The Patient Navigator is a column that answers reader questions on how to navigate our health-care system. Send your questions to firstname.lastname@example.org
The question: I'm terrified at the thought of surgery. What questions should I ask a surgeon before agreeing to an operation?
The answer: No one can provide better insider information than a surgeon. So I asked Chris Jamieson, professor of surgery at Dalhousie University, what questions he would ask if he was about to go under the knife.
At that first consultation, a patient needs to determine whether an operation is required. A diagnosis of breast or bowel cancer means surgery is warranted. But with prostate cancer, diverticulitis or the presence of a gallstone, that may not necessarily be the case, advises Dr. Jamieson, past president of the Canadian Association of General Surgeons.
Once it's been established that an operation is needed, ask how frequently the physician has done the surgery, he said.
Studies have shown the number of times a surgeon has done a given operation is an important indicator of skill. Think of airplane pilots: More flying time translates into more proficient skills. Would a passenger feel safe in a jet with a pilot who had only flown a few times?
"I've been in practice as a surgeon for 33 years and I still get asked if I've done this operation before. I give them an honest answer," said Dr. Jamieson, a general surgeon who specializes in colorectal surgery. If the surgeon refuses to answer that question, he said that's "not appropriate."
Next, patients will want to know how good that surgeon is at the operation.
For coronary-artery bypass surgery or joint replacements that information may be readily accessible because complication rates are often tracked in those frequently done operations. With many other operations, however, surgeons may simply not know their own rates as they don't keep a database of complications for the many different operations they perform, said Dr. Jamieson.
If surgeon-specific figures are unavailable, patients can ask the hospital if they have rates for the entire institution. Ontario, for example, publishes hospital-standardized mortality ratios by hospital name in an online report card at http://www.myhospitalcare.ca/Pages/homepage.aspx. It compares actual hospital deaths to the number that would have been expected based on the types of patients it treats. The website also posts infection rates.
"Another question to consider is when the surgery might take place and whether a delay might be harmful," said Dr. Jamieson. "I suggest the patient ask the surgeon if the timing of the surgery is a concern and if the surgeon does feel that a delay could be detrimental."
If that's the case, patients may be able to go to another hospital with shorter waits.
"Except for high-risk procedures," said Dr. Jamieson, "most patients can expect safe surgery by experienced hands in their local hospital."
A patient's focus should not solely be on the surgeon. Some complications can be reduced by patients themselves. Quitting smoking six weeks before an operation helps. Smokers don't heal as well, have more infections and are more prone to pneumonia than non-smokers. Obese patients should lose weight, especially before a hernia operation, suggests Dr. Jamieson.
Here's the bottom line: Ask the surgeon what the significant risks are of an operation and how many times the physician has done that surgery. If you can't find out the complication and death rates for a given procedure by surgeon, see if you can obtain it by hospital. And if surgery seems a looming date far off into the future, ask if it's safe to wait. If it isn't, shop around for a hospital or surgeon with a shorter queue.
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