Understanding Surgery. Dr. Joel Psy.D. Berman
If the surgery is an emergency, then obviously it cannot be delayed by laboratory values, but these values will help the doctor to correct problems just prior to or during the surgery itself. If the surgery is elective (does not have to be done NOW!), then the patient should be made as healthy as possible before being brought to the operating room. This means that your surgeon must use common medical sense and never rush anyone into elective surgery without a proper workup.
Sometimes, the patient is such a poor surgical risk that alternative and second best options for treatment must be considered. The adage, “The operation was a success but the patient died,” is a hard one to explain to a family and for the surgeon to explain to himself.
That is the preoperative workup in a nutshell. Arranging for these studies, getting them done, evaluating them and getting surgery scheduled appropriately takes time and usually involves multiple phone calls by an office staff person. And this doesn't include the ins and outs of getting permission from an insurance company or a managed care group. Multiply this situation by ten or twenty in a surgeon's office, and you will understand why getting a surgery scheduled may not be as easy as it seems. Be patient and understanding...eventually, everything will get done safely and completely.
Chapter 10
TALKING TO YOUR SURGEON
Second Opinions, Credentials and Qualifications
You can bet your britches, and I can bet mine too,
That if you become a surgeon, you may rue the day you do.
'Cause every time you do a case someone will go inspect
The whole shebang to see if you have done the thing correct.
I mean, does every workman and contractor have to prove
That every corner done has just a perfect tongue in groove?
So what if you forget to tie a vessel off or two?
Why should everyone come out and point a thumb at you?
In what other profession do we ask for 100 percent?
Why can't these stringent rules, just a little bit, be bent?
Then I could advertise in public and the daily press.
I'm a real surgeon and guarantee 80% success.
Now if you were in school an 80% would be a solid B
Enough to get you by with some respectability.
Unfortunately with surgeons, it doesn't work that way,
Everyone expects you to always have an A.
Your kindly family doctor, Dr. Noodledorf, examines you and tells you that you have a hernia and recommends that you have it repaired. He refers you to Dr. McGillicutty in the suite next door, so you make an appointment to see him and discuss the situation. Now, if you have been a patient of Dr. Noodledorf's for twenty years and have a high regard for him professionally, you may say to yourself: “Hmm. If my doctor recommends this guy, he must be good,” and you may well be right in assuming so. But let me advise you about surgeons so you can make your own informed decision.
Although not trained specifically in surgery, every physician who graduates from medical school has a license which lists him as a physician and surgeon. In other words, anyone is potentially able to do surgery legally. Of course, one wouldn't be able to get privileges in any reputable hospital or surgical center without proper credentials, but anyone can do just about anything in his own office. So beware and look for the training and credentials and be sure your surgeon is indeed a trained surgeon. He should have gone through an accredited residency program in that type of surgery in which he specializes, and this usually means completing the senior residency or chief residency. Then he should be eligible for or have passed the specialty boards in his specialty, such as general surgery, orthopedics, neurosurgery, etc. Board Certification is something all physicians are proud of, and they usually have “board certified” on their business cards, and the certificate is usually displayed in their office. Look for it or ask the secretary about board certification if you want to be sure. It's your one guarantee that the individual has met a least the minimal requirements of the National Specialty Board for practicing his profession.
Next, you should get a general impression from others who may know the community and ask about this surgeon. But be aware that this can be dangerous in both directions. I know a very poorly trained surgeon who has a very good bedside manner. He has more complications than most of his colleagues, but the problems are overlooked by the patients because his personality is so charming. Conversely, I also know another surgeon who is well-trained and highly competent, but is very abrupt with patients and has a poor bedside manner. These are obviously the extremes, but I bid you take caution that you get a well trained, competent surgeon; comments from former patients may not give you the entire story. Do your homework, ask nurses or other doctors, and you may get a better idea with whom you're dealing. And remember, almost every doctor has lawsuits. The number may reflect how busy he is, the type of surgery he does, or the location in which he is working. Sometimes doctors are sued for nonsense reasons, but it's cheaper for their malpractice insurance carrier to settle the case for twenty or thirty thousand dollars rather than put up a defense which may cost twice that amount. And I have known excellent surgeons who have been sued and lost cases when nothing was done outside the standard of practice. The legal system sometimes fails, as we have seen in a recent well-publicized murder trial. No one can predict the behavior of a jury, especially when someone has suffered pain or severe illness, whether or not the surgeon is responsible for doing something wrong. The general impression is that the suffering patient needs to be compensated and a scapegoat is sought. There are many cases where the physician has done grievous harm, and yet the case is thrown out for some nonsensical legal reason. It works both ways.
You might want to look at what a surgeon does in the way of education, lecturing, and what positions he holds in the medical community. How is he regarded by his colleagues? Has he been a chief of surgery or given lectures on some area of his specialty? Most specialties have a highly respected college of that specialty; in general surgery, it is the American College of Surgeons. The surgeon who has been evaluated by this college and accepted into its ranks has the right to use F.A.C.S after his name (Fellow of the American College of Surgeons). There are colleges in several countries, and many foreign physicians have several credentials you should look at. Conversely, there are several initials which can essentially be “bought” and placed after your name just by receiving an application and sending in your membership fee. Be careful what you accept as legitimate credentials!
You should always ask your surgeon what his qualifications are and how often he has done the proposed procedure. There are some cases which I do every week, such as gall bladder or appendectomy surgeries, and then there are some that I may only do once a month, such as thyroid or stomach. And yet I have been well trained to handle these procedures. I have probably done five hundred to a thousand gall bladder procedures over thirty years, and far fewer thyroids. And yet I feel equally qualified to handle each one. If I only did one thyroid a year and only two gallbladders a year, I would probably be less qualified; but, depending on my training, my ability, and my overall competence, I may be very able to do each of those procedures well. So choosing a surgeon is not an easy matter, and a number of factors must be weighed carefully.
In summary, the strongest basic recommendations I would make are: (1) A completed residency program, (2) Board Certification by the American Board of that specialty, (3) Fellowship in the American College of that specialty, and then take into consideration all the other factors I have mentioned.
To get onto another topic, I want to talk briefly about Second Opinions. In today's world with patients much more informed, especially with the Internet availability, the surgeon will be asked more questions and the patients will demand more information and answers. Remember that the Internet information is not screened and edited by experts, and a lot of what you see may not be “the truth and nothing but the truth.” Don't believe everything you read. Often, it takes a physician to clarify medical situations to you, and you shouldn't be afraid to ask about conflicting information. Some patients always want