PREPARATION FOR SURGERY-THE PATIENT'S PERSPECTIVE
Many millions of Americans undergo surgery on an annual basis. The procedures range from the simple, such as removal of an ingrown toenail to major, complex operations involving the brain, the internal organs or the musculoskeletal system. The vast majority of procedures result in successful, uncomplicated outcomes.
Essentially all surgeries involve some type of anesthetic, either local for smaller procedures (such as Novocain, used in the filling of dental cavities) to general sedation used for longer, more invasive procedures. General sedation typically mandates administration by a physician known as an "anesthetist" or a well trained "Certified nurse anesthetist." Surgeries may take place in hospital settings or may be handled at ambulatory care centers. Some surgeries may require hospital admission while others may be done on an out-patient basis.
It is safe to say that any surgical procedure may cause patients some degree of apprehension. Proper preparation by the patient can go a long way to enhancing the prospects for a satisfactory and successful outcome. The patient should prepare both mentally and physically.
Pre-Operative Preparation
Most surgeries are called "elective." This means that they are not done on an emergency basis but are done as the schedules of the patient, physician and care center may allow. This provides the patient time to consider the procedure.
- When you meet with your surgeon to discuss the procedure have him or her explain the procedure. Often they may have literature that explains what will be done as well as recovery times.
- Ask about the surgeon's experience with the specific procedure at issue. The more familiar he may be, the greater degree of comfort they should have as well as an ability, built on prior experience, to deal with complications that may arise. Ask frankly about their rates of complication, have them describe what these may be as well as their rates of successful outcomes.
- Many surgeries are quite specialized. Ask your surgeon about special training he may have received. Also ask about "board certification." Board certification is a process, often involving written and oral examination administered by other physicians which tests the doctor's knowledge base.
- With respect to post-operative complications, make sure you are aware of their signs and symptoms. These may arise after you are discharged from the hospital and their detection may rely on your knowledge and vigilance.
- Ask about alternative, more conservative therapies and the pros and cons of trying those.
- Ask about recovery times and limitations on physical activity which may be imposed. This will allow you to plan accordingly with respect to child care, work and any assistance you may require in your activities of daily life.
- In planning your day of surgery consider making it earlier in the week as opposed to Thursday or Friday as the availability of help in the event of complication may be more limited over the weekend.
- Make sure the surgeon is aware of all regular medications you take so that they may judge whether any need be altered in advance of surgery.
- Similarly, be candid with any other chronic or acute diseases or health issues from which you may be suffering.
- Ask whether medical clearance should be obtained prior to proceeding with surgery. This will often require a visit to another physician who may order heart, lung and blood studies to ensure your body's overall health status. Surgery is a trauma and one wants to ensure you are fit enough to withstand this trauma.
- Do not be shy asking about what type and degree of pain or discomfort may be experienced in the post-operative period. Ensure there is a pain control plan in place. This may call for with over-the-counter pain medications or prescription medications.
- Ask whether the doctor anticipates the need for blood products during or following the procedure. If so, consider providing your own blood prior to the procedure so it is ready should the need arise. Though sources today tell us our blood supply is reasonably safe, knowing if the need arises your own blood will be used may alleviate some anxiety.
- If you smoke, stop. Smoking significantly inhibits the healing process.
- Get plenty of rest and eat a healthful, reasonable diet. A strong, well-rested body heals more quickly.
- If you will experience significant physical limitations during your convalescence consider re-arranging furnishings and appliances. If you live in a multi-story home, you may consider arranging to sleep on the ground floor until you are capable of negotiating stairs.
- Check with your doctor and insurer to know exactly what insurance will cover versus what is your financial responsibility. No one needs the shock of a large, unexpected bill weeks after the surgery.
- If you are not comfortable after this discussion, seek a second opinion.
The Day of Surgery
The days of overnight admission prior to the day of surgery has largely passed. Typically, you will be asked to come to the hospital the day of surgery. Limit what you take to the hospital or care center. Do not take valuables or large amounts of cash. These should not be necessary and may be a source of anxiety when you are separated from them during the procedure. Pay attention to the instructions you have been given. For general sedation you will be told not to eat or drink for a period of time prior to coming to the hospital. Follow these instructions. If you fail to do as instructed, candidly tell the health care providers as serious complications could otherwise arise. Arrive promptly at the time instructed and ensure you have arranged transport home as you may not be capable of driving. Also consider that the person accompanying you may need to receive instructions from the doctors which you may be too groggy to understand. Select a responsible person for this task.
Either the day of surgery (or ideally prior to that day) you will be asked to sign a "consent" form. These forms are typically pre-printed and in a general fashion recite the complications you acknowledge may arise without any fault on the part of the care providers. Take your time reviewing this document and raise any questions you may have. Again, it is your health at issue and you should not feel rushed or pressured. Make sure you fully understand the risks prior to signing this document. If any new health concerns have arisen since your last visit, tell the doctor or nurse.
Post-Op
Upon discharge you will receive instructions. Follow these instructions. There may be instructions for keeping the surgical wound clean. Ask whether you should use any special antimicrobial soaps. These can go a long way to preventing or minimizing the chances of post-operative infection. Be mindful of the symptoms of post-surgical complication and report them immediately should they arise. For example, pain out of proportion to what you are told to expect can be a sign of problems. Early treatment of complications can minimize their impact on your recovery. Keep your post-operative appointments. It is only through proper follow-up that the healing process can be properly monitored.
Legally Speaking
Sometimes things go wrong. If you are concerned, ask your doctor. If unsatisfied do not be afraid to seek a legal opinion from a qualified attorney. There are time limits for the filing of legal actions. If you fail to bring the case within the time required by law, your legal remedy may be forever lost, regardless of whether the health care provider was negligent. A proper investigation may require a significant period of time. If you feel something has gone wrong and you or a loved one has suffered a devastating injury following surgery, contact an attorney. These consults are typically done with no hourly fee charged by counsel.
Conclusion
The suggestions above are not intended to be exhaustive. Rather, we merely have tried to cover some basic techniques for preparation that may nevertheless enhance your prospects for a good outcome and good health care experience.
