There’s not much that is scarier or more confusing than having your doctor tell you need surgery. You might have gone to see the doctor because you were having some pain in your belly. He ordered a test called an ultra sound of the abdomen. You went to the radiology department and a technician rubbed a wand like instrument over your mid section which revealed that you have stones in your gall bladder.
Is this an emergency? It could develop into one over the course of time. Gall stones can cause horrible pain, necessitating a trip to the emergency room. They can block ducts that carry important enzymes to your digestive system. But gall stones may also be treated homeopathically in some cases, which you won’t hear from your surgeon. A surgeon may tell you that it would easier to operate on your gall bladder before it becomes infected, inflamed, or even gangrenous. He may tell you that done laparscopically; gall bladder surgery is as safe as surgery can be. But there are risks involved, which we will talk about later.
So what does all this mean? First of all, what brought you to the doctor in the first place? Secondly, is the first time you have complained of the problem? Or is it ongoing? How is this problem affecting your life? Before we talk too much about making the decision to have surgery, let’s discuss some of the important questions you should ask before signing the consent.
The first thing you should know than is….
Is it absolutely necessary that I have this surgery? Will I lose my life or limb if I don’t have it? Will the quality of my life deteriorate if I don’t have it?
As in the gall bladder discussion, there are variables that come into play when making the decision to consent to surgery. First of all, what can go wrong if I decide to go to the operating room?
Again, using Laparoscopic gall bladder surgery as our example, it is a commonly performed operation. In the hands of an unskilled laparscopist, lot’s can go wrong. But problems are encountered by even the most skilled of surgeons.
Unusual anatomy of the patient is a condition which is usually not detectable until the patient is on the table, under anesthesia. We are similar inside as human beings, but there are variations. The most crucial procedure in the operation is the clipping and cutting of the cystic duct and cystic artery. These structures carry blood and bile to the gall bladder. Easy, right? Just two little structures. But the truth is, if the cystic duct is cut too far away from the gall bladder, into the common duct, a very unpleasant, life threatening situation can occur which will require additional extensive surgery. What can go wrong if I decide NOT to have the surgery? Not having an infected gall bladder removed can lead to peritonitis, even death if left untreated. But a healthy gall bladder should be left in place.
Are the risks involved for the surgery you are contemplating having worth risking your life for? The risks involved should be spelled out in the consent form you are asked to sign.
Let’s look at this from the perspective of joint replacement. Here is another elective surgery, one fraught with risks, huge expense and long rehabilitation. Why would anyone subject themselves to the risks of infection? Now we are talking quality of life. Not being able to walk without intense pain would be an acceptable reason to have this surgery. So joint replacement can improve quality of life, allowing a return to work and living. Worth the risk? Probably.
You should also always ask for second opinion from a surgeon in a practice not associated with your surgeon’s.
You have had a heart attack and now find you must have bypass surgery. You aren’t a candidate for the angioplasty procedure that is done so frequently now, although you did ask about that! This may not be an elective surgery.
How can improve your chances of having a good outcome? Can you reduce the chances of problems like common duct damage and joint replacement infection? You absolutely can.
The second thing you should know is….
How many times has my surgeon performed this surgery? How often is this surgery performed at the hospital I am going to? Is the nursing staff familiar with the techniques? Do they have all the equipment needed?
Your surgeon is a highly trained, well educated, hard working person. He or she sacrificed years of life and tons of money to get to this point of being able to diagnose and treat you. But he is not God. He should be willing to listen to you and answer your questions, one of which should be ‘How many times have you done this surgery?”
Everyone has to have a ‘first time’. Even surgeons have to do a surgery for the ‘first time’ An experienced surgeon who wants to learn a new technique will usually train under the watchful eye of a surgeon who is well versed in the technique.
Hospital operating rooms have huge capital budgets for equipment that rapidly age and require replacement, upgrading and inventory maintenance. How can you be sure that the hospital you go to has the required equipment, instrumentation and supplies?
Total joint replacement requires hundreds of specialized sizers, instruments, positioning equipment and implants. Each patient needs different size implants. Usually, a hospital doesn’t need to stock everything needed for a surgery. The company providing the implants sends trays of instruments that are processed by the sterilization facility at the hospital, along with hundreds of different sizes of implants. A knee replacement surgery, for instance, requires four different components. Each component may come in ten or more different sizes. All of these parts must be in place before the surgery can take place. If the staff is inexperienced, absent or incorrect instrumentation and implants can go unnoticed and even the most experienced surgeon cannot do successful surgery under these circumstances. In many cases, representatives from the implant companies attend the surgeries and are there as a resource to the surgeon and nursing staff.
Vascular implants are a concern because most hospitals must stock a huge supply of sizes, even the unusual, rare size, just in case. Vascular surgery can be necessary in an emergent situation, so implants and instrumentation sterile and in stock is crucial.
These are just a few of the possibilities which can occur. Knowing in advance what level of expertise your local hospital is functioning at can save a lot of frustration, and perhaps your life.