Assessing Your Surgeon and Questions You Need to Ask

Patients should consider initiating questions, conversations to protect themselves 

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Follow the entire   "What You Need to Know About Surgery" series here.

In series, 'What You Need to Know About Surgery,' we’ll share how to determine if your surgery is right for you, how to ask the right questions, and what you can do to prepare and recover optimally.

Bobbie Colgan visited her doctor 13 years ago because she was constantly fatigued and left the appointment disappointed at the perplexing recommendation: gastric sleeve weight loss surgery.

At 310 pounds, she was able to easily lose 20 pounds and change her lifestyle habits. Ms. Colgan initially rejected the suggestion of surgically shrinking her stomach. Over subsequent visits, her doctor persisted and used her young son and the fact that her insurance would cover the procedure to convince her it was right for her.

“My blood pressure was starting to get higher. Anything I told her about stomach issues, acid reflux, and stuff, she would just say, ‘It’s because you’re fat,’” Ms. Colgan said. “She said it could be considered abuse if I wasn’t taking care of myself, and if I’m a single mom, why don’t I care about my son enough to take care of me?”

Conflicted and worn down, she caved to the advice for her son’s sake and had an event-free surgery—one that's now considered safe enough to be performed on children. From the outside, she appears to be a picture of better health, but she traded pounds for problems that were never fully explained. Since then, her stomach symptoms have worsened and multiplied.

A review of studies across various surgical procedures published in a  2017 World Journal of Surgery article found that 1 in 7 patients reported regret about their decision. The authors described the statistic as “uncommon.”

Regret is a relevant pre-surgical subject because evidence shows that both regret and adverse events can be lowered if communication is improved. It’s something that health systems, surgeons, organizations, and blogs address by publishing all the questions patients ought to ask before surgery. However, it’s questionable whether surgeons are as forthright, as one study in Canadian Journal of Surgery found that 23 percent of clinical discussions don’t meet basic informed consent standards.

Communication Is Critical in Surgical Care

An extensive section in the peer-reviewed book “Vignettes in Patient Safety,” notes that doctor-patient communication has become more collaborative and patient-centered. However, authoritarian styles in health care are plenty—and it's associated with increased medical errors. One report blamed lack of communication on more than 60 percent of adverse events.

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Not only can poor communication strain the doctor-patient relationship, naturopath Dr. Rosia Parrish told The Epoch Times in an email that it can also delay surgical recovery and cause unrealistic expectations for both parties.

But communication is more multifaceted than simple transparency—as pointed out in “Vignettes of Patient Safety.” Subtle nuances in communication help patients identify physician biases and red flags.

It begins with the setting of communication—whether it’s poorly lit, full of distractions, or conducted online or with anyone other than the surgeon. Other red flags are surgeons who block conversation by offering advice or reassurance, explain distress as normal, change the topic, ignore the emotional toll of a condition or decision, and jolly patients along, as the authors explained.

They further described barriers in patient education that can include medical jargon, monologues with little attempt to understand the patient, time restraints, language barriers, and limited understanding of health literacy.

A 2011 study in the Journal of General Internal Medicine noted that many doctors have a bias in that they believe that patient beliefs are aligned with their own. On the flip side, results showed that physicians who better understand patients’ health beliefs and values proposed treatments that are better suited for their circumstances and needs.

Communication Is a Surgeon’s Responsibility

While there are patients who prefer to leave all decisions up to their physicians, it’s up to doctors not to assume that and approach each situation objectively. This is done with communication that's clear and understood, as well as giving patients time to make up their minds, according to “Vignettes in Patient Safety.”

It’s the doctors’ responsibility to discern if “internal noise” is interfering with communication, including whether they or the patient are fatigued, hungry, or angry. That’s what makes feedback vital; surgeons should be rephrasing what patients said for confirmation to assure total comprehension on their end.

“Though it may take time, once shared decision is made, the process will be long and compliance will be total,” the article stated. “Research has indicated that those who use these tools consistently have not only gained clarity in their communication but they improve the physician-patient relationship and outcomes as well.”

Ethically and even legally, the burden of communication falls on the health care providers, Dr. Parrish said. They shouldn't be closed-minded to conversation, questions, alternatives, and delayed timelines—even when initiated by patients.

“This breach erodes trust and hinders shared decision-making, while also potentially exacerbating healthcare disparities. In essence, the failure to provide thorough risk information undermines patient autonomy, trust, and equitable health care access,” Dr. Parrish said.

The Toll of Regret

Consulting other surgeons—or even other types of providers such as naturopaths or functional medicine doctors—can help patients get another perspective, slow down the decision-making process, and gather more certainty around their decision.

Surgery is irreversible, including organs that are permanently removed, new conditions that could result from the operation, and a chance of other adverse events or even errors. As such, the decision demands a more contemplative approach.

“There’s a lot of people who had their appendix out or even their gallbladder removed, and the problem didn’t get better,” Dr. Scott Doughty, an integrative family practitioner with U.P. Holistic Medicine, told The Epoch Times.

Dr. Doughty said it's common for surgeons to downplay the importance of the appendix and so see little issue with removing it, even if they aren't sure it's the problem.

"It’s a good guess,” he said.

Recent research indicates that the appendix may play a role in keeping inflammation and infection at bay. Ironically, the fear of deadly sepsis infections that can result from a burst appendix is likely to spur surgeons to continue advising patients to have them removed.

Understanding Your Risk Factors

Still, second opinions are a good tool—and even required in some cases—to examine the necessity of surgery. Dr. Doughty said it might be particularly beneficial to get an opinion from someone who doesn’t have a financial incentive to steer you toward the operating room.

“The question is, ‘Should I be seeking an opinion from some other doctor who has a different toolkit?’” he said.

The stark reality is surgery inherently carries risks that patients deserve to know. Among them are shock, hemorrhage, wound infection, deep vein thrombosis, pulmonary complications, urinary retention, and reaction to anesthesia.

Not everyone is a good candidate for discretionary surgeries. Considerations for surgery, according to Stanford Medicine, include age, overall health and medical history, the extent of disease, the type of surgery being performed, your opinion/preference, and your tolerance for medications, procedures, and therapies.

A more thorough screening process could reduce mortality rates in the year after surgery. Surgeons who referred their patients to primary care physicians and presurgical care clinics for a frailty assessment experienced an 18 percent reduction in the odds of one-year mortality, according to a study of more than 50,000 patients published in February in JAMA Surgery. 

Assessing Competent Surgeons

It can be complicated to navigate the murky waters of how competent your surgeon is, but it’s an issue that’s attracted some attention. Some believe doctors should also be subject to occasional assessment.

A handful of hospitals have introduced mandatory age-based evaluations—similar to age-based testing and forced retirement for professions such as pilots, judges, air traffic controllers, and more—according to a 2017 review published in JAMA Surgery.

The article noted that the number of practicing physicians older than 65 in the United States has increased by more than 374 percent since 1975. In 2015, 23 percent of practicing physicians were 65 years old or older.

“Research shows that between ages 40 and 75 years, the mean cognitive ability declines by more than 20 percent, but there is significant variability from one person to another, indicating that while some older physicians are profoundly impaired, others retain their ability and skills,” the authors wrote.

Basic cognitive testing could be misleading when medical students with little experience are ranked above surgeons with years of practice, according to a statement from Columbia University Irving Medical Center.

“As for what makes a good surgeon, the list is long, but certainly involves manual dexterity, a fund of knowledge, ability to think and readjust on your feet, compassion, and most importantly, judgment,” Dr. Paul Kurlansky said in the statement. He is associate director of Columbia’s Center for Innovation and Outcomes Research and a cardiothoracic surgeon.

Trusted referrals, reviews, and online tools can help determine whether your doctor can handle your surgery. The Society of Thoracic Surgeons, for instance, has an online tool to research outcomes by physicians.

Uncommon Questions to Ask

You can become your own advocate by arming yourself with as many questions as you need. The internet is also filled with lists of what to ask before any specific surgery.

A blog by orthopedic surgeon Dr. Ashvin K. Dewan takes typical lists a step further by discussing questions your surgeon doesn’t want you to ask. It includes:

• Do you double-book surgeries? This is a common practice that’s sometimes abused. It’s important to know what part of your operation will be handled by your surgeon and what part might be done by attending physicians.
• Will you see me post-operatively? Due to reimbursement, Dr. Dewan said many delegate this responsibility to physician assistants or trainees.
• What bills will I get after surgery? Your surgeon should be able to help you understand the overall cost of your surgery beyond the operation including use of the facility, anesthesia, implants, equipment, etc.
• How often do you do this surgery?
• What is your success rate with this surgery?
• Can I delay my surgery?
• Have you ever canceled a surgery because you were mentally or physically unfit?

For Ms. Colgan, more questions may have helped her avoid the problems she's faced since her gastric sleeve weight loss surgery.

The biggest regret she has is not taking a longer list of questions to her doctor.

“I thought I asked a lot of questions. There’s so much more I wish I would have asked ahead of time,” Ms. Colgan said.

She’s seen many doctors since her surgery in an attempt to resolve the same issues, as well as new food sensitivities that have worsened since her operation.

While her doctor no doubt had good intentions, the fact remains: Surgery is a serious intervention and should remain a last resort for most people.

10 Questions to Ask Before Surgery

Dr. Parrish, a naturopath and certified functional medicine provider, has compiled 10 questions to ask your doctor about surgery.

1. Is surgery the best option for my condition?
2. What are the potential risks and complications associated with this surgery?
3. What is the success rate of this procedure for my condition?
4. What is the expected recovery time?
5. What are the short-term and long-term effects of this surgery on my overall health?
6. What are the anesthesia options and associated risks?
7. How experienced are you in performing this procedure?
8. Are there any lifestyle changes I should make before the surgery?
9. What can I expect in terms of pain management and discomfort after the surgery?
10. What is the cost of the surgery and what does it include?

Next: How you prepare for surgery can change the outcome. 

Read the entire  "What You Need to Know About Surgery" series here.