Book Publications The Columbia Presbyterian Guide to Surgery

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How do I choose who to bring with me?

In tracking your illness and recovery, one of the important choices to make is the selection of your personal support staff. Who do you trust to bring to doctor's visits? With whom can you really discuss your personal feelings and medical data? Who will be objective? There are no absolutes—even in the basic matters of who goes with you and with whom you discuss your medical concerns. You are in charge of how you move forward, and lining up your team is part of controlling how well the process flows.

The options vary here. Your major consultant, like a spouse or a parent, may or may not be the best person to bring with you to an office visit. If someone is anxious, and will only feel more so in a situation such as this, you might absorb that discomfort. The tension could affect your ability to concentrate. You may want to review the information with that person at a calmer time later in the day. Bring another relative or a friend instead, someone who can sit and have a cup of coffee after the appointment or who has the ability to make you laugh even in the tensest moments.

Someone in your family might feel bad because he's been left out of the information loop regarding your treatment. Or another person may not want the responsibility of helping you make this decision, and may say no to your request to go visit the doctor with you. The whole process is very stressful for the family members involved, who are also coping with your illness. As a person dealing with a medical challenge, you may not want to deal with the reactions of family, including feelings of rejection. This is a time to center on yourself, so you may have to explain to others that you are making the choices that work best for you at this moment.

Surgery is a major life occurrence, and as such, it does provoke reactions in relationships. And it's not always reassuring. In some cases, such as for an elderly person, the input of relatives is very important. But family members can have their own agendas. Many a doctor has consulted with relatives, especially where a will may be involved, only to be asked a little too eagerly, "He's going to die—isn't he?"

Concerned relatives really can make a positive difference. When an elderly woman was diagnosed with breast cancer, her doctor told her to have a lumpectomy and radiation. Her relatives were concerned. Why didn't the doctor tell her also to have the lymph nodes removed, a standard procedure to see if the cancer has spread? Was it because she was older and he figured it didn't matter as much for her? In fact, the woman loved life and wanted to do everything possible to prolong it. Her relatives took her to another surgeon where they discussed all the options in a standard treatment program.

Sometimes relatives serve as translators passing along information. "Dad, what the doctor is telling you is...." And sometimes they see themselves as gatekeepers, holding back information. If dad's brother recently died of a stroke, they may decide it will make him too anxious if he hears that there is a small risk of stroke during the operation. On the other hand, what if dad gets an infection after the operation that requires another surgery and he's never been told it's a possibility? A patient can get very upset if he finds out information was being withheld only to have a problem he never expected.

Ideally, the patient should be informed fully, since he's the one going through the operation, but doctors will also respect the family's input on this matter. A doctor is unlikely to say to the family, "I don't care what you think, I'm going to tell him anyway." At the very least, the doctor will make sure someone in the family has a complete grasp of what could happen.

The operating principle here is who, and what, is in the individual's best interest, whether you're picking a physician or a treatment plan, and whether it's for you or for a person you're helping.

In the following pages, we will take a closer look at just how you can find the right surgeon and how you can make the best choices of treatment through getting a second opinion and gaining an understanding of all your alternatives.

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