1. I will always tell you the truth, even if it’s hard.
  2. If I do have to give you a hard truth, I don’t enjoy it. I do it because I want you to be completely informed – even if that makes me the bearer of bad news.
  3. Every patient comes in with a different working knowledge of their diagnosis, their expected treatment plan, and their expectations for the impact of that treatment. My goal in each visit during our short, allotted time together is to bring everyone up to speed and on the same page. These bullet points help me do that.
  4. For most surgeons, it’s easier to sign you up for an operation and cut into you than it is to talk to you, teach you, explain to you your options, and treat you. If you look hard enough, you will always find a surgeon willing to operate on you – but that may not always be the best thing for you.
  5. I want to maximize all non-operative options before offering you surgery. No one wants to have surgery, and I get that.
  6. If I offer you an operation, that means I trust we have used up all the nonoperative options and I feel we will all share in the benefits of an operation.
  7. If I don’t offer you an operation, it means I still believe we can get you better without the risk of an operation at all!
  8. I chose to leave my home in Southern California for 11 years and train where I did, so I could learn from the best and see the most complex situations to serve this community I love. It was a hard decision, but I wanted to return equipped with the best for you.
  9. Hip and knee replacements don’t save lives or legs. But gone bad, they can ruin lives and legs. This is elective, lifestyle-saving surgery.
  10. Hip replacements generally do excellently. Unfortunately, one in five knee replacement patients regretted getting the operation a year later. This is likely due to surgeons not choosing the correct candidates.
  11. I treat the correct candidates with the best available evidence at any given time, which means treating you the patient – and not just your x-rays. What I see on your x-ray only tells me half the story of your candidacy. The rest – for better or for worse – is based on what you tell me. Anyone in the world over the age of 60 will have hip or knee x-rays consistent with arthritis – but not everyone needs surgery to get better! Be wary of the surgeon who knows your X-rays better than they know you.
  12. The factors that result in a great outcome are in my control, your control, and nobody’s control. I have spent over a decade perfecting those in my control. The factors in your control are: weight (BMI needs to be under 35), smoking (need to prove you quit smoking for at least 6 weeks – we will check with a blood test!), and diabetes (A1c < 7.5). The factors in nobody’s control include preexisting medical conditions that predispose to complications.
  13. In order to determine whether you would benefit from surgery, I need to understand your misery. I need to know how debilitating and painful your condition is outside this office, which is subjective. I want to know what activities you used to do and to what degree you no longer can do them. I want to know what basic nonoperative treatments you have already tried (time – at least 4 months of pain; medication – Tylenol or Motrin; physical therapy; injections; assist devices – brace, cane, walker).
  14. If you come to see me, I automatically care about you. Talking to you is why I went into medicine, and it is the greatest privilege of my life.
  15. This is not a job to me. You are not a customer. We are in this together. I have to diagnose, explain, treat, and follow through with you – for the rest of our lives.
  16. If my team or I can do something better, share us that hard truth the same way I would do with you. Some things are in our control, and some things are not, but I need to know to serve you and the rest of my people better.
  17. Before you leave, make sure you let me know how you found me! I need to know who to thank.