Surgery: To Cut or Not To Cut Is the Question

Excerpted from
Special Treatment : Ten Ways to Get the Same Special Health Care Your Doctor Gets
By Kevin J. Soden, M.D., M.P.H., Kevin J. Soden, M.D., M.P.H.

If you question a surgeon, he or she will always tell you that no operation, no matter how simple, is always the same. Things can and do go wrong in something as simple as an appendectomy. No surgery is without risk, despite the best intentions of everyone involved. Surgeons have operated on the wrong leg of patients. Wrong medications have been given during surgery or after surgery. Surgeons have performed an operation they didn't have the skills to do. It's disturbing and alarming to hear these things, but it's a fact of life.

In this chapter, we'll teach you some of the key questions to ask if one of your doctors recommends surgery. Don't think that it can't happen to you. Thirty-five million Americans undergo operations every year. But a good many of them may not be necessary. We'll help you explore some of the things you can do to protect yourself or a family member and improve your odds for success if you're ever told that surgery is needed.

Let's first look at a hypothetical situation:

You've had low back pain for weeks and it seems to be getting worse. You see your family doctor who refers you to an orthopedic surgeon for further evaluation. After a brief exam by the surgeon, you're told that you need surgery. Despite the many questions you have going through your mind, you decide that he or she wouldn't have recommended surgery if it hadn't been in your best interest. So, you immediately schedule surgery for the very near future.

Change the type of surgery and the specialty of the surgeon and you have a typical scene that's repeated in doctors' offices all across the country every day. So, what's wrong with this picture? In many cases, there may be nothing wrong with it. But patients do need to be less passively trusting, and need to know that they often may have other options. If a doctor or his or her family member were the patient in the above scenario, we doubt that it would have gone exactly the same way.

What would a doctor do? Let us assure you that prior to any surgery, a doctor would have immediately asked a great many questions. In this chapter, we'll teach you what the most important questions are. In the example above, we would hope you'd ask some of the following:

• Is an orthopedic surgeon the best choice, or is a neurosurgeon the better choice?

• Are there other alternatives that should be used prior to referral to a surgeon, i.e. medicines or physical therapy?

• Should more definitive testing be done prior to the referral to better define the problem?

• What can I expect from surgery and what questions should I be sure to ask my surgeon?

• Are you referring me to the doctor you would use?

These are just a few of the questions your doctor would know to ask . . . and that you should be asking before scheduling any surgery.

What Doctors Know About
Surgery ... And You Should Too

1. Surgery is not without risks, no matter how minor it is. Ask about the risks and look for alternatives when you can.

2. Not all surgeons are created equal. Be very careful about the surgeon you pick.

3. A general surgeon is not the best surgeon for most high-risk procedures.

4. Be just as cautious when choosing the hospital you go to and your anesthesia team.

5. There are things you can do to reduce the risk of problems before and after surgery.

6. Once the actual surgery is complete, the real healing begins. Rehabilitative care or physical therapy should often be an essential part of that surgical aftercare.

In this chapter, we'll examine these points and many more. We know that when you ask your doctors the questions that we suggest, surgery may be avoided in many cases . . . and may never be needed. Most surgeries are elective. That means you have to decide if surgery is, in fact, the best option for you. Let's look at some of the key questions to ask prior to any surgery to keep you from making some potentially bad mistakes and reduce your risk of serious medical problems.

Are There Any Options Other Than Surgery?

Surgery is not without serious risks, no matter how common the procedure or how good the surgeon. Death is a very real possibility for high-risk surgeries like cardiac bypass surgery and abdominal aortic aneurysms, but is also a possibility even in simple surgeries like an appendectomy-albeit a remote one. Other problems that can occur with surgery are infections, lung problems, paralysis, and wound breakdowns, not to mention those associated with anesthesia.

As you've learned in the chapter about hospitals, just being in a hospital exposes a person to all sorts of potential risks like medication errors and hospital-acquired infections. As we've said, despite the best intentions of everyone involved in a surgical procedure, things can and do go wrong. The best doctors know that surgery should be a last option and utilized only after all other options have been exhausted. In some instances (and obviously in emergency situations), immediate surgery is both appropriate and necessary, but in the United States, most are elective. They don't have to be done right away but can be scheduled sometime in the future. This provides sufficient time for you to do your homework and to consider your alternatives.

Let's take as an example a very common surgery performed on many Baby Boomers as they age-hip replacement. This surgery is done all the time by many excellent surgeons. The success rates are exceptional, but the procedure is not without risk. Dick Schapp, the well-known sportscaster, died in 2001 of complications following what he thought was going to be routine hip replacement. He certainly knew of many other famous sports figures who had had similar surgeries with great success and few problems. He certainly didn't go into surgery thinking that anything would go wrong.

With every surgery you undergo, you are taking the chance that something can go wrong. Orthopedic surgeons who do frequent replacement procedures know this, and the good ones try to persuade their patients to wait as long as possible before undergoing surgery. Only when a patient has exhausted all other options, and can't take the pain any longer, do the best surgeons recommend surgery. Doctors know the same thing. We recommend strongly that you resort to surgery only as a last option.