When a close family member was recently
advised by a doctor to have a minor operation, I was overwhelmed by fear and
uncertainty. How could we be sure surgery was necessary? Should we get a second
opinion or trust the doctor who recommended it? What should we do to prepare?
اضافة اعلان
To find out how best to think through the issue, I
reached out to three physicians who study medical decision-making and health
literacy.
The first thing you should do is to take a deep
breath, said Dr Susan Pitt, a surgeon at the
University of Michigan’s Center
for Healthcare Outcomes and Policy who studies how treatment decisions are made
between patients and doctors. Facing an operation is a lot to digest. If your
doctor hasn’t already explained the rationale, ask why the procedure is needed.
You should also ask if the procedure is typically recommended for your
condition under physician guidelines.
Consider asking if you can record the conversation
on your phone so you can review the information later when you are calmer,
advised Dr Harlan Krumholz, a cardiologist who directs the Yale School of
Medicine Center for Outcomes Research and Evaluation. Or at the very least,
take notes. An app called Abridge records doctor-patient conversations and
shares the recording and transcript with the patient while also summarizing the
information for the physician to help with record-keeping.
Even if your doctor makes a compelling case for
surgery, you may have other options. Pitt suggested asking if there are other
kinds of surgeries that might be less invasive or nonsurgical options. Specify
that you are not just interested in the alternatives your particular doctor
could offer, but also treatments that could be available to you through other
doctors as well.
Do not forget to ask what might happen if you do not
do anything at all, she added. Perhaps the worst-case possibility is not all
that bad.
You should ask your doctor about the potential
benefits of any procedure, Krumholz said. Often, doctors perform surgeries to
increase the chance that someone will feel better or that a future risk will be
averted — but some surgeries do not achieve those goals, he said.
When Krumholz and his colleagues interviewed
US adults who were candidates for elective angioplasty — a procedure that opens
blocked arteries — 70 percent said they believed the procedure would lengthen
their life or prevent future heart complications, even though it typically does
not. (It usually just relieves chest pain.)
When it comes to understanding the risks and
benefits of medical procedures, “there’s lots of common misunderstandings”,
Krumholz said, so it is wise to probe.
You could, for instance, ask how many people out of
100 with your condition who get this surgery typically feel better afterward or
how much the surgery typically reduces the risk of future health problems or
death.
Some surgeries are not even needed and may not be
helpful: In a 2017 survey of more than 2,000 US physicians, doctors estimated
that 11 percent of medical procedures, including surgeries, are unnecessary.
It is crucial to get a sense for the potential
risks, too, Pitt said — and ask for clarification if what your doctor says
sounds vague. For complicated surgical decisions, you could ask the hospital if
it has patient advocates or nurse navigators, both of whom can come to
appointments and help make sense of what you are being told, she added.
Ask about what your recovery from surgery could be
like. How long might it last? What will you be able (and not able) to do? How
many people never fully recover?
“That’s vital information to understand,” Krumholz
said. Ask what costs you will be expected to shoulder, too.
“Many people don’t realize that they’re going to
have a big bill,” he said, even if they are covered by health insurance.
It may also help to get a second opinion from a
different doctor, said Dr Glyn Elwyn, an expert on shared decision-making at
the Dartmouth Institute for Health Policy & Clinical Practice, especially
if the first doctor did not suggest any alternatives to surgery. He recommended
getting that opinion from a general practitioner, such as an internist, who
might be more knowledgeable about nonsurgical treatment options.
When my family member’s doctor did not mention any
alternatives to surgery, he sought a second opinion from a different surgeon,
who pointed out that there were, in fact, several nonsurgical options.
Krumholz agreed. “It’s your body, and you have a
right to be able to hear what other people have to say,” he said.
If you choose to move forward with surgery, your
next big decision is who should do the operation. One guiding principle is that
the more surgeries doctors do per year, the better their patients tend to do,
Krumholz said.
Krumholz suggested asking doctors how many of this
particular kind of surgery they have done in the past year and over the course
of their careers — and how that rate compares with the threshold that is
associated with good outcomes in their field.
“If the doctor says, ‘I don’t know,’ that’s
revealing,” Krumholz said, and you may want to find another doctor.
You can also ask how the doctor’s surgical outcomes
— rates of efficacy and complications for this kind of surgery — compare with
those of other surgeons.
“Surgeons should know where they sit compared to the
national average,” Pitt said. There is no national registry where patients can
access this information, so asking your doctor directly is best.
If your doctor performs surgeries at a teaching
hospital, ask whether a junior physician might be assigned to do the surgery
instead, and if so, how much experience they have and what the hospital does to
ensure that they provide excellent care, Krumholz said.
If your doctor gets testy that you are making so
many inquiries, that is a red flag, Elwyn noted.
“If they’re uneasy answering these questions, I
wouldn’t feel comfortable myself as a patient,” he said.
If you decide to have an operation, bring an
overnight bag even if you are just having an outpatient procedure, Pitt
suggested, in case you need to stay longer. Pack comfortable clothes. You may
be able to wear them, instead of the dreaded hospital gown, during recovery,
depending on where your incision is, she said. And bring a toiletry bag
containing anything you would want to have with you for personal hygiene.
However, keep your nice jewelry, watch, and
medications at home. Typically, hospitals and medical centers will not let
patients take outside medications on their watch because they cannot be certain
that what is in the bottle is what is on the label, Pitt said.
After my relative sought out a second opinion and
learned about other treatment options, he decided to first try a less invasive
procedure that involved a quicker and easier recovery. It has improved his
symptoms immensely. Surgery might still be in the cards one day, but maybe not.
“There are all sorts of ways that people are made to feel as
if surgery is a done deal and there’s no other option when, in fact, there are
almost always options,” Krumholz said.
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