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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.
Overview
- What operation are you recommending?
- Why do I need the operation?
- Are there alternatives to surgery?
- What are the benefits of having the
operation?
- What are the risks of having the operation?
- What if I don't have this operation?
- Where can I get a second opinion?
- What has been your experience in doing
the operation?
- Where will the operation be done?
- What kind of anesthesia will I need?
- How long will it take me to recover?
- How much will the operation cost?
Surgeons' Qualifications
For More Information
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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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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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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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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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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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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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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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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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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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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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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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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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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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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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.
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.
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 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.
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
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