Magnetic resonance imaging, knee arthroscopy, and clinical decision making: a descriptive study of five surgeons.
OBJECTIVE
A randomized controlled trial (RCT) showed magnetic resonance imaging for patients waiting for knee arthroscopy did not reduce the number of arthroscopies. Our study aimed to identify decisions made by orthopedic surgeons about whether patients on a waiting list should proceed to arthroscopy, and to describe surgeons' decisions.


METHODS
Five surgeons were asked to Think Aloud (TA) as they made their decisions for twelve patients from the original RCT. Audiotapes of the decision making were transcribed for analysis.


RESULTS
For five patients, surgeons agreed about proceeding with arthroscopy, although reasoning differed. In no cases did surgeons agree about not proceeding to arthroscopy. Agreement was more likely in patients with clinically diagnosed meniscal abnormality, and less likely in patients with osteoarthritis.


CONCLUSIONS
Surgeons' decisions were influenced by patient wishes. For some patients, the decision to proceed with arthroscopy was based solely on clinical diagnosis; MRI may not be advantageous in these instances. Surgeons disagreed more often than they agreed about the decision to proceed with arthroscopy, particularly when OA was diagnosed. This has implications for decision making in the current NHS patient choice environment. Patients may choose a treatment provider from a list of available providers at time of original clinical assessment and diagnosis. The treating surgeon does not necessarily re-examine the patient until the day of surgery. Given the variation between surgeons about the merits of proceeding with arthroscopy, surgeons may end up in the invidious position of providing surgery to patients whom they do not believe will benefit from arthroscopy.
Injury Prevention Research Unit, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. sarah.derrett@ipru.otago.ac.nz
Sarah
S
Derrett
Gayle D
GD
Walley
Stephen A
SA
Bridgman
Paula
P
Richards
Nicola
N
Maffulli
D000328:Adult; D000368:Aged; D001182:Arthroscopy / Q000706:statistics & numerical data*; D003657:Decision Making; D018450:Disease Progression; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020370:Osteoarthritis, Knee / Q000601:surgery; D012959:Socioeconomic Factors