Are
you facing surgery? You
are not alone. Millions of Americans
have surgery each year. Most operations
are not emergencies. This means you
have time to ask your surgeon questions
about the operation and time to decide
whether to have it, and if so, when
and where. The information presented
here does not apply to emergency surgery.
Surgeons' Qualifications
- For
More Information
- Surgery
- Second
Opinion
- Anesthesia
- Pain
Control
- General
The most important
questions to ask about elective surgery
are why the procedure is necessary
for you and what alternatives there
are to surgery. If you do not need
to have the operation, then you can
avoid any risks that might result.
All surgeries and alternative treatments
have risks and benefits. They are
only worth doing if the benefits are
greater than the risks.
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.
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Following are
12 questions to ask your primary care
doctor and surgeon before you have
surgery, and the reasons for asking
them. The answers to these questions
will help you be informed and help
you make the best decision. Sources
are listed at the end of these questions
to help you get more information from
other places.
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.
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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.
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2. Why do I need
the operation?
There are many
reasons to have surgery. Some operations
can relieve or prevent pain. Others
can reduce a symptom of a problem
or improve some body function. Some
surgeries are performed to diagnose
a problem. Surgery also can save your
life. Your surgeon will tell you the
purpose of the procedure. Make sure
you understand how the proposed operation
fits in with the diagnosis of your
medical condition.
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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.
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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. There might be a need for a
second operation at a later date.
For other procedures, the benefits
may last a lifetime.
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.
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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. There
is almost always some pain with surgery.
Ask how much there will be and what
the doctors and nurses will do to
reduce the pain. Controlling the pain
will help you be more comfortable
while you heal, get well faster, and
improve the results of your operation.
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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?
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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.
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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.
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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 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, a lot
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.
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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.
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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.
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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.
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Surgeons'
Qualifications
You will want
to know that your surgeon is experienced
and qualified to perform the operation.
Many surgeons have taken special training
and passed exams given by a national
board of surgeons. Ask if your surgeon
is "board certified" in surgery. Some
surgeons also have the letters F.A.C.S.
after their name. This means they
are Fellows of the American College
of Surgeons and have passed another
review by surgeons of their surgical
practices.
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Surgery
The American College
of Surgeons (ACS) has a free series
of pamphlets on "When You Need an
Operation." These documents are available
online at
http://www.facs.org/public_info/operation/wnao.html.
For print copies, write to the ACS,
Office of Public Information, 633
N. Saint Clair St., Chicago IL 60611.
Pamphlets in this series range from
those providing general information
about surgery to those explaining
specific surgical procedures.
Second Opinion
For a free brochure
on "Medicare Coverage for Second Surgical
Opinions: Your Choice Facing Elective
Surgery," write to Health Care Financing
Administration, Publications, NI-26-27,
7500 Security Blvd., Baltimore, Maryland
21244-1850. Ask for Publication No.
HCFA 02173.
To get the name
of a specialist in your area who can
give you a second opinion, ask your
primary doctor or surgeon, the local
medical society, or your health insurance
company. Medicare beneficiaries may
also obtain information from the U.S.
Department of Health and Human Services'
Medicare hotline: call toll-free 800-638-6833.
Anesthesia
Free booklets
on what you should know about anesthesia
are available from the American Society
of Anesthesiologists (ASA) or the
American Association of Nurse Anesthetists
(AANA). For copies, write to ASA at
520 North Northwest Highway, Park
Ridge, IL 60068-2573, or phone (847)
825-5586; or AANA at 222 S. Prospect
Avenue, Park Ridge, IL 60068-4001,
or phone (847) 692-7050.
Pain Control
"Pain Control
After Surgery: A Patient's Guide"
is available free from the Agency
for Health Care Policy and Research
(AHCPR). For a copy of this consumer
version of the AHCPR-supported clinical
practice guideline and for information
on other patient guides, write to
the AHCPR Publications Clearinghouse,
P.O. Box 8547, Silver Spring, MD 20907,
or call toll-free 800-358-9295.
General
For almost every
disease, there is a national or local
association or society that publishes
consumer information. Check your local
telephone directory. There are also
organized groups of patients with
certain illnesses that can often provide
information about a condition, alternative
treatments, and experience with local
doctors and hospitals. Ask your hospital
or doctors if they know of any patient
groups related to your condition.
Also, your local public library has
medical reference materials about
health care treatments.
For further information
you may also wish to see "The Savvy
Patient: How to Be an Active Participant
in Your Medical Care," by David R.
Stutz, M.D., Bernard Feder, Ph.D.,
and the Editors of Consumer Reports
Books, Copyright 1990, published by
Consumers Union of U.S., Inc., Yonkers,
NY, 10703.
Reference
to these materials does not constitute
endorsement by the U.S. Department
of Health and Human Services.
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AHCPR Publication
No. 95-0027
Current as of January 1995
