Your primary care doctor, that is, your regular doctor, may be the one who suggests that you have surgery and may recommend a surgeon. You may want to identify another independent surgeon to get a second opinion. Check to see if your health insurance will pay for the operation and the second opinion. If you are eligible for Medicare, it will pay for a second opinion. You should discuss your insurance questions with your health insurance company or your employee benefits office.
Overview
Following are 12 questions to ask your primary care doctor and surgeon before you have surgery, and the reasons for asking them.
Your doctors should welcome questions. If you do not understand the answers, ask the doctors to explain them clearly. Patients who are well informed about their treatment tend to be more satisfied with the outcome or results of their treatment.
1. What operation are you recommending?
Ask your surgeon to explain the surgical procedure. For example, if something is going to be repaired or removed, find out why it is necessary to do so. Your surgeon can draw a picture or a diagram and explain to you the steps involved in the procedure.
Are there different ways of doing the operation? One way may require more extensive surgery than another. Ask why your surgeon wants to do the operation one way over another.
2. Why do I need the operation?
3. Are there alternatives to surgery?
Sometimes, surgery is not the only answer to a medical problem. Medicines or other nonsurgical treatments, such as a change in diet or special exercises, might help you just as well or more. Ask your surgeon or primary care doctor about the benefits and risks of these other choices. You need to know as much as possible about these benefits and risks to make the best decision.
One alternative may be “watchful waiting,” in which your doctor and you check to see if your problem gets better or worse. If it gets worse, you may need surgery right away. If it gets better, you may be able to postpone surgery, perhaps indefinitely.
4. What are the benefits of having the operation?
Ask your surgeon what you will gain by having the operation. For example, a hip replacement may mean that you can walk again with ease.
Ask how long the benefits are likely to last. For some procedures, it is not unusual for the benefits to last for a short time only.
When finding out about the benefits of the operation, be realistic. Sometimes patients expect too much and are disappointed with the outcome, or results. Ask your doctor if there is any published information about the outcomes of the procedure.
5. What are the risks of having the operation?
All operations carry some risk. This is why you need to weigh the benefits of the operation against the risks of complications or side effects.
Complications can occur around the time of the operation. Complications are unplanned events, such as infection, too much bleeding, reaction to anesthesia, or accidental injury. Some people have an increased risk of complications because of other medical conditions.
In addition, there may be side effects after the operation. For the most part, side effects can be anticipated. For example, your surgeon knows that there will be swelling and some soreness at the site of the operation.
Ask your surgeon about the possible complications and side effects of the operation.
6. What if I don’t have this operation?
Based on what you learn about the benefits and risks of the operation, you might decide not to have it. Ask your surgeon what you will gain—or lose—by not having the operation now. Could you be in more pain? Could your condition get worse? Could the problem go away?
7. Where can I get a second opinion?
Getting a second opinion from another doctor is a very good way to make sure having the operation is the best alternative for you. Many health insurance plans require patients to get a second opinion before they have certain non-emergency operations. If your plan does not require a second opinion, you may still ask to have one. Check with your insurance company to see if it will pay for a second opinion. If you get one, make sure to get your records from the first doctor so that the second one does not have to repeat tests.
8. What has been your experience in doing the operation?
One way to reduce the risks of surgery is to choose a surgeon who has been thoroughly trained to do the procedure and has plenty of experience doing it. You can ask your surgeon about his or her recent record of successes and complications with this procedure. If it is more comfortable for you, you can discuss the topic of surgeons’ qualifications with your regular or primary care doctor.
9. Where will the operation be done?
Most surgeons practice at one or two local hospitals. Find out where your operation will be performed. Have many of the operations you are thinking about having have been done in this hospital? Some operations have higher success rates if they are done in hospitals that do many of those procedures. Ask your doctor about the success rate at this hospital. If the hospital has a low success rate for the operation in question, you should ask to have it at another hospital.
Until recently, most surgery was performed on an inpatient basis and patients stayed in the hospital for one or more days. Today, almost 70% of surgery is done on an outpatient basis in a doctor’s office, a special surgical center, or a day surgery unit of a hospital. Outpatient surgery is less expensive because you do not have to pay for staying in a hospital room.
Ask whether your operation will be done in the hospital or in an outpatient setting. If your doctor recommends inpatient surgery for a procedure that is usually done as outpatient surgery, or just the opposite, recommends outpatient surgery that is usually done as inpatient surgery, ask why. You want to be in the right place for your operation.
10. What kind of anesthesia will I need?
Anesthesia is used so that surgery can be performed without unnecessary pain. Your surgeon can tell you whether the operation calls for local, regional, or general anesthesia, and why this form of anesthesia is recommended for your procedure.
Local anesthesia numbs only a part of your body for a short period of time, for example, a tooth and the surrounding gum. Not all procedures done with local anesthesia are painless.
Regional anesthesia numbs a larger portion of your body, for example, the lower part of your body for a few hours. In most cases, you will be awake with regional anesthesia.
General anesthesia numbs your entire body for the entire time of the surgery. You will be unconscious if you have general anesthesia.
Anesthesia is quite safe for most patients and is usually administered by a specialized physician (anesthesiologist) or nurse anesthetist. Both are highly skilled and have been specially trained to give anesthesia.
If you decide to have an operation, ask to meet with the person who will give you anesthesia. Find out what his or her qualifications are. Ask what the side effects and risks of having anesthesia are in your case. Be sure to tell him or her what medical problems you have including allergies and any medications you have been taking, since they may affect your response to the anesthesia.
11. How long will it take me to recover?
Your surgeon can tell you how you might feel and what you will be able to do or not do the first few days, weeks, or months after surgery. Ask how long you will be in the hospital. Find out what kind of supplies, equipment, and any other help you will need when you go home. Knowing what to expect can help you cope better with recovery.
Ask when you can start regular exercise again and go back to work. You do not want to do anything that will slow down the recovery process. Lifting a 10-pound bag of potatoes may not seem to be “too much” a week after your operation, but it could be. You should follow your surgeon’s advice to make sure you recover fully as soon as possible.
12. How much will the operation cost?
Health insurance coverage for surgery can vary, and there may be some costs you will have to pay. Before you have the operation, call your insurance company to find out how much of these costs it will pay and how much you will have to pay yourself.
Ask what your surgeon’s fee is and what it covers. Surgical fees often also include several visits after the operation. You also will be billed by the hospital for inpatient or outpatient care and by the anesthesiologist and others providing care related to your operation.
Outpatient Surgery
Today many people have the luxury of skipping a dreaded hospital stay thanks to improved technology, less invasive surgical techniques, advances in pain control, and increased pressure to reduce the high cost of hospitalization. This year, well over 60 percent of all patients slated for surgery will have it on an outpatient–or ambulatory–basis. Procedures that can be done on an outpatient basis include: Tonsillectomies, hernia repairs, gallbladder removals, cosmetic surgeries and cataract removals. In outpatient procedures, surgery-related complications occur less than one percent of the time. The most common problems include bleeding (which may require a transfusion), respiratory complications, injury to surrounding tissue, and infection.
Of course, not all procedures can be done on an outpatient basis, and not everyone is a candidate for outpatient surgery. You may only be inviting trouble by insisting on having ambulatory surgery if the surgeon or anesthesiologist is against it. Patients with an underlying health problem, such as diabetes, heart disease or kidney disease, are at higher risk for complications.
Benefits of Outpatient Surgery
Compared with traditional inpatient surgery, there are many advantages to ambulatory surgery. It is perhaps most reassuring to know that it is effective without compromising quality of care or safety. Numerous studies show that both patients and physicians are very pleased with the medical results of outpatient surgery. Some of its benefits include:
- Recovery in the privacy of your home. Surgery that does not disrupt your routine is more comfortable and can ease recovery.
- Lower cost. Since there are no hospital room charges, and all that comes with that room, a typical bill reflects big savings. As a result, many insurance plans cover certain surgical procedures on an outpatient basis only–unless your physician certifies that you require greater supervision, for example, because a medical condition makes surgery more risky for you.
- Less stressful than an inpatient stay. This is especially true for children, who are often afraid of being away from home or of spending the night alone. Also, given today’s busy schedules, many people find it difficult to take a few days off. And, of course, some people just don’t like hospitals.
- Fixed schedule. A number of factors, including emergency operations and procedures that take longer than expected can cause delays in a hospital’s operating room schedule. Outpatient centers, however, can adhere more closely to their schedules since procedures are simpler and more routine, and no emergency operations are performed at these centers.
Where to Have Your Surgery
Although you may not always be able to choose where you have your surgery, know that there are three different types of places where outpatient surgery is routinely performed:
- Hospital outpatient centers. Hospital owned and operated facilities that specialize in outpatient surgery are usually located on hospital grounds.
- Freestanding surgery centers. Traditionally owned by a group of physicians or a for-profit national company, these centers often specialize in a particular type of surgery, for example, cataract removal.
- Physicians’ offices. Physicians can sometimes perform minor procedures in their offices. For example, dermatologists often do skin biopsies and remove moles or beauty marks in their examination rooms and general physicians can operate benign cysts in their offices.
To find the outpatient center in your area that best suits your needs, seek referrals from trusted doctors and friends. In addition, ask these general questions about any facility:
- Is the center licensed or certified as a medical facility by your state?
- Should anesthesia or sedation be required, is a trained and board certified anesthesiology specialist available to administer it?
- Does the center have emergency provisions, like emergency cardiac equipment, bottled oxygen and a staff trained in cardiopulmonary resuscitation (CPR), in the event of surgical complications?
- Does the center have a transfer agreement with a hospital to take care of any emergencies that may occur during surgery?
- Has the doctor been trained to do the specific type of surgery that you require? How many similar procedures has the doctor done?
- Is information on the procedure and its risks readily available?
- Is precise information on fees available before the operation?
Are both the doctor and the facility’s staff forthcoming with answers to these and all of your questions?
Choosing a Surgeon That’s Right for You
No matter what type of surgery you’re considering, the most important thing is choosing the right surgeon.
Make a List
First, gather a list of names. You can develop your list from any of the following sources:
- Friends and family—If you know someone who’s had the same procedure you’re considering, talk to him or her about it.
- Doctors—Your primary physician may be able to recommend a good surgeon.
- Nurses—If you know an operating room nurse, you can probably get a well-informed opinion on surgeons with whom he or she has worked.
- Hospitals—Call a respected hospital in your community and ask for a list of its board-certified surgeons who perform the procedures.
Check Credentials
Once you’ve compiled your list, you need to check their credentials. While good credentials can’t guarantee a successful outcome, they can significantly increase the odds.
Training—Ask the candidates on your list about their training. Did he or she complete an accredited residency program specifically in transplant surgery?
Hospital Privileges—The surgeon you choose should have privileges to perform that procedure at an accredited hospital in your community. Call the hospital to make sure.
Experience—You should feel comfortable that the surgeon you select is well versed and up-to-date in the procedure you’re considering. Ask the doctors on your list if they perform the procedure frequently and when they last did one.
The Interview
After narrowing your list down to two or three surgeons, you may want to visit them for an initial consultation to compare their opinions, fees and the way they answer your questions and explain the risks involved. The doctor should:
- answer all of your questions thoroughly, in terms you can understand;
- ask about your motivation and expectations for surgery;
- offer alternatives, where appropriate, without pressuring you to consider unnecessary procedures;
- welcome questions about professional qualifications, experience, costs and payment policies; and
make clear not only the risks of surgery but also the possible variations in outcome.
Preoperative Visit with the Surgeon
For elective or required surgeries, it is valuable to prepare yourself before meeting with your surgeon.
- copies of any x-rays, CT scans, or MRI scans already performed
- results of lab tests
- complete medical history
- list of all medications, including prescription and over-the-counter, you are taking (or have recently taken)
- list of all your allergies (especially latex allergy)
What you can expect during the preoperative visit:
- Is there any alternative to having surgery?
- What are the expected results?
- What are the possible risks and complications?
- How long will the surgery take?
- What type of anesthesia is required for this surgery?
- How long I have to stay in the hospital?
- Will I have any pain and what kind of medicine will I receive for it?
- Will my I require a blood transfusion?
- What will the incision look like and will I need to change dressings? Will there be scarring?
- Will I require antibiotics, or other medications, after surgery?
- What postoperative care will be required?
- When can I resume normal activities?
After your questions have been answered, your surgery can be scheduled (considering the urgency of the surgery, your condition, and the surgeon’s availability).
If additional questions should arise before your scheduled surgery, call your surgeon. Your confidence in knowing what will happen before, during, and after surgery will help you in preparing.
When will I be discharged?
If you are having minor surgery, you may be discharged home a few hours after the procedure. Your healthcare team will make sure that you are fully awake, that vital signs (i.e., heart rate, breathing rate, temperature, and blood pressure) are normal, and that you can take some liquids by mouth without becoming nauseated.
Even after minor surgery, some patients will remain in the hospital overnight for observation, and to receive medications to help with pain or to prevent infection. In the morning, your surgeon will examine you to determine if you may be discharged.
If you are discharged within 24 hours after surgery, you may notice.
- you may sleep more than usual for the first day or two at home.
- you may have some nausea and vomiting.
- you may be a little unsteady when walking.
These problems are usually related to anesthesia, and should improve after 24 to 48 hours at home. If symptoms persist, consult you physician right away.
After major surgery, you will need to stay in the hospital more than 24 hours. Some patients may even be in the ICU for one or more nights. From the ICU, you will be transferred to a regular hospital unit. Your surgeon should be able to give you an estimate of the number of days you will be in the hospital when you first discuss surgery in the preoperative visit.
After your surgeon has determined that you may be discharged, a registered nurse will need to discuss home care with you as well as provide you with written instructions. Before discharge, make sure you understand:
- any treatments you need to provide at home, such as changing dressings on a wound or doing deep breathing exercises.
- medications you may need, such as antibiotics or pain medications.
- any activity restrictions you may have, and for how long they must be observed.
- when you may have a bath or shower.
- when you may resume certain activities or work.
- signs and symptoms of possible complications from your particular kind of surgery, and who to report them to.
- when to return for a follow-up appointment.
If you will need to take medications at home, a prescription will be provided for you to fill at the local pharmacy of your choice.
Errors in Surgery and Other Medical Procedures
The best way to protect yourself against errors during any major medical procedure is to do your homework in advance. You should have a complete understanding of what’s going to be done, why it’s being recommended, and how qualified the doctor is. For example, you should:
- Get a second opinion. It is always a good idea to get a second opinion when a health care professional recommends surgery or another major medical procedure. A second expert can help you evaluate the quality of this advice.
- Make sure you are seeing a specialist at a hospital with lots of experience in the recommended procedure. Don’t hesitate to ask the doctor how many times he performs the surgery in an average month, and how many the hospital does. Ask him if he has received any special training or certification relevant to the procedure you need.
- Expect to go through an “informed consent” process in advance. Before the procedure, your health care professional should discuss with you the risks and benefits of the procedure as well as what may happen if you do not have the procedure. Your health care professional should also provide you with a written document that summarizes this. Before you agree, you should have the opportunity to ask questions about anything that you do not understand.
- Ask what to expect after the procedure and how soon you can return to normal activities.
- On the day of the procedure, confirm what is going to be done. Ask for a verbal confirmation of what the procedure involves and confirm the site. The
Professional Surgery-related Associations
Health associations are some of the best resources. The list of sites below includes those sponsored by the top groups.
American
American Association of Critical Care Nurses http://www.aacn.org
American Association of Neurological Surgeons http://www.neurosurgery.org
American Association of Nurse Anesthetists http://www.aana.com
American Cancer Society http://www.cancer.org
American Society of Anesthesiologists http://asahq.org
American Society for Bariatric Surgery http://www.asbs.org
American Society of Colon and Rectal Surgeons http://www.fascrs.org
American Society of PeriAnesthesia Nurses http://www.aspan.org
American Society of Plastic Surgeons http://www.plasticsurgery.org
American Society of Transplant Surgeons http://www.asts.org
AORN, Association of periOperative Registered Nurses http://www.aorn.org
National Association of Theatre Nurses http://www.natn.org
Society of American Gastrointestinal Endoscopic Surgeon http://www.sages.org
Society of Laparoendoscopic Surgeons http://www.sls.org
Society of Surgical Oncology, Inc http://www.surgonc.org
Society of Thoracic Surgeons http://www.ctsnet.org