Clinical Approach in Youth Sports Medicine

Patients' and Guardians' Desired Characteristics in Sports Medicine Surgeons

Jennifer J. Beck, MD; Martha M. Murray, MD; Melissa A. Christino, MD


J Am Acad Orthop Surg. 2019;27(13):479-485. 

In This Article


Orthopaedic surgeons are seeing an increasing number of adolescent patients for sports-related injuries.[20] With patient satisfaction at the forefront of healthcare discussions, desired characteristics in sports medicine surgeons in this growing population is unknown. In this study, both adolescent patients and their guardians reported shared decision making and understanding patients' sports and goals as surgeon qualities that were more important to them than surgeon sex or reputation. Although shared decision making was highlighted as important by both patients and their guardians, only 33% of the time did patients and their guardians decide on the physician together.

In contrast to the physician-driven and paternalistic medial decision making of past decades, healthcare decision making has evolved into a shared model. Bryant et al[12] described three treatment decision-making approaches: paternalistic, informed decision making, and shared decision making. It is important to understand the application of each decision-making approach and its efficacy within each individual practice. Our study shows the importance of shared decision making to both adolescent athletes and their guardians in regard to their sports medicine care.

More recent orthopaedic surgery literature has described the effect of shared decision making on orthopaedic practices, reinforcing its importance within our field.[12–14] Similar to this study, shared decision-making approaches and benefits have been highlighted in upper extremity trauma,[15] carpal tunnel release,[16,17] and ankle fractures[18] literature. The involvement of adolescents in their medical care is a challenge for their guardians and medical providers. During a time of psychological growth and developing independence, adolescent decisions may change with growth, development, and alterations in family or social context.[23] Pressures from coaches, teammates, and peers may be underestimated in this population. Adolescents are more likely to focus on immediate, short-term treatment effects and quality of life, whereas parents take a longer term view.[24] Careful explanations of details, while avoiding confusion, may enable adolescents to make informed decisions without adding stress and confusion.[25] Adolescents do appreciate being included in decisions and having their opinion valued,[26] and in this study, most adolescents seeking sports medicine care wish to play active roles in their healthcare decisions.

The current study showed that male adolescents had higher preference for male surgeons, whereas female adolescents had less of a preference. This somewhat contradicts previously cited studies. Proposed reasoning for this discrepancy could be because of sex-based role biases. Nationwide, orthopaedic surgery continues to be a male-dominated specialty, with only 5.3% of orthopaedic surgeons being women.[27] Orthopaedic surgeons, and surgeons in general, are stereotypically and actually predominantly men. In 2014, the Association of American Medical Colleges reported that orthopaedic surgery had the lowest proportion (16%) of full-time female faculty of any clinical or preclinical department.[28] Male adolescents may feel more comfortable expressing their desires for a male physician knowing the high likelihood of having a male orthopaedic surgeon. On the contrary, female adolescents must be more open-minded to either sex as the likelihood of having a female orthopaedic surgeon is very low.

As the only similar study performed within orthopaedic surgery, Bridwell et al[19] surveyed guardians and patients before an upcoming scoliosis surgery. They had similar results to our study that adolescent patient and guardian concerns and opinions regarding scoliosis surgery are different. Specifically, Bridwell noted that guardians and patients did not agree on reasons for having surgery or on their specific concerns or expectations about the surgery. Similarly, our study only had fair agreement between patients and guardians regarding surgeon characteristics. Life experiences and alteration in perspectives on present versus future effects may influence guardian and patient responses to these surveys.