PRINCIPLES OF PRACTICE FOR PATIENTS WITH CHRONIC RHINOSINUSITIS (CRS)
(Originally composed 2004, amended 2009)
1. Seek first to understand the patient, and then be understood.
2. In order to care for the patient, you must truly care for the patient.
3. You are treating and caring for the patient, NOT the patient's CT scan.
4. Begin with an end in mind - that being the safe and effective resolution of the patient's symptoms -
NOT what might disturb the physician about the patient's CT scan.
5. Listen to the patient, and construct a treatment plan (which might include surgical intervention) to
reconcile that which concerns the patient. It is inappropriate to perform radical surgical procedures,
with great inherent risks to the patient, when attempting, simply, to improve the patient's quality of
life - as per their specific requests.
6. Always remember, as the surgeon, to carefully review with the patient the RISK BENEFIT RATIOS of
any procedures suggested to the patient. When treating Chronic Rhinosinusitis, the surgeon is not
confronting a life threatening entity, such as cancer or severe vascular disease. The sinus surgery is
utilizing a sinus surgical procedure as part of thoughtful, evidence based, holistic approach to
reconciling the chronic symptoms of sinusitis which do not threaten the patients very life but often
jeopardize the patients quality of life. Therefore, the inherent risks of such a sinus procedure must
be those appropriate for and commensurate with the symptoms the patient most wants resolved
and the character of post-operative recovery should be essentially uneventful.
Initial surgical procedures, performed for the quality of life improvement sought by patients suffering from chronic sinusitis, should seek to repair and preserve the inherent immune functions of the sinuses, should be inherently very low risk procedures, low morbidity procedures, which require brief recovery periods, as well as highly effective procedures which rarely require revision surgery.