Chapter 41: On the Way to the Operation Theatre: What You Should Ask Your

The greatest triumph of surgery today…
lies in finding ways for avoiding surgery.
- Robert Tuttle Morris

The two most important questions to ask about planned surgery are: why is the procedure necessary for you, and what alternatives are there to surgery? If you do not need to undergo the operation, then you can safely avoid any risks that might result! Remember that all forms of surgery entail both risks and benefits; a surgery is worthwhile only if you can be reasonably assured that the benefits are greater than the risks.

Your primary care doctor could be the one who suggests that you go in for surgery and he may recommend a surgeon. You may also want to identify another independent surgeon to get a second opinion. Your doctor should welcome relevant questions about the surgery and if you do not understand the answers, ask him to explain them clearly and unambiguously. Patients who are well informed about their surgery tend to be more satisfied with the results.

1. What operation are you recommending?

During your session with the surgeon, request him to explain the surgical procedure. For example, if some organ has be repaired or removed, find out why it is necessary to do so. Your surgeon can use illustrations or models to explain to you the steps involved in the procedure. Today, there are often different ways of performing the same operation and one way may require more extensive surgery than another. For example, hysterectomy (surgery which involves removal of the uterus) can be done through a large abdominal incision, through many tiny ones (using laparascopic technology) or through the vagina. You need to understand which method your surgeon will be adopting, and why your surgeon prefers one procedure over another.

2. Why do I need the operation?

In response to the crucial question as to why surgery is necessary there can be many reasons. Some operations can relieve or prevent pain; others can reduce symptoms or improve some body function; yet others are performed to diagnose a problem. Make sure you understand how the proposed operation fits in with the diagnosis of your medical condition.

3. Are there alternatives to surgery?

Often, surgery is not the only solution to a problem. Medical therapy or other non-surgical treatments, such as a change in diet or special exercises, might help you just as well as surgery, or even more. Ask your surgeon or primary care doctor about the benefits and risks involved in the other choices. You need to know as much as possible about these benefits and risks in order to make the most appropriate decision. One alternative may be watchful waiting, a process in which both you and your doctor check to see if your problem is getting better, so that you may be able to postpone surgery, perhaps indefinitely. Sometimes, a "tincture of time" provides a shield against the surgeons knife!

4. What are the benefits of undergoing the operation?

Ask your surgeon what you will gain by undergoing the operation. For example, a hip joint replacement could mean that you can walk again with ease. Also, ask how long the benefits of surgery are likely to last. For some procedures, it is not unusual for the benefits to last for a short time only. A second operation may be needed at a later date. For other procedures, the benefits may last a lifetime. When identifying the benefits of the operation, one should be realistic. Sometimes, when patients expect too much, they can be disappointed with a perfectly satisfactory results!

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5. What are the risks of undergoing the operation?

All operations carry an element of risk, which is why you need to carefully weigh the benefits of the operation against the risks of complications or side-effects. Complications are unplanned events, such as infections, too much bleeding, adverse reactions to anaethesia, or accidental injury. Some people face an increased risk of complications because they have medical problem, such as diabetes or hypertension. In addition, certain side-effects may result after the operation, such as swelling and soreness at the site of the surgery. Ask your surgeon to specify the possible complications and side-effects of the operation. There is always some pain almost to after surgery. It would be prudent ascertain how much pain you may have to endure and what the doctors and nurses will do to reduce it. Controlling the pain will help you become more comfortable during recuperation, which will help you to recover faster.

6. What would happen if I dont undergo this operation ?

Based on the information you have collected about the benefits and risks of the operation, you may decide against it. However, you should definitely ask your surgeon what you will gain - or lose - by not undergoing the operation immediately. Could you develop more pain? Could your condition get worse? Could the problem go away?

Getting a second opinion from another doctor is a very good way of making sure that undergoing the operation is the best alternative for you. If you are seeking a second opinion, make sure to get your records from the first doctor so that the second one does not have to repeat the tests. You may get a second opinion from another surgeon or from a medical specialist.

CHOOSING THE RIGHT SURGEON

One way of reducing the risks of surgery is to choose a surgeon who has been thoroughly trained to perform the procedure and has plenty of experience. You can ask your surgeon about his recent record of successes and complications, with the specific operation. If you feel it is necessary, you can discuss the topic of the surgeons qualifications and experience with your family doctor.

THE OPERATION VENUE

Most surgeons nowadays practice at one or more local hospitals. Find out the venue where your operation will be performed and ask your doctor about the success rate at that hospital. Research has shown that some operations, such as cardiac bypass surgery, have a better outcome if they are done in hospitals that perform many such procedures (perhaps because these hospitals have a heavy workload, which is why their surgical team has more experience). If the hospital has a low success rate for the operation in question, you should ask your surgeon to perform it at another hospital, which has a higher success rate.

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INPATIENT OR OUTPATIENT?

Until recently, most surgery was performed on an inpatient basis; i.e., patients stayed in the hospital for one or more days. Today, a lot of surgery is done on an outpatient basis in a special surgical center, or a day surgery unit within a hospital. Outpatient surgery is less expensive because you do not have to pay for staying in a hospital room. Therefore, confirm whether your operation will be done in an inpatient setting or in an outpatient setting. One point should be borne in mind. If your doctor recommends inpatient surgery for a procedure that is usually done as outpatient surgery - or vice versa, i.e., he recommends outpatient surgery that is usually done as inpatient surgery - ask him for the reasons for his decisions. You should ensure that you are at the right place for your operation.

THE IMPORTANCE OF ANAESTHESIA

The purpose of using anesthesia is to ensure that surgery can be performed without unnecessary pain. Your surgeon can specify whether the operation calls for local, regional, or general anesthesia and also why this form of anesthesia is recommended for your procedure. Local anesthesia numbs only a part of your body for a short period of time; for example, a finger. In most cases, you will remain awake after being administered regional anesthesia. General anesthesia numbs your entire body for the entire duration of the surgery and you will be rendered unconscious.

Anesthesia is quite safe for most patients and is usually administered by a specialized physician, called an anesthesiologist or anesthetist. If you decide to undergo an operation, ask to meet the person who will give you anesthesia. Find out what his qualifications and experience are. Also, ask him about the side effects and the risks of going in for anesthesia in your case. Do not forget to tell him about medical problems you may have (including any allergies), or any medications you have been taking, since they may affect your response to the anesthesia.

THE PERIOD OF RECOVERY

Your surgeon is the ideal person who can tell you how you may feel and what you will be able to do - or not do - during the first few days, weeks, or months after surgery. Ask him how long you will need to remain in the hospital. Find out what kind of supplies, equipment and any other help you will need when you go home. Knowing what to expect can help you cope better with recovery. Ask when you can start regular exercise again and when you can go back to work. You should follow your surgeons advice strictly to make sure that you recover fully as soon as possible.

THE COST FACTOR

You need to determine the total expenses you will incur in the entire process of surgery. First, find out what your surgeons fees are, and what all they cover. Surgical fees often include the cost of follow-up visits after the operation, and may include the services of a surgical assistant as well. You will also be billed by the hospital for operation theatre time; inpatient or outpatient care; and the cost of consumables and disposables used. Additional costs are those of the anesthesiologist and other medical staff who provide services related to your operation. You need to find out what your total expense for the surgery will be - i.e., how much you will need to pay as a total figure. Many hospitals now also offer all-inclusive package deals for certain operative. However, unforeseen complications can considerably add to the costs and you may need to budget for these as well. The health insurance coverage for surgery can vary, and there may be some costs which you will have to bear on your own. Before you undergo the operation, find out from your insurance company how much of these costs it will bear, and how much you will have to pay yourself.

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How to Avoid Unnecessary Surgery And Other Related Aspects

The following guidelines could prove helpful in avoiding unnecessary surgery:

Dont go directly to a surgeon for medical treatment. If at all possible, start out by going to your regular family doctor - a general practitioner or a physician - for the initial diagnosis or treatment.
Consider getting an independent consultation or a second opinion before subjecting yourself to surgery, even if your family doctor and surgeon agree that surgery is necessary. Consultations, according to some studies, reduce operations by as much as 20 to 60 per cent, and you may be lucky enough to fall into this category
Dont push a doctor to perform surgery on you. If you insist on surgery, even if it is actually unnecessary, you are likely to find a surgeon willing to perform it. There are enough overtreaters who are willing to perform unnecessary surgery; so dont invite trouble for yourself.
Sometimes, the huge costs may compel you to discard the option of surgery. Discuss frankly the fee for surgery with your doctor. You should know what the surgery is going to cost so that you can make financial arrangements, if necessary. Any surgeon worth his scalpel will gladly discuss this aspect.
check out the credentials of a surgeon by inquiring about him from those who know him or have been operated upon by him. This category includes other patients as well as colleagues of the surgeon. One good way of finding the ideal surgeon is to find out whom doctors go to when they need surgery for themselves or their families. The greatest compliment to a surgeon is paid when he is chosen by a doctor or his family.
Make sure the surgeon knows, and is willing to work with, your general practitioner or family doctor. To ensure complete, continuous and quality care, close contact between the surgeon and your doctor is vital. If they cant work coherently as a team, you may be the loser.
Select a surgeon who is not too busy to devote enough time and attention to his patients. Surgeons who handle too many cases are bad news for the patient for obvious reasons. The reality is that the best surgeons are likely to be very busy. But the best surgeon who must rush through an operation and zip past his patients is not likely to achieve worthwhile results.
Be on guard, especially if some of the operations which are most often unnecessarily performed, are proposed to you. These operations include hysterectomies, haemorrhoidectomies, and tonsillectomies. These operations have been referred to as remunerectomies by some cynics ( derived from the word remuneration).
Listen carefully to the experts. But remember, the ultimate decision is yours. Youre entitled to all the facts you need and youre entitled to decide whether or not to go ahead with the surgery. It is the patient, not the doctor or the surgeon, who is supposed to (and is entitled to) make the final decision on whether or not to undergo surgery.

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GETTING READY FOR SURGERY

One inescapable reality is that surgery subjects your body to major stress, and could drain you of much of your energy which is essential for post-surgery recuperation. However, going in for surgery does not mean that you leave everything in the hands of the surgeon! Just as the surgeon needs to prepare for the surgery, so do you! There is a lot you can do to help your body to heal better and recover more quickly from the effects of the surgery. Here are some practical pre-surgery measures to help build your stamina and improve your recovery:

Get enough rest. Sleeping for eight hours or more every day is ideal for boosting your immune system and for optimizing the healing process after your operation.
Discuss the intake of medications and alcohol with your physician. Inform your surgeon or anesthesiologist about any drugs that you may be using. This precaution is necessary because some substances can cause your body to react unpredictably to anesthetics and may contribute to adverse effects. For example, aspirin or ibuprofen can worsen bleeding, and you may be advised to stop these drugs prior to surgery. Another mandatory precaution: stop-smoking!
Ensure that you get good nutrition. Certain vitamins and minerals are critical for healing and acquiring immunity. choose foods high in vitamins C, E and A as well as in zinc and iron. You can start taking multivitamins and iron supplements if your doctor advises you to do so.
Exercise regularly, so that you can be as fit as possible for surgery.
Learn mental relaxation techniques. For instance, meditation, breathing exercises, massage or other techniques can help ease your mind and calm your body. Studies have shown that patients who listen to their favorite music during surgery (even when under anesthesia) recover faster and experience less pain.
Bank your blood. If your surgeon feels you may need a blood transfusion during surgery, Enquirer about banking your blood prior to surgery (autologous transfusion). This is the safest method of blood donation available, in which you store your blood a few weeks prior to surgery, so that it can be kept as a standby during your operation, if needed. However, if you need a larger amount of blood, you should get your friends and relatives to donate blood, or remain on call as needed.

VARIOUS TYPES OF SURGERY

Some wags have humorously defined surgery as major when it is done on them and minor when its being done on someone else! A more realistic definition would be to consider that surgery as major, which involves vital organs, requires a long time to perform entails a blood transfusion.

Surgery can be classified under various categories. For or instance:

Emergency: An immediate operation to save a life or maintain the functioning of a body part.
Curative: An operation that rids the body of a problem or corrects a condition.
Urgent: An operation that must be done within a matter of hours.
Diagnostic: An operation that helps in making a diagnosis about a suspected problem.
Planned or elective: Surgery planned well in advance of the actual operation date.
Exploratory: This type explores a body organ or body area for a suspected disorder.
Palliative: This type eases body pain, but doesnt cure the problem.

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WHAT TO EXPECT PRIOR TO SURGERY

Your doctor will most probably need to order a series of tests to make sure that you are fit for surgery as well as for withstanding the effects of anesthesia. These tests include: urine analysis, blood tests, chest X-ray and ECG, depending upon your age and the type of surgery required.
Your anesthesiologist will visit you prior to surgery. He will review important information such as the timing and duration of surgery and what type of anaesthetic needs to be used. He will remind you not to consume any food or water for a specific period prior to the operation, such consumption can cause life- threatening vomiting during the course of surgery. The anesthesiologist will also need relevant data about any allergies or previous surgical experiences that you may have had.
Surgical preps are often necessary, depending on the kind of surgery scheduled. A preparation can involve a variety of activities such as cleaning and shaving of the surgical area, a special preoperative diet of only liquid foods, placing a catheter in the bladder, administering, putting an enema, or drops in the eyes. A patient should feel free to ask the surgeon what to expect by way of surgical preparation. Knowing what to expect can ease preoperative stress to a great extent.
The doctor or nurse will ask you to remove all valuables and possessions and hand them over to your relatives or friend or the hospital authorities. The items could include watches, jewelry and eyeglasses.
The hospital authorities will need you to sign a surgical consent form. You must read this form carefully, especially the fine print, before affixing your signature on it.
Usually, a sleeping pill will be offered the night prior to surgery. Most people tend to be anxious about the forthcoming surgery and find such medication helpful.
Request your doctor to try and schedule your surgery as the first operation of the day. Not only does this mean that you will be starving for a shorter time, but it also means that the operation theatre staff is fresh; i.e., more alert and more efficient.

AFTER THE SURGERY: AN ACTIVE ROLE CAN ASSIST YOUR RECOVERY

Here is a list of dos after surgery, which could prove helpful:

Do leave the hospital accompanied by a responsible adult. This person should ensure that you travel home safely; he should also provide immediate care at home. You should ensure that this adult stays with you for 24 hours after surgery.
Do remain quietly at home for the day and take rest. You need rest both because you have received anesthesia and because you have undergone a surgical procedure, even one that is considered minor. If, after a day, you still do not feel that you have recovered, you should continue your rest for an additional day or two. Discuss your plans to return to work or normal routine with your doctor and obtain his approval.
Do take liquids initially and slowly progress to a light meal (such as soup, dal, biscuits, toast, plain rice, or yogurt).
Do call your doctor if you have any questions, even if they seem trifling. Moreover, if you feel your recovery is not progressing to your satisfaction, consult your doctor, rather than worry unnecessarily! Your doctor should make it a point to advise you about the warning signs of potential problems after surgery (such as excessive pain, fever or bleeding) and to whom you should report these symptoms.

Your doctor may prescribe some medications after your surgery, such as painkillers or antibiotics. Take these medications without fail as advised. Your doctor will also advise you how to take care of the surgical wound (incision), so that it heals well. For example, he may advise you not to wet it for a few days; and will tell you when to return for your suture removal, if required.

Your follow-up visit after surgery is extremely important. During this visit, your doctor can make sure that you are recovering as expected and that your wound is healing properly. He will inform you about his findings during the surgery, and also provide the details of your operation. Make sure that you have obtained or collected a complete record of your operation before you leave the hospital or clinic! You should insist that all the tissues removed from your body be sent for histopathologic examination and that a copy of the report be kept in your medical record, as it provides critically important information. Some varieties of surgery, such as endoscopic surgery, can be videotaped. Make sure that a copy of this video also becomes a part of your medical record!

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After the "dos", heres a list of donts after surgery:

Dont drive a car for at least 24 hours. After being subjected to anaesthesia, your reflexes, reactions and judgement may be impaired. Such impairment makes driving a car dangerous, not only for you, but also for others.
Dont take any important decisions or sign any legal documents for 24 hours. The potential for impairment relates not only to physical activities, but also to your mental state. Moreover, the anxiety that frequently accompanies the taking of important decisions should be avoided. The day should be spent resting.
Dont drink alcohol for at least 24 hours. Alcohol is also considered a drug, meaning that an alcoholic drink has the potential to react negatively with the anaesthetic present in your system after surgery. Alcohol includes hard liquor, beer and wine.

Heres a sample surgery checklist which can help you to critically think about surgery, if your doctor feels you need an operation.

Surgery checklist
Type of operation ________________________________________
Description _____________________________________________
Diagnosis _______________________________________________
Name of the surgeon _____________________________________
How often does the surgeon performs this surgery? ____________
Who will be the primary surgeon? __________________________
Risk of: Operative death? _____(%) Serious complications? ____%
Possible complications _____ Possible complications chances of these occurring ________%
Is this surgery only for symptom relief? ______________________
What symptom? _________________________________________
Is this surgery necessary to prevent death? ____________________
Likelihood of dying without surgery _______(%) in _______ years.
What non-surgical treatment can be tried first? ________________
________________________________________________________
Can surgery be done as an outpatient? _______________________
Can surgery be done with a local anaesthetic? ________________
If so, is anaesthetic standby necessary? _______________________
Does surgery require a surgical assistant? _____________________
If yes, of what caliber? ____________________________________
Name of anesthesiologist __________________________________
At what hospital is the surgery planned? ______________________

What other hospital could be used? _________________________
Expected duration of hospitalization? _________________________
Expected duration of recovery? ______________________________
How long will I tire easily? ________________________________
How soon can I go back to work? ___________________________
How soon can I resume normal exercise? ____________________
How long will I experience some pain or limitation of activity? ________________________________________________________
Surgical fee Rs. __________________________________________
Assistants fee Rs. __________________________________________
Anesthesiologist Fee Rs ___________________________________ Total Rs. ________________________________________________
What will insurance cover? Rs. _____________________________
COMMENTS _______________________________________
___________________________________________________
___________________________________________________
____________________________________________________

Fill out this checklist when considering any surgery. Complete a separate checklist for each opinion you receive and each surgeon you consult.

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Chapter 41: On the Way to the Operation Theatre: What You Should Ask Your

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