Book Publications The Columbia Presbyterian Guide to Surgery

A NOTE TO THE READER

Inclusion of any resource listings in this book in no respect implies any endorsement or recommendation by Columbia University, New York–Presbyterian Hospital, or the Publisher of the book. This book is not intended, nor should it be used in any way, to provide diagnoses or to prescribe any specified treatment or medication. For the diagnosis and treatment of medical conditions, readers should in all cases consult their own doctor or other medical provider.

PART ONE: DO I NEED SURGERY?

Chapter 1: Understanding Your Medical Problem, and Its Surgical Solution

No one ever wakes up one day and says, "Gee, I'd really love to have an operation." Everyone wants to feel better, look better, live longer, and stay disease-free, but no one wants to be cut open, endure discomfort, and put normal activities on hold.

Yet it's a prospect that faces millions of people each year. Surgery is not inevitable, but it is quite likely that you or someone you care about will someday have to consider it as an option.

How you do react when surgery is recommended? With a sense of relief that there's help for your problem? Or with a denial that you even have a problem? Are you hit by an overwhelming desire to have the operation right now? Or do you just go numb, letting the doctor's words float out of your consciousness?

There are as many ways to react as there are types of surgery. No matter how you first react, try to make the effort and take the time to find out why an operation is recommended, what it entails, and how your health will improve.

If you decide to have surgery, it should be for a very specific reason: you are convinced that it is the medical alternative that supports your best interest.

It helps to recognize a point that can get buried in the emotions aroused by the word surgery. When you hear your diagnosis, you are not just a patient in a doctor's office—you are also a consumer buying a very important service.

It may seem a strange concept at first, especially for those who grew up in an era when the doctor gave the orders and the patient did as told—no questions, no options. But it isn't crass to question your doctor. Nor does it imply disrespect to professionals who have studied and practiced for years. If you are concerned about offending your doctor, remember this: doctors expect you to ask lots of questions, perhaps get a second opinion, and possibly end up following a different strategy than the one they originally recommended.

You can compare the situation to any major purchase. The stakes are very different, but wouldn't you expect to put at least as much effort and ask as many questions about an operation that could alter your life as you would about buying a car?

You want the medical system to work to your advantage. After all, you are buying into a treatment package—physicians and staff, medical center, type of operation, recovery plan—that will make a difference in the quality, even the length, of your life.

I urge you to establish from the outset that you have a big role to play. Be proactive. You can break your responsibilities down into these ten steps:

1. Choose medical professionals who are caring and knowledgeable.
2. Gather the facts of your medical condition through testing and discussion.
3. Obtain a clear description of your diagnosis and treatment alternatives.
4. Put that description into the context of what it means for your everyday life.
5. Create a support team of friends and relatives.
6. Confirm your diagnosis and treatment options through a second opinion.
7. Evaluate the risks and the benefits of your options.
8. Understand what happens to you during the operation, in recovery, and post-operatively.

9. Form realistic expectations of what an operation can accomplish.
10. Decide whether or not to have surgery.

Of course, if there is a medical emergency and your life—or the way you live it—is in immediate jeopardy, you may have to have surgery on the spot without going through this sequence. When there is a choice, however, try to use these steps to help you make the best choice.

Taking the time may be tough, given the risks of surgery, the expense, the immediate impact on your lifestyle, the demands it places on your family, and the rigors of the recovery process. But it is worth every ounce of effort you put into being a proactive consumer in the surgical process. Understood and used properly, surgery can provide powerful benefits for you.

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