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Dr. Tomaino's Blog

The Importance of Self-efficacy

October 17th, 2019
Psychologist Albert Bandura has defined self-efficacy as one's belief in one's ability to succeed in specific situations or accomplish a task. One's sense of self-efficacy can play a major role in how one approaches goals, tasks, and challenges.

In the course of my practice, I often share with my patients the value of developing self-efficacy in order to improve coping with ongoing pain or functional loss. Many of the conditions I take care of are problems that are not life threatening. So—if one can “live with” the problem, one might be very justified in avoiding surgery. By the same token, if one cannot, surgery may be very helpful. Many degenerative conditions are truly part of the human condition—tennis elbow, thumb basal joint arthritis, and even rotator cuff impingement, for example.

When I reflect on how I practice today—in my 26th year---I am much more inclined than I was in my 1st decade of practice to empower my patients’ self-efficacy so that they appreciate the feasibility of trying to live with their condition if possible. Sometimes I even bring up the story of The Little Engine That Could.

The Little Engine That Could is an American fairytale (existing in the form of several illustrated children's books and movies) that became widely known in the United States after publication in 1930 by Platt & Munk. The story is used to teach children the value of optimism and hard work. In the tale, a long train must be pulled over a high mountain after its engine breaks down. Larger engines are asked to pull the train; for various reasons they refuse. The request is sent to a small engine, who agrees to try. The engine succeeds in pulling the train over the mountain while repeating its motto: "I-think-I-can".

Why encourage a patient to avoid surgery by building one’s capacity to cope with pain and/or dysfunction? Simply answered---because if they can, they may in fact be better off. Even the best that a surgical procedure can offer, does not necessarily always meet expectations. And, if one is challenged to try to live with their problem, and cannot, I have found that they often do pretty well with surgery—partly because they appreciate the benefit of even just marginal improvement. If there is a 100% success, that’s a bonus.

My take home message is that conservative care should be the default for many of the problems we may experience from our fingertips to our shoulders. My currency in this 26th year of practice is not merely as surgeon, but as physician-counselor. My goal is to provide clarity so that you, my patient, can make the best decision for you. This is much better that being steered to surgery when conservative (nonoperative) care may result in a satisfactory outcome. Exercising one's personal agency leverages self-efficacy and coping skills, which may obviate the necessity for surgery.



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