Book Publications The Columbia Presbyterian Guide to Surgery

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In some cases, the decision is fairly easy to make. You're clear about what you want and the medical data confirms your best option. In others, the decision will take a lot of probing, discussing, and researching to answer the question: "Do I need this operation?"

Surgery can be daunting, but it need not be shrouded in mystery. It is a process that includes finding out what's wrong and repairing it. It's common to get stuck on images of the operation itself in which you appear as an unconscious body on an operating table while the surgical team—gloved, gowned, and masked—uses a formidable array of instruments on you.

No wonder people anticipate an operation with concern, if not terror. What an ultimate act of trust! You see yourself as giving up all control to a surgeon who is going to have to subject you to trauma without question. In return, you expect to gain better health and a longer life. It is an agreement that no reasonable person enters into lightly.

Your participation in the decision-making process of surgery can lead you to enter into that agreement wisely. You exercise control beforehand so you can feel safe in the operating room. But your role in treating your medical condition doesn't mean you have to operate! You are not expected to pass the scalpel, advise the surgeon, or monitor equipment during the operation. That would be absurd.

But it is also unthinkable, unless you are in an emergency, that you would end up in an operation without knowing who is operating on you, why you're there, and what benefits will result from it.

Your intention to get the best information possible and your belief that the decision is yours to make will lead you to a realistic goal: to have the data in your hand and the feeling in your gut that having that particular surgery performed by that specific surgeon is the best option for you. Being wheeled through the operating room doors is not the beginning of surgery; it is the culmination of the process.

Collaborate or abdicate?

Just because a procedure is doable doesn't mean it should be done on you. Your best approach is to view the process from the start as a collaboration between you and your doctor, not as a predetermined course from which you cannot veer. You and your physician need to listen to each other to understand what is relevant to create an outcome that best suits your needs.

What, then, can you bring to the discussion? Doesn't the doctor, with his experience, data, and presence of mind hold all the cards?

No. You have the critical pieces that complete the puzzle of how to proceed:

• What is important to you?
• Can the result of surgery make your life better?

Even in a medical crisis, the answers to these questions are an indicator of whether the solution to your problem is surgery, alternative treatments, or doing nothing at all. The level of medical intervention should be a reflection of what fits the way you want to live your life.

For example, perhaps you have a condition called claudication, which is debilitating pain in your leg(s) when you walk due to blockages in the arteries of your leg(s). The choices of treatment range from medication and exercise to placing balloons and stents in the arteries to an operation to bypass them. How do you choose?

You'd start by thinking about your lifestyle in the context of the medical problem at hand. If your favorite activity is running six miles a day and you've had to give that up because of the pain, the level of treatment you seek is more likely to be at the high end of the spectrum than if you are a couch potato who rarely walks more than a block at a time.

The many other questions you'd ask, including whether you could lose the limb in an extreme case, are more meaningful if you see the interrelationship of your lifestyle with your treatment options.

If physicians were treating only the disease process, their job would be a lot easier. But they are treating the whole person and they need to know your thoughts and concerns to map out a plan with you. When one person hears that a lump that's been discovered in his thyroid is benign, he may be so relieved he's ready to fly out of the office. Another person may be so fearful of having any lump at all, that he could only live happily if he has it removed.

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