Book Publications The Columbia Presbyterian Guide to Surgery

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How can I tell if I've had enough tests for an accurate diagnosis—or if I'm having too many tests?

There are many types of tests for most medical conditions. The question to ask your doctor is: "Will the information obtained from this test help us make a meaningful decision about my problem?" If not, then the test is not necessary.

A doctor feels comfortable with the thoroughness of the testing process when he has enough information to establish a definitive diagnosis and to exclude reasonable alternative conditions.

When your doctor provides his diagnosis and explains how he reached it in a way that makes sense to you, you can be assured that the testing process was thorough and complete.

Given my medical condition, what will surgery do for me?

There are two main reasons for recommending surgery:

• To prevent death or a catastrophic illness.
• To relieve symptoms.

It may sound simplistic but remember, no operation will make you feel better if you aren't suffering from symptoms. If your heart valve isn't working properly, but you don't have shortness of breath or chest pain, you won't experience improvement in how you feel after the operation. What you will experience is the knowledge that you've substantially reduced your chance of dying from a heart attack in the near future.

If you're having an operation to keep from getting worse (e.g., preventing the spread of cancer or a heart attack), the questions to ask are: What's the likelihood of preventing death or serious illness if you have the operation or if you don't?

If you do have symptoms, know which ones you're addressing, which will remain, and which will go away. Sometimes people who undergo surgery have a vague sense that an operation will fix a lot of things that are bothering them, although they're unrelated to the specific surgery. If you have chest pain and leg pain, you can expect to eliminate the discomfort in your chest from valve surgery. It will not eliminate the pain in your leg!

Find this out before the operation. You don't want to go into an operation with unrealistic expectations about what is going to change, only to come through it disappointed.

Most decision-making about operations today is based on data from observations of large populations over long periods of time, expressed statistically. Even if you're the type of person who shunned statistics in high school math, try not to block it out when it pertains to surgery. You need to combine an understanding of the scientific data on surgery with your own personal medical history.

You'll undoubtedly hear stories from friends and relatives about how Uncle Joe had the same operation, and did—or did not—benefit from it. Sure, you'll be tempted to get emotional reinforcement from anecdotal evidence. It may be your only personal exposure to that type of surgery to date. And most people are only too willing to share their war stories. But don't get hung up on anecdotes.

These stories are intriguing but are no more than a rough guide to what is going on with you. Medical treatment is a highly individualized process. You are unique and that uniqueness determines which option is best; furthermore, methods and techniques may well have changed since the time of your relative's surgery.

How do I look at risk in deciding whether I should have surgery?

Assessing your tolerance for risk is a concept that's often applied to activities like investing your money, but it's also entirely relevant in a surgical context. Risk permeates the surgical process, including how likely it is you will improve through surgery. For example, if you have back pain and there is a chance that it will recur after surgery, you would want to know if that chance is 2 percent or 30 percent before you decide on the operation.

Looking at the numbers helps you put your medical condition in context of what is likely to happen to you, not what is definitely going to happen. One woman in her mid-forties found out she had colon cancer and a section of her colon was removed. Although she had surgery, her doctor said that in the future she still had twice the chance of getting cancer in another part of her body and ten times the chance of getting colon cancer again than the average person.

Ten years later, when tests showed some abnormal-looking cells in her colon, she was faced with a decision of whether to have surgery to remove them. The doctor said he felt 95 percent sure that the cells should be taken out. She went ahead and had the surgery. No cancer was found. The statistics helped her decide on the need for the surgery; they were not a guarantee of the outcome. She didn't feel her surgery was unnecessary. Given her risk factors, she felt it was a wise decision. Her overwhelming sense was one of relief that all was well.

You place confidence in your physician's ability to identify the statistics that have a direct bearing on the surgery you're considering, and to make them understandable.

You want to know answers to questions such as:

• What are the chances of curing the problem through surgery?
• What is the chance that specific symptoms will improve?
• How much improvement can I expect in how I feel or in my life expectancy?
• What is the chance the symptoms or disease will recur?
• Where do these figures come from and how valid are they?

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