Anticipating Surgery? What You Need to Know

During a medical emergency that requires surgery we have no real alternative but to rely on the recommendations presented to us at the time. However, most surgery is planned days or weeks in advance. This article is for people who have the luxury of time to plan for their surgery.

For those of you who thought your doctor alone planned your surgery, think again. Physicians now realize that patients play the most critical role in medical conditions like diabetes or high blood pressure. In my opinion a patient's role in planning surgery is no less important.

Choosing your Surgeon
This may be your most important decision when contemplating elective surgery. If you have a personal physician then ask him/her for a recommendation. If not, I advise calling your nearest regional medical center Department of Surgery for a list of board certified surgeons who specialize in the type of procedure you need. If your medical insurance limits access to participating physicians, then cross check the hospital's list with the list of surgeons in your plan.

Next, visit the surgeon for a consultation. First impressions matter. If you feel that your needs are being met, that the surgeon answers your questions completely, and that the office is managed professionally, then it's time to move ahead with your decision making process, as described below.

The Decision to Have Surgery
I know many excellent surgeons who routinely advise their patients NOT to have surgery. A surgeon's recommendation should be NOT to operate unless the following criteria are met:

--A procedure's benefit outweighs it's risks (including the small risk of death associated with routine anesthesia)
-- A procedure's cost makes sense to the patient (including the costs of post-operative pain, loss of employment and potential disability associated with possible complications)
-- True informed consent is obtained from the patient. This means that your surgeon has spent the time it takes to educate you regarding your condition, discussed any non-surgical therapy if possible, listed the possible complications of the procedure (including anesthesia-related death), discussed what outcome is likely if surgery is not done, and described exactly what procedure is planned

Obtain a Second Independent Surgical Opinion
Even if all of the above criteria are met I recommend that the following be done before you proceed to elective surgery:

See your personal physician for a pre-operative medical consultation. If you don't have a personal doctor then you need one (this is a topic of an upcoming article). Most surgeons require a pre-operative medical consultation, and consider it routine before any surgery. When in the office ask your personal physician for his/her opinion on your planned procedure. Ask if the doctor agrees that the procedure is indicated now and, if not, why. Then ask for the name of another surgeon who performs the same surgery, and who is not associated with your surgeon. Make an appointment with the other surgeon for a second opinion consultation. You don't have to tell your own surgeon about the second opinion, however be sure to tell the second surgeon that you are there for his/her independent opinion on the planned procedure. Ask the second opinion surgeon if there are any medical centers, or other surgeons, that are particularly well known for performing the type of surgery planned. Ask if he/she recommends that you proceed with the planned surgery. If the second opinion surgeon and your personal physician agree that it is in your best interest to go ahead with the surgery as planned, then chances are this is the right decision.

Beware the Physician Who Objects to a Second (or third) Opinion
Your doctor's primary responsibility is to assist you in obtaining the care you need. This takes many forms, and often includes suggesting other expert opinions. No physician is expected to know everything about every disease. However, every physician should be comfortable having his/her recommendations reviewed by peers, and advising that patients seek other professional opinions. If your doctor bristles at the mention of a second opinion then it is time to find another doctor.

The Internet
Medical websites and disease-specific chat rooms offer valuable information when planning surgery. These resources are becoming increasingly helpful in obtaining both general medical information and recommendations, and when researching specific medical topics. What they lack is professional, independent feedback on your particular needs and risks. The truth is no two people are the same. Despite general recommendations, and reports from others who have undergone the same type of surgery, each individual is best served by taking all available information, from all sources, to an independent qualified physician for a personal recommendation.

Summary
There is no such thing as safe surgery. Even the most routine surgical procedures can result in death or serious complications. The decision to undergo surgery should never be taken lightly. Given the luxury of time you can reduce your risks by learning all you can about your medical problem and procedure being planned. Your best resources for reliable recommendations include your personal physician, your surgeon, independent second opinion physicians and your own research.