Do I Follow the Protocol or Not?

One common challenge that new graduates and younger clinicians face is deciding whether to strictly follow surgical protocols. With so many different protocols out there—each varying significantly depending on the orthopedic surgeon—it can be difficult to know how closely to adhere to them. Some protocols are detailed 20-page documents outlining every exercise and progression timeline, while others are vague and offer minimal guidance.

Understanding Protocols and Patient Expectations

First, recognize that many patients arrive for their initial evaluation unaware of the existence of a protocol or what it entails. Often, the surgeon, physician assistant (PA), or nurse practitioner (NP) has not thoroughly reviewed the protocol with the patient. As a clinician, it’s crucial to:

• Review the protocol with the patient during their first visit.

• Explain what the protocol means in terms of expectations and recovery timelines.

• Follow up regularly to ensure the patient understands where they stand in relation to the protocol.

Factors to Consider When Deciding Whether to Follow the Protocol

The decision to follow a protocol depends on several variables:

1. Your Experience Level

   If you’re new to treating a specific procedure or lack experience with post-operative care, it’s generally safer to stick with the protocol. Over time, as you gain more knowledge and confidence, you’ll develop the ability to make more individualized decisions.

   
   

2. Your Organization’s Policy

   Different organizations have varying policies regarding protocols. Some require strict adherence, especially if they have close relationships with certain surgeons. Others grant clinicians more autonomy to tailor treatment plans based on patient needs.

   
   

3. Your Comfort with Diverging from Protocol

   Are you comfortable going against what the protocol suggests if you believe it’s in the patient’s best interest? This often involves a willingness to communicate and, at times, disagree with the surgeon’s prescribed approach.

   
   

4. Patient Preferences

   Always engage the patient in the decision-making process. Some patients may fully trust your judgment and be open to progressing faster than the protocol allows, while others may prefer to stick closely to the protocol for peace of mind.

   
   

General Recommendations

For new graduates or clinicians with limited experience, following the protocol is usually the best course of action. However, use each case as a learning opportunity:

• Study the protocol and compare it with others.

• Pay attention to how different patients respond to the same protocol.

• Build a foundation of experience that will help you make more nuanced decisions in the future.

As you gain confidence, you’ll realize that strict protocols don’t always account for individual variability. Patients recover at different rates due to numerous factors—age, fitness level, medical history, and personal motivation, to name a few. Over time, you can begin to:

• Progress faster than the protocol recommends for patients who demonstrate the ability to tolerate it safely.

• Adjust timelines for those who may fall behind the expected recovery milestones.

Communicate and Collaborate

Perhaps the most critical element in deciding whether to follow a protocol is communication. Always discuss your treatment plan with the patient and ensure they are comfortable with the approach. For example:

• If a patient feels restricted by the protocol and wants to progress more quickly, explain the potential risks and benefits, then proceed with close supervision.

• Conversely, if a patient prefers to adhere strictly to the protocol, respect their wishes and adjust your approach accordingly.

Final Thoughts

The decision to follow a protocol isn’t always straightforward. It requires careful consideration of your experience, organizational policies, patient preferences, and clinical judgment. By staying informed, communicating openly, and prioritizing patient safety, you can provide the best possible care while navigating the complexities of surgical protocols.

Remember: protocols are valuable guidelines, but they aren’t one-size-fits-all solutions. With experience and thoughtful decision-making, you can strike the right balance between adhering to protocols and providing individualized care.