What to ask your surgeon?

It is normal to be afraid of surgery. If given a choice, all of us would stay away from surgery. Our reasons for avoiding surgery are obvious. Surgeries come with a baggage of complications. Rarely a complication is severe enough to offset any potential benefit promised by the surgery. The complication itself becomes a bigger problem than the original illness. A complication can happen with the best surgeon having the purest intentions. Therefore it is wise to be scared of surgery. 

Yet we often find ourselves facing surgery. The truth is many problems cannot be solved effectively unless tackled by surgery. Surgery today is far more successful due to improved knowledge, experience and technology. Many patients have undergone surgery and have benefitted tremendously. So if a patient is offered surgery, how should he/she approach the situation?

The first question to be answered is 'Is my problem bad enough?' This is an obvious question and most patients address it correctly. Doing a major surgery for minor issues is a strict 'NO'. Often the alternative non surgical treatments are equally effective. Even though this is a simple decision to make, sometimes patients get carried away by social and economic pressures. I find patients asking for surgery just because they have seen a friend benefit from it or they have the money to buy it! Surgeries are of 2 types: the 'life saving' surgery and the 'quality of life' surgery. With life saving surgeries, the decision is easy. The problem is with 'quality of life' surgeries. For example: a decision to do angioplasty (heart) surgery is easy as it is life saving but a decision to do knee replacement is difficult as it is done to improve quality of life. 

The second question is 'what is the risk-benefit analysis?' Is the benefit promised by the surgery more than the risk of something going wrong or a complication happening. The best surgeries are the ones that offer good results with little risk. For e.g. Knee Replacement completely solves the patients problem (huge benefits) and has a low complication rate. At the other end of the spectrum are surgeries that are new, experimental and unproven. Beware of these as failure rates are high and complications are more.  In between are the surgeries that have proven good results but with a high complication rate. In this situation, I encourage patients to understand the risks completely by a detailed dialogue with the surgeon. 

The next question is 'How good is the surgeon?' This is a difficult question for the patient to answer. As a general rule a specialist will be better. Patients gauge a surgeons skill by his success. Though patients don't have a better way, this method of finding a good surgeon is flawed. Success or fame is multi factorial and a 'famous' surgeon may not necessarily be the most skilled. One effective way is to speak to patients already operated by the surgeon. They often give lots of insight and improve your confidence. 

The last question is 'Have I done my research?' We do a lot of research when we have to buy a new car or a new house. Similarly I encourage patients to do research when they are facing a surgery. Today is the age of information technology and all is available on the Internet. Details of the illness, the success rate of the surgery, the potential complications, the experience of other patients etc need to be researched by patients looking at a surgical option. The procedure should be discussed in detail with your surgeon. I see patients asking questions like 'Is there any guarantee for this surgery?' The answer is obvious and the surgeons who say 'YES' are lying. While this is not a sensible question to ask, there is a list of questions that every patient must ask his/her surgeon. 'What is the percentage of success of the surgery?', 'What are the complications?', 'What are the chances of something going wrong?', 'If a complication occurs, what is its treatment?', 'What is the recovery time?', 'How long will the surgical pain last?' are some of those questions.  

To conclude, everyone would like to avoid surgery but sometimes we cannot. If facing surgery, we should arm ourselves with knowledge beforehand so that we can take intelligent decisions and avoid facing nasty surprises later.