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Questions To Ask Before Agreeing To Surgery

Questions To Ask Before Agreeing To Surgery

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  • Why do I need this operation?
    • Why do you recommend this particular operation?
    • How does the surgery relate to my medical condition?
  • What operation are you recommending? It is important to understand all aspects of the surgery before consenting. Continue to ask questions until you are satisfied that you understand what is being proposed, as well as the alternative methods of performing the operation. Following are examples of questions that will help clarify what operation is being recommended:
    • What will happen in the surgical procedure? For example:
      • If something is going to be repaired or removed, what is being removed and what effect it will have? Could less be removed?
      • Where will the incision be?
      • Will you perform the surgery with a traditional opening or a laparoscopic type small opening?
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        • If the surgery will be with a traditional opening, how long will the scar be?
        • If the surgery will not be a small opening, is it because you do not perform the procedure or because it doesn't work for the type of surgery we're talking about or because of my particular situation?
        • If it could be laparascopic and you don't do that type of surgery, can you recommend someone who does?
      • Could the incision be somewhere that is less noticeable?
      • Will organs have to be moved to clear a path?
      • Will any lymph nodes be removed? If so, which ones? Why?
      • Will other tissues be removed? If so, which ones? Why
      • If it would help to understand the procedure, ask your surgeon to draw a picture or a diagram or show you on a dollor model of the human body what is proposed.
    • Are there different ways of performing the operation? If so,
      • What are the advantages and disadvantages of each alternative?
      • Why do you recommend the suggested procedure instead of the other alternatives?
      • If the surgeon does not voice a preference between competing procedures, ask: If you had a child with my condition, and a choice had to be made between these competing procedures, what would you choose for your child?
    • How long will the surgery last?
    • Will anesthesia be local, regional or general? (To learn more , see Anesthesia.)
    • Is there a pamphlet or other information about the information that I can read, or a video I can see?
      • The American College of Surgeons (ACS) has a free series of brochures on specific types of surgery: Frequently Performed Operations. These documents are available online at www.facs.org offsite link. For print copies, write to the ACS, Office of Public Information, 633 N. Saint Clair Street, Chicago, IL 60611. There may also be a video of the actual or simulated version of the surgical procedure you can watch. Videos of procedures may be difficult to watch, but they can help you make decisions. At the least, a video may help you formulate questions for your doctor. For additional help locating videos about various surgeries, see: Videos Of Medical Procedures.

  • Once you think you have a grasp of the operation being proposed, repeat it back to the surgeon in your own words to be sure your understanding is correct.
  • What are the benefits of the operation?
    • What will I gain by having the operation? For example, a hip replacement may mean that you can walk with ease.
    • How long are the benefits likely to last? For some procedures it is not unusual for the benefits to last only for a short time. There might be a need for a second operation at a later date. For other procedures the benefits may last a lifetime.
    • Is there published information about the outcomes of the procedure? Published information can give you an idea of what happens to a large number of people who have had the operation. Published information becomes a base point from which to compare the experience of your surgeon and hospital.
    • Are there other people with whom I can speak who can tell me about the practical realities of the benefits, as well as what to expect?
    • Is there a quality of life measurement applicable in this situation?
  • What are the risks relating to the operation? While it may be difficult to consider, all operations have some risk. It is up to you to decide whether the possible benefits are worth the risks such as:
    • Complications - unplanned events such as infections, or reaction to anesthesia.
      • Some people have an increased risk of complications because of other medical conditions.
      • Make certain that the surgeon is aware of all of your medical conditions.
      • Ask about complication rates: the percentage of times there have been significant complications resulting from this procedure.
    • Side effects - such as pain or swelling.
    • The surgery not being successful.
    • The surgery possibly making things worse.
    • Possibly dying. What is the percentage of people who have died (the "mortality rate")?
    • NOTE: Computer based risk calculators let surgeons know individual patient's chances of surgical complications based on personal medical history and physical condition. For example, the calculator may say a particular person's risks while undergoing a particular surgery are 1% of dying, 12% risk of a minor complication and an 8% chance of a more serious complication such as cardiac arrest. The calculators are currently not available to the public. However, you can ask if there is such a program for the surgery you are considering, and, if so, what it says. The calculators help you give "informed consent."
  • What can be done to minimize the side effects and risks? For example:
    • There is almost always some pain with surgery. Doctors can control pain. Controlling pain will help you to be more comfortable while you heal, enable you to get well faster, and improve the results of your operation. (For information about pain, click here.)
    • Starting antibiotics within one hour before starting surgery dramatically cuts infection rates.
  • What effect will the surgery and recovery from the surgery have on my ability to do my work?
  • What are the long term effects of the operation? For instance:
    • Will there be any lasting effects?
    • What, if anything, will I be able to do better?
    • What, if anything, won't I be able to do at all? Or only in part?
  • What are the alternatives to the proposed surgery? There are times when surgery is not the only solution to a medical problem. Ask your surgeon or primary care doctor about the benefits and risks of the alternatives. Common alternatives to surgery are:
    • Medications
    • A change in diet
    • Special exercises
    • Radiation treatment
    • "Watchful waiting." You and your doctor periodically check to see if your problem gets better or worse. If your condition gets worse, you may need surgery at that time. If it gets better, you may be able to postpone surgery, perhaps indefinitely.
  • What if I don't have the surgery?
    • Am I likely to be in more pain?
    • Could my condition get worse?
    • Could the problem go away on its own?
  • Who will perform the surgery? You or one of your associates?
  • It frequently happens that a patient meets with and vets a surgeon, and expects that person will perform the surgery. In fact, if a surgeon works with other doctors, it is not unusual for another doctor to perform the operation. If this is not all right with you:
    • Let the surgeon know that you only want him or her to perform the surgery.
    • Check the consent form you will be asked to sign before surgery to be sure that it only gives consent to the doctor you want to do the operation. If you make a change to the form, be sure to initial the change.
  • Where will the surgery be performed?
    • Will the operation be done in the hospital or in an outpatient setting? Until recently most surgery was performed on an inpatient basis and patients stayed in the hospital for one or more days. Today, many surgeries are done on an outpatient basis in a day surgery unit of a hospital, in special surgical centers and in doctors' offices. Outpatient surgery is less expensive because you do not have to pay for staying in a hospital room.
    • If the surgery will be performed as an outpatient, ask whether you will need someone to drive you home.
    • If your doctor recommends inpatient surgery for a procedure that is usually done as outpatient surgery, or recommends outpatient surgery that is usually done as inpatient surgery, ask why. You want to be in the right place for your operation.
    • If the surgery will be performed in the hospital:
      • Which hospital does the surgeon recommend?
      • How many times has the procedure been performed in the last few years in that hospital?
      • With what success rate? Some operations have higher success rates if they are done in hospitals that perform many of those procedures. If the hospital does comparatively few of the operation in question, or has a low success rate for the operation, consider asking to have it at another hospital. For more information, see Choosing a Hospital.
  • Who will the anesthesiologist be? The anesthesiologist performs an essential task for successful surgery. The anesthesiologist maintains the patient's blood pressure and vital signs while keeping the person unconscious so that the surgeon can do his or her job. Anesthesiologists also play a key role in pain management during the initial post-operative healing. The anesthesiologist and surgeon work together as a team. If you think of sports, a team of qualified basketball players is likely to do better than a team of stars who haven't worked together before. Consider asking:

    • What are the qualifications of the person who will administer the anesthesia? Preferably the person is board certified. To learn more, see: Board Certification.
    • Do the two of you work together regularly?
    • Does the anesthesiologist have a lot of experience with the type of surgery?
    • Is the anesthesiologist experienced with a patient population like me?
    • If the doctor and anesthesiologist haven't worked together much, ask your surgeon if there's an anesthesiologist he or she has worked with a lot, and whether that person is available for your surgery.

  • What do I need to do to prepare for the surgery? For example:
    • Are there drugs, supplements, vitamins or herbs I am taking that I should stop taking for a while? If the answer is "yes", consult with the prescribing doctor to let him or her know you will be taking a drug vacation and find out if you should be doing something else in the meantime.
    • Should I be exercising?
    • Changing my diet?
    • NOTE: "Prehab" is usually covered by health insurance. Prehab involves physical therapy as well as nutritional counseling to improve your body's ability to handle the stress of an operation.
  • What additional tests will I need before the surgery? Ask about:
    • The test
    • When and where it will be performed
    • Whether the test will be covered by your insurance
    • The cost.
      • If the cost is covered by insurance, how much will you have to pay as co-insurance or a co-pay?
      • If the test is not covered, or you do not have health insurance, are there less expensive ways to perform the test, or less expensive places in which the test can be done? (To learn how to save money on medical bills, click here. For information about obtaining health care without insurance, see: Uninsured.)
    • How much time the test will take?
    • Will there will be time lost from work either preparing for, or recovering from, the test? If so, how do I minimize it? For example, if a colonoscopy is suggested, if you schedule it for the first day of the work week, you do not lose time from work cleaning your insides.
  • After surgery, how and when I learn about its success?
    • How long do I have to wait for my laboratory test results? Do I call you, or do you call me?
    • Will a pathologist examine the tissue and write a report? Who will explain that report to me?
    • When will I need to return for a follow-up appointment?
  • What will the recovery be like and how long will it take? Knowing what to expect can help you cope better with the recovery.
    • How will I feel, and what will I be able to do for the first few days, weeks, and months after surgery?
    • How long will I be in the hospital?
    • Will I have to go to a rehabilitation facility? If so, for how long?
    • Will I need supplies, equipment, and/or help when I go home? If changes will be required in your home, like moving scatter rugs, consider making them before going for the operation so you don't have to tend to these matters when you're not feeling well.
    • Will I be bedridden at home? If so, for how long?
    • Will I need help at home? If so, to do what? For how long?
    • Will there be surgical drains? If so, what will they be like and how long will they be used? (A surgical drain is a tube inserted into the body to remove liquids.)
    • How long before I am physically able to return to my normal activities, including work?
    • Describe your basic life activities. What won't you be able to do, and for how long? If applicable, ask when you can start regular exercise again and when you can go back to work. You do not want to do anything that will slow down the recovery process. Lifting a ten-pound bag of potatoes a week or two after your operation may not seem to be "too much," but it could be.
    • How long before I can have sex?
  • How much will the operation cost? Even if you are insured, there are some costs you may have to pay. Find out about such costs as:
    • The surgeon's fee and what it covers. Surgical fees often include several visits after the operation.
    • The anesthesiologist's charge.
    • The costs for other doctors or other professionals who may be involved in the surgery.
    • The hospital charge for inpatient or outpatient care. (The doctor can tell you how long to expect to be in the hospital. The hospital business office can tell you about their rates.)
    • What expenses relating to the surgery am I likely to incur afterward? For example: physical therapy, occupational therapy, home nursing care, help getting around, private transportation.
    • Check with your insurance company to find out how much of these costs it will pay and how much you will have to pay yourself. If you do not have insurance, see Uninsured.
  • If I undergo surgery, are there any treatments that I will not be able to have in the future?
  • Where can I get a second opinion?
    • Many health insurance plans actually require patients to obtain a second opinion before they have certain non-emergency operations. Most insurers, including Medicare, pay for second opinions even if one is not required.
    • If your insurer balks at paying for a second opinion but you and/or your doctor feel that it is necessary, you can argue your position. To learn more, read Obtaining a Second Opinion and Appealing Your Health Policy.
    • When obtaining a second opinion:
      • Make certain to get your records from the first doctor to the second doctor so he or she does not have to repeat tests.
      • Tell the second doctor about your symptoms, the type of surgery that has been recommended and the results of any tests you've already had.
      • Ask the same questions you asked of the first doctor.
    • If you still have questions after seeing a second doctor, consider seeing a third doctor. Your primary care doctor may also be able to answer questions and help you decide what to do.
  • By when do I have to make a decision?; Take the time you need to make a decision with which you are comfortable. On the other hand, you do not want to postpone a decision to the point that the delay hurts your chances for healing. Delay could also result in complications which require you to go to the nearest emergency room for care rather than the facility in which you would prefer to be treated.
  • If you are a member of an HMO or other managed care health insurance plan, ask:

    • Does the insurer provide financial incentives for doctors to use a preferred treatment?
    • Is the doctor prohibited from informing you about treatment options other than the one or ones approved by the managed care company? This is a practice known as "gagging". "Gag orders" are supposed to be a thing of the past. However, it is still worth confirming that you have been advised of all of your treatment options.
    • Does the plan limit your doctor's choice to order treatments and make referrals if a patient's needs go beyond the plan's protocols?

    NOTE:

    • An increasing number of hospitals are letting families stay in the operating room during surgery. The concept is known as "family presence." It is result of a growing body of evidence shows both patients and families can benefit from remaining near each other in stressful situations. Apparently family members aren't a hindrance to doctors or nurses. If this matters to you, ask whether your family can be present.
    • If you have difficulty getting the doctor to answer your questions, see the video, Talking With Your Doctor, and/or read How To Work Most Effectively With Your Doctor.
    • If the surgeon doesn't have time to answer all your questions when you are together, ask what is the best way to ask your additional questions. The doctor may set another appointment or suggest you send them by e mail or perhaps speak with another doctor or nurse in his or her practice.
    • Choose a surgeon with as much consideration as you give any important decision in your life. For information about how to do that like an educated health care consumer, click here.
    • Before you enter a hospital as an inpatient, read Hospitals to help limit stress, save money, reduce medical error, and maximize your stay and post discharge period.
    • For information about avoiding medical error with respect to surgery, click here.
    • For information about dealing with the stress of waiting for a procedure, click here.

     

     

     


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