SCOUT'S HONOR It's sometimes easier said than done to come clean with patients and families after surgery.

We should always tell patients the truth, even when, as in these scenarios, the news isn't what they want to hear.

• 'More arthritis than we bargained for.' Sometimes even the most sophisticated MRI unit misses appreciable arthritis. What initially looked like a reasonable shoulder really has less mileage left than my 1964 Studebaker. A patient who may have aspired to pitch for the Yankees may have to settle for a mixed softball league. Thankfully, underhand throwing is not just for sissies.
• 'We couldn't fix it all.' Many patients put off rotator cuff surgery until their tissue quality approaches that of Kleenex. At surgery, at best we can accomplish a partial repair and not fully restore native anatomy. The patient needs to know that bench pressing is not in his future and that his rehab is going to be longer than the turnover time at the Veterans Administration OR. Patients usually find significant pain relief, but when they return 6 months later and still can't lift a laundry basket, they'll know why.
• 'We didn't really find much.' Some patients display many signs and symptoms consistent with meniscus tear of the knee, yet have equivocal imaging findings. After months of rehab and exhaustion of every conservative means possible, I'll sometimes recommend arthroscopic evaluation just to be sure and for closure. Sadly, on occasion, the findings at surgery are meager at best. In surgeon parlance, this is called a surgical "airball." The presumed meniscus tear causing the medial knee pain was simply not there and some softening of the patella was the likely culprit. When told the news, many patients are adamant and insist that I missed the tear. They're quick to inform me that they read on the Internet that their symptoms are totally consistent with a "tear of the posterior horn of the medial meniscus." They failed to mention that they visited 'Joe's meniscus website' for their information. Joe received his training at Organic Green Homeopathic Institute, and is double-boarded in acupuncture and mixology.

• 'The accident did not cause it!' For the select few workers' compensation patients I have the blessing to treat, the claim for compensation for injury is naturally based on causation. Since the accident at work was the root of all evil, patients are determined to prove that all their symptoms are a direct result of the, ahem, I-N-J-U-R-Y. After arthroscoping a workers' compensation patient's shoulder, I may find that the rotator cuff tear was the size of West Philly and clearly present for years. The patient needs to know that the fall off the ladder last month was not the sole cause of the disability! I just realized that I opened the door to reams of litigation-related paperwork and countless phone inquiries and depositions. However, Sister Angela Patrice would have been proud I told the truth.

Nothing but the truth
In this age of spins and damage-control renditions of the truth, some of us have to take a stand and tell it like it really is. Patients merely deserve to know the truth, no matter how hard it may be to convey it. When we tell the truth, we Catholics in recovery do sidestep the fear of a yardstick crashing on our heads — but we will all sleep better!