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!
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.
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.
How to Avoid Unnecessary Surgery And Other Related Aspects
The following guidelines could prove helpful in avoiding unnecessary surgery:
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:
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.
WHAT TO EXPECT PRIOR TO SURGERY
Here is a list of dos after surgery, which could prove helpful:
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!
After the "dos", heres a list of donts after surgery:
Type of operation ________________________________________
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. _____________________________
Fill out this checklist when considering any surgery. Complete a separate checklist for each opinion you receive and each surgeon you consult.