QUESTION: I am going to have an operation and I must admit I am nervous that something might go wrong. A friend said I should ask the doctor how often he has done the surgery. Practice makes perfect, I suppose. But is it that a valid question to ask?
ANSWER: As a patient, you are entitled to a full discussion with your surgeon about the potential benefits -- and risks -- of an operation before you give consent to the treatment.
"Patients certainly shouldn't feel intimidated or concerned about asking questions. It is ultimately their health that is at stake," says Sally Bean, a Policy Advisor and Ethicist at Sunnybrook Health Sciences Centre.
"In my experience, most surgeons are quite happy to discuss those types of things with you."
So, to answer your question, it is okay to ask a doctor how often he or she has performed the procedure. Studies suggest that a surgeon's success rate tends to improve with more experience.
EXPERIENCE COUNTS
It's worthwhile having some context for the answer you will be given, says Dr. Donald Redelmeier, a Sunnybrook physician and Professor of Medicine at the University of Toronto.
"Less than 10 in the past year is infrequent. More than 50 is a reasonable volume," he explains.
Of course, those numbers would apply to fairly common procedures such as hernia and gallbladder operations.
In the case of a relatively rare surgery, "doing it 20 times could be a lot," says Dr. Avery Nathens, Chief of the Department of Surgery at Sunnybrook.
To get a better idea of the surgeon's level of experience, Dr. Nathens says a patient may want to ask a few more questions, such as:
- How often have you done this operation compared to other surgeons?
- Are you considered one of the experts?
- Do you do this as part of your routine practice, or is it relatively rare for you?
- Have you received any advanced training for this type of surgery?
"Questions like this are reasonable to ask," says Dr. Nathens, who is also a Professor in the Department of Surgery at the University of Toronto.
If your operation is performed at a teaching hospital, there's a strong likelihood that a trainee -- such as a fellow, a resident or a medical student -- will be involved in your procedure and post-surgery care.
That possibility makes some patients very nervous, but you can rest assured that you can get excellent care in a teaching hospital. In fact, teaching hospitals are often at the cutting edge of new and innovative therapies.
Even so, you are entitled to ask about the amount of supervision that your surgeon will be providing throughout the operation.
RISK OF COMPLICATIONS
Your doctor will also discuss the possibility of surgical complications and may even mention some statistical probabilities. What you need to know is how these statistics relate to you. If you are older than the typical patient or suffer from several health problems, then you may face an above-average risk. Ask the surgeon about the possibility of risks for a patient with your age and health profile.
There are other questions you can ask to get an idea of what to expect during your recovery.
For instance, ask the surgeon how long the operation is expected to last.
"If it is less than 30 minutes, it is usually going to be an uncomplicated and swift recovery," says Dr. Redelmeier. "If it's more than three hours, it will be both a much more prolonged recovery and there will be higher risks for complications."
Once the surgery is over and you wake up from the fog of the anesthetic, you -- or a family member -- can ask a related question: How long did the operation actually take to complete?
If the time is either longer or shorter than the prediction, then you will know whether your operation was easier or more complicated than expected, says Dr. Redelmeier.
Dr. Nathens says you should also ask about the post-surgery communication plan. In particular, who is going to tell you what happened during the operation and what you can expect in the first 24 hours of follow-up care.
APPOINT AN ADVOCATE
Most people are feeling pretty groggy and disoriented in the hours, and sometimes days, following an operation. That means it's really important to have someone there to act as your advocate.
"Patients should identify someone who can speak for them," suggests Dr. Nathens. "This doesn't have to be the legal next-of-kin. It's someone who is going to be engaged, someone who is going to be present and someone who is going to ask the questions that you are too unwell to ask or too intimidated to ask."
Before your surgery, you should also think about completing an Advance Directive or so-called Living Will.
This is a document that states what medical treatments you would want to receive if you can't speak for yourself. The surgeon is unlikely to make this recommendation. Truth be told, many surgeons don't want to mention the outside possibility that something could go seriously wrong -- especially for fairly routine operations. They tend to feel that bringing up the subject of an Advance Directive will make their patients unduly nervous.
And the surgeons have a valid point. As a general rule, patients are not very good at planning for when things do go unexpectedly wrong -- or even for making arrangements when we are at the natural end of our lives. If you already have an Advanced Directive, mention it to your health-care team and your family or advocate.
MAKE A LIST
Dr. Nathens has one last piece of surgery-preparation advice: Make a list of all your questions before you meet with your surgeon and bring it to the appointment. It's too easy to forget something important if you don't have it written down, he explains.
Some surgeons may not like it when you pull out a long list of questions because it could take some time to answer them, but Dr. Nathens notes that it's the responsibility of the surgeon to address all your concerns before you agree to a medical treatment. "It's okay to ask questions. That's what we are here for," he says.
Written by Paul Taylor, Sunnybrook's Patient Navigation Advisor.
Read more health tips & information from Sunnybrook experts at health.sunnybrook.ca
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