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50 Secrets Surgeons Won’t Tell You

The above title was on the cover of a popular monthly magazine in October 2012.  I have kept the magazine in my desk drawer until now.  I remember being shocked when I first read it.  Could it be true?  Am I keeping secrets from my patients?  Am I naïve to think my patients trust me 100%?  

I re-discovered the magazine recently when I was cleaning out my desk.  I have decided to answer every one of those 50 items the article lists.  My patients deserve to know!  So here we go!  Some answers are brief but other deserve a more detailed explanation:

  1. Hospital employees often know which doctors have a good reputation. I agree.  I think operative nurses know which surgeons are better than others from their daily interactions.
  2. Ask your doctor about complication rates.  All surgeons have complications.  If the surgeon operates enough then he will.  Let’s say the complication rate for a certain surgery is 1-2%.  This means that if your surgeon performs that operation 100 times, 1-2 patients will experience those complications.  You should ask your doctor about their complication rate and make sure it is not above the standard acceptable range.
  3. Find out if your doctor is board certified? Fellowship trained?  I think this is important to know.  I am both board certified and have completed additional training (fellowship) in my field of minimally invasive surgery.
  4. Some referrals from primary care doctors can be politically or financially motivated.  I can assure my patients that their referring physicians are by no mean compensated financially.  They trust me to care for their patients and I respect that trust immensely
  5. Ask a former patient. In many instances, my patients have volunteered to talk about their experience with other prospective patients.  They can share from a patient’s point of view.
  6. Some surgeons may not disclose certain surgical options because they do not perform them.  This is true for many older surgeons that do not perform minimally invasive surgery.  Many local urologists refer patients to me for my expertise in less invasive surgery.  Some decide to send their patients out of state, rather than send them to their ‘competing’ urologist.
  7. Who will take care of you after surgery? A student, intern, resident, or a physician assistant?  I always see my own patients after surgery while hospitalized and afterwards for their follow-up visits. 
  8. Elective surgeries are better early in the week as the surgeon may not be around on the weekend.  I usually operate on Mondays and Tuesdays.  Most of my patients are home by the weekend.
  9. It is better to bring family members to your preoperative appointment.  I welcome family members for pre-operative discussions.  I believe they are instrumental in the recovery and healing that occurs at home after patient has left the hospital.
  10. It is important to know who your anesthesiologist is.  This is true.  I only used board-certified anesthesiologists.  When I had to undergo surgery, my own anesthesiologist put me to sleep!
  11. It is good to get a second opinion from another pathologist.  This can be arranged in most cases.  Be aware, your insurance company may pass on the additional cost to you.
  12. Many risks are listed on the consent form.  Which ones are true concerns?  I am happy to discuss the risks that concern me the most.
  13. You may be able to donate your own or family members blood.  This is rarely an issue as for most minimally invasive surgeries, transfusions are rare.
  14. In academic institutions, find out if residents or training staff are involved in your surgery.  I perform my own operations and do not use residents.
  15. Patients sometimes disclose personal information just before they fall sleep.  Although this may happen, the good news is whatever you say is often unintelligible!
  16. Even surgeons are surprised by the extent of disease they see in the operating room.
  17. Surgeons have to deal with risk of being stuck with a contaminated needle.  We are trained to take proper precautions.  If a surgeon is stuck with a needle he may ask you to give him or her permission to test your blood for transmittable diseases as a safety measure.  This is to help initiate therapy as soon as possible.
  18. Surgeons may have derogatory records from another state.  I fortunately have not had to deal with a malpractice lawsuit thus far.  But as most surgeons will tell you in today’s medico-legal climate, it is only a matter of time.
  19. Surgeons are control freaks.  In most cases, surgeons would like having a controlled environment during surgery and I believe this contributes to surgical success.
  20. Training surgeons make mistakes but are often fixed without anyone being harmed.  This is true in academic (teaching) hospitals.  It is an inevitable part of training future surgeons.  I however do not operate with training surgeons.  
  21. Surgeons can lose their cool in the operating room.  Yes this is possible as we are human.  However, much of the drama you see on TV is just that: ‘drama’ not reality.
  22. Some surgeries may not ‘cure’ the situation like in case of back pain.  This is less of an issue in urology, as we do not operate just to address pain.
  23. There is an inherent financial conflict of interest with surgery.  The need for surgery is addressed for each individual patient.  Surgeons realize that if they operate on a candidate that should be managed medically, the outcome will be inferior and it reflects badly on the surgeon.  I strive to have good outcomes and value my reputation.
  24. Always ask about non-surgical options.  These options are available to some conditions and not for others.  In case of urologic cancers, my field of expertise, nonsurgical options do not have as good of an outcome.
  25. Surgeons push you to schedule surgery.  For many urologic cancers, a few days or even weeks usually makes no impact on the disease therefore, there is no ‘rush’ to operate.
  26. Read the operative report.  This is readily available as part of your medical records.  It can be obtained from the medical records department of the hospital.
  27. Blood clot formation is a risk of any surgery.  Be aware of calf swelling and pain or sudden shortness of breath after surgery as this may be a sign of deep venous thrombosis.
  28. What surgeons worry about as much as complications is a non-compliant patient.
  29. One of the biggest risk factors for poor outcomes after surgery is obesity. This is true.  Obesity makes surgery harder, post-operative care more difficult, and delays proper healing.
  30. If you ask too many questions you are branded as a pain in the neck. I prefer to answer your questions before surgery.  I believe if you go into surgery with your questions answered you have a more realistic expectation after surgery.  So write them down and bring then with you to your appointment.
  31. Administrators for hospitals put pressure on surgeons to do more cases. I have no financial affiliation with any of the hospitals at which I operate.  As an independent surgeon, it is purely my choice to operate at a facility.  I choose my facility based on the availability of high-tech instruments and the expertise of my surgery team. 
  32. New restriction on resident hours will affect quality of future surgeons.  These restrictions were not in place when I trained.  Whether, the limited hours affect quality of the surgeons has yet to be seen.
  33. Surgeons have a financial incentive to operate at their surgery centers. The model of surgeon-owned surgery centers is in play throughout the country.  I personally have had no investments in any surgery centers.
  34. Some orthopedic surgeons make money through consulting agreements with device manufacturers.  I have no such affiliation with any device company or medical manufacturer.  I am not reimbursed or rewarded for using any surgical products.
  35. Ask your surgeon of his or her financial relationship with vendors and companies.  I have a limited relationship with 2 companies as a surgical proctor (Intuitive Surgical and American Medical Systems).  I am paid for only for my time spent on teaching other surgeons.  I am in no way reimbursed or incentivized to use any product during surgery.  My relationship is limited to a teaching or proctor capacity only.
  36. Surgeons are susceptible to emotions and depression. My response is yes we are human after all!
  37. Surgeons cherish their patient appreciation.  I have to admit it bring me much joy to receive a card or hand-written note from a patient who has had a good surgical outcome.  I have kept every single card or letter!  I plan on posting a few on the website.
  38. Surgeon schedules are hectic.  Yes it is true we are busy.  We often have to run from the office to the hospital to operate only to return shortly after to check on our post-operative patients. It does not make us care any less.  It is what we signed up for. 
  39. Surgeons make mistakes.  This is truly a profession, which does not allow mistakes.  In medicine, there are mistakes made and most do not harm the patient.  We do what’s humanly possible to avoid them.  For example, I insist on having films in the operating room and will refuse to operate to remove an organ unless films are at hand.
  40. Ask if your surgeon was up all night on call before your surgery.  Since my residency days, I do not spend all night operating therefore this is not an issue for my patients.
  41. Ask your surgeon if he knows another doctor who is not qualified to practicing his or her specialty and they will say yes.  Just like any other profession, there are good surgeons and not so good ones.  So do your research.
  42. Surgeons do not like to be surprised during surgery.  This is true so let your doctor know if you have had any and all prior operations.  Prior surgeries cause scar tissue and your surgeon needs to anticipate it and formulate a plan to get around it.
  43. Scar creams can be effective in reducing scars.  Although this applies more to plastic surgery, you can discuss this with your physician if this is a concern.
  44. Pre-operative and post-operative instructions are important.  Ask your doctor if he or she has written instructions for your review before surgery.  It can make treatment course much smoother.
  45. Time to recovery may be longer than stated.  It depends on your physical condition, age and weight and the surgical procedure.  Times can vary.
  46. Permanent implants in the body carry risk.  Any implanted device is foreign to your body.  It runs the risk of malfunction, infection, rejection and need for replacement.  Think thoroughly before undergoing an implant procedure.
  47. Teaching hospitals have residents 24 hours watching over patients.  I take every phone call and concern from the nurses on the floor.  I have more responsibility.  I am more aware of a patient’s condition than an attending at a teaching hospital, who has residents and interns overseeing day-to-day care.  There is no resident to ‘filter’ the information before I am alerted something is wrong.  
  48. If it’s broken does it need to be fixed?  In some case, it is true that just because some part of the body is not working right, it has to be ‘fixed’.
  49. Surgeons are afraid of being sued.  I wish this was not true but it is.  To a certain extent we have to play defensive medicine so we don’t have a finger pointed at us later.  It is the reality of our medical system.  To the most part it does not affect day-to-day care that we deliver.
  50. Surgeons may feel an operation is more “urgent”, afraid what may happen if they wait.  We constantly have to balance the benefit of intervening surgically versus active surveillance.  Sometimes being conservative and waiting my put your health at jeopardy.  This is where you have to have trust in your surgeon to make the right and safe decision.

As you can see, this is not ground-breaking stuff.  Most of it is common sense.  However, you have to admit “Secrets Surgeons Won’t Tell You” is a sexy title and sells magazines.  I hope this help restore some faith in your surgeon.

Until next time