Entering a hospital is usually never a good sign for anyone, including some doctors. That’s why a few hospitals have a clever tag, “we hope you never need us”. Getting medically treated for an illness is one thing, with the number of patients we see every day with phobia of needles alone, surgery on the other hand is something that puts the patient at immediate risk and instantly measures the level of trust you have in your Doctor.
The Patients Perspective
Every Patient I have operated on has this one question, “Is Surgery absolutely necessary, don’t you have a medicinal cure?”
The way I usually answer that is, “If there was one I would have offered it to you.” And in such scenarios a second opinion is warranted based on how experienced your Surgeon is.
Another common question is, “Why so many tests?”
There is a battery of tests that Surgeons do before the Patient lands up in the OR, some in the interest of the Patient and some in the interest of the Doctor or the Hospital. Some of the commonly done tests are:
|INVESTIGATION||USE TO THE PATIENT/HOSPITAL|
|COMPLETE BLOOD PICTURE||ANAEMIA, TO RESERVE BLOOD IN THE EVENT OF BLOOD LOSS RELATED TO SURGERY FOR TRANSFUSION DURING SURGERY OR IN THE POST OPERATIVE PERIOD, ANY ACTIVE SYSTEMIC INFECTION|
|RANDOM BLOOD SUGAR||SCREENING FOR DIABETES=INCREASED RISK OF INFECTIONS POST OPERATIVELY|
|RENAL FUNCTION TESTS = BLOOD UREA AND SERUM CREATININE||TO MAKE SURE THAT THE DRUGS GIVEN DURING SURGERY WILL NOT BE TOXIC TO THE KIDNEYS AND THAT THEY WILL LEAVE THE SYSTEM NORMALLY|
|CHEST RADIOGRAPH||IN THE EVENT OF GENERAL ANAESTHESIA THAT MAY HAVE TO BE CONSIDERED , THE LUNGS AND HEART CONDITION DETERMINE THE EFFICACY OF ANAESTHESIA AND THE ABILITY OF THE PATIENT TO SUSTAIN THE ANAESTHESIA|
|ECG ( ELECTROCARDIOGRAPH)||AN ELECTRONIC RECORDING IN A GRAPHICAL FORMAT TO MAKE SURE YOUR HEART IS FUNCTIONING NORMALLY, A SCREENING TOOL FOR FURTHER CARDIAC EVALUATION IF NEEDED|
|BLEEDING AND CLOTTING TIME||TO MAKE SURE THE PATIENT WILL NOT BLEED TO DEATH ON THE TABLE AND THAT THE BLEEDING WILL EVENTUALLY STOP|
|HIV AND HEPATITIS B||TRANSMITTED VIA ALL KINDS OF BODY FLUIDS, THE RISK FOR HEPATITIS B IS HIGHER THAN HIV. DONE TO MAKE SURE EXTRA PROTECTION AND CARE IS TAKEN IN POSITIVE PATIENTS AND SHARPS USED IN SUCH CASES DISPOSED OFF PROPERLY|
In the event of an abnormality, further testing may be required and other doctors in the field of their expertise may be consulted for fitness for surgery.
What is the risk involved?
Every drug you take, every needle prick and every Surgery has a percentage of risk. There is a risk even when you cross the road, that doesn’t mean you won’t cross it if you have to. Some conditions just cannot be repaired or treated without Surgery.
Medical conditions that absolutely require Surgery can be stalled and maintained with several methods to prevent complications. In other words, in conditions that require Surgery, the Surgery can only be delayed unto such time that a complication related to the illness.
In certain cases, where Surgery was warranted before, Patients who have stalled the procedure may end up becoming inoperable. So it goes without saying that risk is a part of any Surgery and these can be related to the Drugs used, or Patients pre existing health condition including complications and the Surgery itself. All of which have to be explained to the Patient prior to any procedure and a written, informed and verified consent taken.
How long will I take to recover?
This totally depends on the type of Surgery, the organs involved and the setup in which the Surgery is performed. Certain procedures that used to require 3-4 days of hospital stay are now being done in day care Surgery with a hospital stay of less than 24 hours.
How much information is relevant to my condition?
Any information whether indirect (Patient informing the doctor) or direct (direct questions pertaining to the illness asked by the doctor), may be relevant to the disease condition. So nothing is too trivial and nothing should be considered too personal to be revealed to the treating doctor as that one thing might alter the outcome of your procedure. And Patient confidentiality exists to the extent that only he/she can decide till what extent the condition of his/her illness can be revealed to their relatives/beneficiaries but that is invalid if the Patient has a communicable/sexually transmitted disease.
The Surgeon’s Perspective
One of my mentors once told me that “You should never become a victim of your knowledge”, in addition to this he also said that the best Surgeon is one who knows when NOT to operate. That kind of perspective comes with experience.
Surgery and its finesse come with experience, when in doubt the patient must always try to consult an experienced doctor for a second opinion to decide on going under the knife.
Like every other science even Surgery is evolving and there are better surgical options with minimal hospital stay involved such as Laparoscopy, with the younger Surgeons more experienced in recent trends in surgical management, it’s always a better option to choose what kind of surgical approach is best in the Patients’ interest.
Since there are varied options for treating a particular condition there may be a difference in opinion as some surgeons would advocate a particular technique they are proficient in, whereas, another surgeon wouldn’t advise surgery only. It all depends on personal comfort and practices of the Surgeon.
In every profession there are unscrupulous agents, so also in the field of medicine there are doctors who would advise surgery where it is not required. It is left to the patients discretion as to how such agents should be dealt with, but the mindset of the patient has to change to acceptance once he/she has consented in the right frame of mind to undergo a surgical procedure, as consent is the single most important document that the Patient signs voluntarily for any kind of procedure.
Eventually if there is a surgical cure to a particular condition, a non invasive and medical approach to treating the condition would only delay the natural course of disease but not prevent the Patient from going under the knife if the delay hasn’t resulted in inoperability.