Does advice from clinicians have an impact on patients' beliefs and behaviours?

Carpal tunnel release is a commonly performed procedure, from which some patients return to work very quickly with others remaining off sick for many weeks. Ratzon et al.3 followed up 50 consecutive patients operated on by five surgeons, assessing them before and after for severity of symptoms. They found that the surgeons’ recommendations for return to work varied from 1 to 36 days, and the time to return to work varied from 1 to 88 days. The surgeons appeared to relate their advice to the type of work done but this was not highly predictive. The duration of sickness absence was not related to the severity of symptoms before or after surgery. The surgeon’s recommendation had the strongest influence on duration of absence.

The fact that patients follow their surgeon’s advice is not surprising. It becomes a problem if the surgeon’s advice is not evidence-based and a much longer period of absence than necessary is recommended. This is particularly a problem if long rest periods are recommended, as this can lead to substantial deconditioning with possible associated weight gain. In middle-aged and older patients it can be extremely difficult to regain fitness and pre-surgery weight.

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