Book Publications The Columbia Presbyterian Guide to Surgery

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It is not responsible for the surgeon to follow a treatment course simply because you, the patient, want it, if he thinks you can be harmed by it. Nor is it his job to predict what you want; it is your job to tell him as clearly as you can.

A breast surgeon determined that the cancer in a young woman could be successfully treated by the standard method of removing the lump and the lymph nodes along with radiation. However, the woman insisted she only wanted the lump removed, nothing else. Rather than do an operation he considered substandard, the surgeon referred the woman to a radiologist and an oncologist so she could find out more about the impact of making that choice.

Of course, you can also opt out of this whole process and let the doctor decide. You can say, "I don't want to hear anymore. I'm too upset about this. Just go ahead. I trust whatever you want to do." Such autonomy dumping, as I've mentioned, is an option. It's quick and easy. But most people, when they consider the consequence of handing over a decision that could have a major impact on their lives, think better of it. At the very least they may say, "I trust what you're going to do. Tell me about how you'll do it and what the outcome will be."

In some cases the patient is mentally impaired, too young, or too old to make the decision for himself. You may be called upon to go through all the steps of the decision-making process for this loved one. The question remains the same: given the set of facts and the lifestyle needs of the person who is depending on you, is surgery in his best interest?

In answering the question of whether or not to have surgery, you may find that the process of collaboration by its very nature leads to some disagreements. Feel free to speak up—as well as to be challenged in turn. It's the give and take that leads to clarity, different perspectives, and finally a consensus. As long as you and your physician treat each other with mutual respect and are open to new insights, you're on the right track.

How do I begin?

You should not be daunted by the prospect of learning about disease and surgical repair. Like all big efforts, you start with small steps. You do not need to know every nuance, every last detail. You do not need to acquire the same level of knowledge as the physician. What you do need is to get the information that will allow you to feel comfortable about making a decision.

"Doctor, what's wrong with me?"

It may happen that you arrive at the doctor's office for routine tests or an evaluation of symptoms. And you leave with a recommendation for surgery. You should expect to get the following information from the doctor with whom you're consulting:

• An opportunity to describe your symptoms, ask your questions, and express your concerns.
• An understandable, coherent explanation of the disease or injury you have.
• A description of its specific implications for you and for your quality of life.

You need to hear your physician describe, in plain English, the basics of your medical condition. If it helps you understand better, ask for pictures and diagrams along with a verbal explanation.

As one woman who had surgery put it, "If I ask the questions, I get the answers."

Imagine discovering you have a heart condition called aortic stenosis. An ideal dialogue between you and your doctor would be the following:

• What is aortic stenosis? It's an abnormality of the aortic valve that guards the left ventricle. The valve is located at the spot where blood leaves the major pumping chamber of the heart.
• What does that valve do? When the valve is normal, it lets blood flow freely out of the heart and keeps blood from leaking back into it.
• What's wrong with my valve? It's gotten so narrow that it's difficult to eject blood from the heart and to prevent blood from leaking back into the heart.
• How do I experience this? You could have shortness of breath, chest pains, or fainting episodes. Or you may have no symptoms.

Adapted to your condition, these questions are your opening salvo for understanding any medical problem and deciding how to treat it. In more general terms, this is what you're really asking:

• What part of my body is diseased or injured?
• What does it do when it's operating normally?
• What's it doing in my case?
• How does this affect me?

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