As physicians, we have the responsibility of evaluating patient problems and making decisions about their plan of care. In today's world, the paternalistic approach to patient care has been appropriately replaced by shared decision making. Therefore, patients who are undergoing evaluation for elective shoulder arthroscopy procedures should be counseled about the risks and benefits of surgery relative to their clinical presentation both physiologically and orthopaedically. No one medical factor in isolation should be used to decide on the appropriateness of surgery, including an absolute body mass index cutoff. Among the main drivers of these cutoff algorithms are alternative payment models and episodes of care, which are here to stay. Although some aspects of these models are beneficial, we cannot let some of these simplistic algorithms replace our decision-making skills as physicians.
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