Ok. So you need an operation (or you think you do, or you’ve been told you do). What do you ask the surgeon? You need the answer to these seven questions.
Having surgery is a scary time. None of us wants to feel like our body has been violated. We all worry about loss of control. The recovery worries us. The risk worries us. First, find your surgeon. When you see them and are thinking about having surgery, ask these seven questions:
1. What are Your Options?
Having a consult with a surgeon is about getting an opinion. You need to know what you choices are. Unless you have a broken bone or cancer (and even then) usually if you are offered surgery, there are choices. Explore all your choices. The choices can include do nothing and observe with follow up, nonsurgical treatments and surgery. There may also be big and little options in terms of surgery. If you choose a surgical option you need to know the long term implications. Is it one and done or is it a recurring problem? Is it better to fix it all in one go or do just what is needed? All options that need to be put on the table. With the coronavirus pandemic delaying surgery, if you can, becomes a real option.
2. What is the Nature of the Procedure?
Ask EXACTLY what they procedure is called. Write it down. Ask for any brochures. Ask what happens in lay persons terms. If the explanation is too technical ask for it to be made simpler. I have seen patients who had surgery elsewhere who did not understand that they would get screws in their back. You need to know how long it takes, what is being done, any implants, whether it’s outpatient or overnight. You need to understand the procedure in simple terms. Right down the exact title and google it to see if there is general information on it. The internet is a general, not a specific guide. The day of surgery, talk to your anaesthesiologist. Ask if it’s local or general anaesthesia. Is there a prep? When do you stop eating? Which pills do you stop before surgery? Most surgeons will give you a ‘surgery pack’ to cover all these things.
3. Is this Condition Common?
Not one we ask enough of and I bring it up a lot. It’s good to have a common condition when it comes to medical problems. Common means that we see a lot of it and treat a lot of it and get good at it. if it’s rare then ask how comfortable the surgeon is in managing the condition. That’s where seeing a teaching hospital is worthwhile as rare conditions sometimes need special expertise.
4. How Many Have You Done?
This ties into how common your problem is. Would you rather have a surgeon who has done 100 or 10,000 of these procedures? If they have done less than 20 then it’s either rare or the surgeon is relatively inexperienced.
5. What are the Risks?
There are 2 kinds of risks: speed bumps and stop signs.
Speed bumps are things like infection, bleeding, anaesthesia reactions, wound problems, postoperative chest problems etc. They happen. Probably <5% in cases. Stop signs are bad things. In my game that includes death and paralysis. This is generally less than 1%. If it’s high you need to know why. Ask what the worst thing that can happen is and how likely that is.
You also need to know if you general health is contributing to it. Things like diabetes, heart disease, obesity, use of blood thinners and smoking all increase risk. You need to know bad things can happen even in the hands of the best surgeons. We try all we can to fix them but if a surgeon tells you there is no risk, you need to find a different surgeon.
6. What is the Likely Chance of a Successful Outcome?
Success is measured in different ways. It all depends why you saw the surgeon. You may not be able to walk because of knee pain. You may have found a breast lump. You may have developed weakness in a leg. If you have symptoms, relief of symptoms is a common goal. If there is pinching of the spinal cord or tumor somewhere, relieving the pressure or taking out the tumor is the goal. There are things you want and there are things the surgeon wants. I see patients with chronic severe back pain and leg pain when they walk. In my hands, the surgery is aimed at buttock and leg pain on walking, not back pain. That would be my measure of success. The patient wanted both relieved. That’s where open conversations are key. If you get 5-10 minutes of facetime with the surgeon then think carefully. If you get no time with the surgeon, run.
7. What is the Recovery Like?
Recover is a few things. First of all are you in hospital overnight or is it day surgery? If you are in hospital, how many nights? The commonest question I get asked is when can I return to work. That is split up by people who have desk jobs and those who do physical. Recovery also covers a return to normal activities. When can you exercise and what kind? When can you travel? What kind of followup is needed? Who do I call if I have problems. What do I need to watch for? What are bad things to watch for? You need to know from the moment you are put to sleep for surgery until you can put that surgery on your past medical history as an afterthought exactly what recovery will take.
Take this list of seven questions to your next surgical consultation.
What until the surgeon finishes talking and see what has not been covered then ask!
8. Other Considerations
For our American readers, the national headache called ‘health insurance’ needs to be factored in. Don’t get me started! Wait! I did start! Find out what it will all cost out of pocket before you have surgery. Find out options in terms of surgery centers versus hospitals and the surgeons preferences. If you have an anaesthesiologist preference, don’t be offended if the surgeon says no; we like working with people who work with us regularly. That way we know what each other expects and work better as a team.
Be educated as you look after your health. You have been put in charge of an amazing machine. That machine is your human body.
Ok. A video to show that you really need to know what you say yes too (don’t watch if squeamish!).
Do you agree or disagree with what I’ve said? Any comments? Please feel free to respond here. I don’t bite!