surgery. that's obviously why they went to school, why they spent five plus years post medical school training, is that they like to do surgery. So. I sometimes prepare my patients and almost prompt them on what questions to ask in order to help guide the conversation because sometimes once the surgeon. takes a look at the imaging. They've already kind of made up their mind that surgery is is or is not an option. As a result the counseling and the advice that they give the patient sometimes is a little bit more brief, especially if we're talking about a five to seven minute visit. So, I stopped trying to convince people that, what, you don't need a surgery, the surgeon's going to say this, so why don't we just try and, and save you the visit because, some people, they need to hear it from a surgeon and I will make that referral, but I do have to kind of prepare them that, you know, the surgeon may not like, this type of referral because you're heading into their clinic space, knowing that you don't want to have a surgery and that might conflict, you know, with, with what they want to do. But that being said, it's still very important, that I do make these referrals to help advocate for my patients. Plus, I think, to dissuade them. for the sake of my own ego is unethical. It's a disservice to the patient. So, if I get the sense that someone actually wants to talk to a surgeon, just to get their opinion or talk to anybody else other than me, I have zero problems. I, you know, in a way, I'm very curious. I want to know what the surgeon has to say as well. I, I think what sets me apart is that when I do refer a patient to see a surgeon, I always want to see them back because I want to understand the patient's experience. what they said and what they document isn't what Always comes across in the clinic and during the patient experience I can't tell you the amount of times that The patient will tell me that the physician the surgeon said surgery is absolutely not an option For X Y Z and then I read the note and it doesn't exactly come across that way And so it can be a little bit sometimes confusing but that being said If they want that opinion, I want to see the patient back so that I can understand how the actual visit went. I think what also sets me apart is that I think a lot of non surgical specialists will make that determination that, you know, what? We have come to the end of what I think I can offer you and surgery is the next option. From that point, a lot of physicians will typically refer them onto the surgeon. If they get surgery, then they are the, under the surgeon's care. I don't look at it that way. If I have a patient that I refer to have surgery and they end up having surgery, I always see them back. I keep track of when their surgery is scheduled so that I can see them back six weeks because not only, do I think it's important for my continuity of care but I think it's important that I know that I made the right call. You know, it's easy to see, MRI evidence or extra evidence of this condition. And I know that from a research standpoint that I've done all the things. But at the end of the day, it's still a judgment call. research is not a certainty. it's really a probability game. So when I see people that I think are going to benefit from surgery, I stick by my recommendation. So, I am obligated to see it through. a lot of surgeons will see people essentially through the post operative period, making sure that they have their pain control, there's no complications. But then once they hit that period where whatever they replaced, whatever they repaired should have healed, which is typically somewhere in that three month to six month mark, most post surgical complications, Should have resolved by then if you're in a surgical practice, it's pretty common for them to say, well, if you continue to have symptoms, there's nothing else I can offer you. And maybe you should go see somebody else. that's just the unfortunate truth is that. if the surgery is successful from a, surgical standpoint, but you have persistent symptoms, The surgeon may not be the best person to help you figure out the rest of your symptoms. And that's really a big part of the patients that I'm seeing is, people that have had these quote unquote successful surgeries, but they continue to have symptoms and they really struggle to find someone to take care of them after that point. And I always want to see people back after they've had a surgery. I see them back six weeks, six months and one year. I think it's important, To make sure that people actually get back to what they are wanting to do which is live their lives just because a surgery is successful or just because a pain Injection is successful doesn't mean that people actually get back to what they are intending to do that being said, I guess I can't really speak for everybody this is just how I run my own practice I like to Consider myself to be a fairly open minded individual. I do like to go by the evidence But at the same time, I like to help people. Helping people takes time, and you have to follow people lifelong, I want to be that physician that walks with you, through all the ups and downs of your life, I want to make sure that you are able to live your life through movement, and I don't do that one injection at a time, I don't do that by referring people to surgery, I do it by making these decisions, giving you objective evidence, helping you come to the decision on your own terms, and then seeing you through all the way to the end. I had a patient recently that I gave them objective evidence, and we came to two separate conclusions, they opted for the other option I still followed up with them because ultimately it's not a matter of who's right or wrong. It's are you better, are you able go on that trip that you've always wanted to, are you making it to graduations? Like that's the point It's not a fact of who's right or wrong, I don't want to be, Stereotyped into this bias that just because I don't offer surgery that I'm anti surgery. That's just completely not the case. But, I hope that, that everyone that's listening to this podcast does have a physician that does look at things from, I guess, all perspectives, if you do have a surgeon that sees you, I hope that they look care, they take care of you for all of your needs, even if they decide not to do surgery. And if you do have surgery, they see you long term and those non surgical specialists, I hope you see people, pass your procedure essentially. I really, really hope you do. I think that's really, that's what patients deserve and that's what sets us apart, from the good ones to the great ones. So anyway, Just wanted to throw these ideas out there. let the public know that, just because we don't do surgery doesn't mean that we're anti surgery. So, anyhow, thanks again for your time. Have a great one. Thank you for listening to the Talking Rehab Podcast. I hope that this podcast stimulates you to question your own practice and how you approach rehabilitation. I truly appreciate your time and attention. If you enjoyed listening, make sure to like and subscribe to the podcast. I wish you a movement filled day. Take care.