Dr. David Ring, a nationally known expert for his work exploring the psychological and sociological influences on musculoskeletal illness and developing alternatives to surgery by focusing on individual patients and the range of health issues they face, is the Associate Dean of Comprehensive Care at the Dell Medical School at The University of Texas at Austin.
How can psychological and sociological issues affect conditions that have been traditionally handled through surgery?
We go to the doctor when we can’t depend on our body. When we can’t be ourselves. Sometimes it’s easy: you get penicillin, the strep throat is cured, and things are back on track. With other conditions – injury or the changes of age, for instance – there may be a lasting difference in your body. Good health becomes more about making good use of your body as it is. In some ways, adaptation and resiliency are the foundation of good health. The right mindset and a supportive environment can help you recover and adapt to the changes in your body during recovery from surgery. Even more powerful: adaptive people often find surgery less appealing than other options.
Thinking of surgery as a tool – a mechanism for achieving better health – how might it be used differently than it’s used now?
Surgery can help put our natural healing back on track. Cut nerves, blood vessels or tendons heal better with surgery. Many fractures tend to heal on their own, but when they don’t heal, surgery can help. Surgery also can help with problems like cancer and infection. But many surgeries are discretionary. That means you can elect to have surgery or not. You have a choice.
Discretionary surgery often addresses quality of life: how you feel, how you look, etc. Sometimes people feel like discretionary surgery is necessary in order to continue their usual activities. Arthritis at the base of the thumb is a good example: that’s one spot where everyone eventually gets arthritis. People with pain and limitations from thumb arthritis tend to come to a hand surgeon because they feel like something needs to be done. Once they understand the facts about arthritis, most of them find supportive treatment and adaptation more appealing than surgery. It’s important to help people find their true preferences.
How are Central Texas and the Dell Medical School different with regard to health, medicine and surgery?
At Dell Medical School, we want to focus on the patient rather than the disease. When you’re ill, you need more than a test, a pill, or a surgery. It’s important that people understand what makes you you and how this illness is getting in the way.
How are the opportunities here different from those you’ve seen in other places through your career?
The way most places currently care for people is a product of tradition and incentives. There is good evidence that we can do better, but change can be uncomfortable, and the incentives don’t always align. The Dell Medical School is rethinking things.
I notice that patients sometimes don’t feel listened to. They may feel that a visit is rushed or that their concerns weren’t taken seriously. Patients often wonder why their doctors aren’t better at communicating and coordinating their care. They may be confused when they get different advice from different members of the care team. And patients often lack a complete understanding of the advantages and disadvantages of the tests and treatments they are offered. I sense that Central Texas and the Dell Medical School want to follow the evidence and help create and foster the incentives to improve these aspects of care.
What difference do you hope your team’s work will make, both in this community and beyond?
I hope our community feels cared for and enjoys the best health possible. I think we can do it with a more equitable and sustainable use of resources. It would be gratifying if we can develop some things that others find worth emulating.