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Question: I am going to have an operation and I must admit I am nervous that something might go wrong. A friend said I should ask the doctor how often he has done the surgery. Practice makes perfect, I suppose. But is it that a valid question to ask?
Answer: As a patient, you are entitled to a full discussion with your surgeon about the potential benefits – and risks – of an operation before you give consent to the treatment.
“Patients certainly shouldn’t feel intimidated or concerned about asking questions. It is ultimately their health that is at stake,” says Sally Bean, a policy advisor and ethicist at Sunnybrook Health Sciences Centre.
“In my experience, most surgeons are quite happy to discuss those types of things with you.”
So, in answer to your question, it is okay to ask a doctor how often he or she has performed the procedure. Studies suggest that a surgeon’s success rate tends to improve with more experience.
Experience counts
But it’s worthwhile having some context for the answer you will be given, says Dr. Donald Redelmeier, a Sunnybrook physician and professor of medicine at the University of Toronto.
“Less than 10 in the past year is infrequent. More than 50 is a reasonable volume,” he explains.
Of course, those numbers would apply to fairly common procedures such as hernia and gallbladder operations.
But in the case of a relatively rare surgery, “doing it 20 times could be a lot,” says Dr. Avery Nathens, chief of the department of surgery at Sunnybrook.
To get a better idea of the surgeon’s level of experience, Dr. Nathens says a patient may want to ask a few more questions, such as:
- How often have you done this operation compared to other surgeons?
- Are you considered one of the experts?
- Do you do this as part of your routine practice, or is it relatively rare for you?
- Have you received any advanced training for this type of surgery?
“Questions like this are reasonable to ask,” says Dr. Nathens, who is also a professor in the Department of Surgery at the University of Toronto.
If your operation is performed at a teaching hospital, there’s a strong likelihood that a trainee – such as a fellow, a resident or a medical student – will be involved in your procedure and post-surgery care.
That possibility makes some patients very nervous. But you can rest assured that you can get excellent care in a teaching hospital. In fact, teaching hospitals are often at the cutting edge of new and innovative therapies.
Even so, you are entitled to ask about the amount of supervision that your surgeon will be providing throughout the operation.
Understand the risk of complications
Your doctor will also discuss the possibility of surgical complications and may even mention some statistical probabilities. But what you need to know is how these statistics relate to you. If you are older than the typical patient or suffer from several health problems, then you may face an above-average risk. Ask the surgeon about the possibility of risks for a patient with your age and health profile.
There are other questions you can ask to get an idea of what to expect during your recovery.
For instance, ask the surgeon how long the operation is expected to last.
“If it is less than 30 minutes, it is usually going to be an uncomplicated and swift recovery,” says Dr. Redelmeier. “If it’s more than three hours, it will be both a much more prolonged recovery and there will be higher risks for complications.”
Once the surgery is over and you wake up from the fog of the anesthetic, you – or a family member – can ask a related question: How long did the operation actually take to complete?
If the time is either longer or shorter than the prediction, then you will know whether your operation was easier or more complicated than expected, says Dr. Redelmeier.
Dr. Nathens says you should also ask about the post-surgery communication plan. In particular, who is going to tell you what happened during the operation and what you can expect in the first 24 hours of follow-up care.
Appoint an advocate
Most people are feeling pretty groggy and disoriented in the hours, and sometimes days, following an operation. That means it’s really important to have someone there to act as your advocate.
“Patients should identify someone who can speak for them,” suggests Dr. Nathens. “This doesn’t have to be the legal next-of-kin. It’s someone who is going to be engaged, someone who is going to be present and someone who is going to ask the questions that you are too unwell to ask or too intimidated to ask.”
Before your surgery, you should also think about completing an Advance Directive or so-called Living Will.
This is a document that states what medical treatments you would want to receive if you can’t speak for yourself. The surgeon is unlikely to make this recommendation. Truth be told, many surgeons don’t want to mention the outside possibility that something could go seriously wrong – especially for fairly routine operations. They tend to feel that bringing up the subject of an Advance Directive will make their patients unduly nervous. And the surgeons have a valid point. But, as a general rule, we are not very good at planning for when things do go unexpectedly wrong – or even for making arrangements when we are at the natural end of our lives. If you already have an Advanced Directive, mention it to your healthcare team and your family or advocate.
Make a list of pre-surgery questions
Dr. Nathens has one last piece of surgery-preparation advice: Make a list of all your questions before you meet with your surgeon and bring it to the appointment. It’s too easy to forget something important if you don’t have it written down, he explains.
Some surgeons may not like it when you pull out a long list of questions because it could take some time to answer them. But Dr. Nathens notes that it’s the responsibility of the surgeon to address all your concerns before you agree to a medical treatment. “It’s okay to ask questions. That’s what we are here for.”
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Paul Taylor, Sunnybrook’s Patient Navigation Advisor, provides advice and answers questions from patients and their families. His blog, Personal Health Navigator, is reprinted on Healthy Debate with the kind permission of Sunnybrook Health Sciences Centre. Follow Paul on Twitter @epaultaylor.
The comments section is closed.
More people and patients need to understand the procedures, diagnosis, recommendations and risks of any potential operation complicated or not. This guide will help you understand some of the basic procedures one could follow.
Great! It’s really useful for people to know more about the surgery they are going to have. I am going to have my hernia surgery from Shouldice Hospital, Ontario the next Friday and this article is really useful for me too to make some questions to ask my surgeon before my surgery,
Although I think its good advice to encourage people to do some “advance care planning” Its time that people STOP advising patients to do documents called advance directives or living wills if they live in Ontario because there are no such documents in the Ontario law. Its also time to stop misstating what an advance care plan does and to whom it “speaks” to .
In Ontario advance care planning involves two elements
a. a patient either understanding who is their automatic substitute decision maker for health care as defined in the Health Care Consent Act who is the person who would give or refuse consents to treatments for the patient if the patient should become incapable to do so for themselves. OR the patient completing a Power of Attorney for Personal Care to choose someone to act for them if they should become incapable. The Health Care consent Act sets out a hierarchy of SDMs that would automatically be a patients SDM should they become incapable. EVERYONE in Ontario therefore has an automatic SDM . The advance planning helps patients understand who that person is , and gives them a chance to pick someone one else if they don’t want that automatic SDM to act for them.
b. the patients expressing their WISHES ( not decisions ) about future care as well as their values and beliefs that may impact on how they would make health decisions if they were able to do so. These wishes, values and beliefs are expressed to help guide the patient’s SDM ( not the patients health providers) when the SDM is in the role of making decisions on behalf of the patient when the patient is incapable. . These wishes are relevant to the health providers only in an emergency .
Advance care planning is NOT decision making about future care . Its SPECULATION about what a patient MIGHT want or not want IF something should happen . Its speculative. In Ontario, the law requires health providers to talk to a PERSON . not to look at any advance care plan form , when getting consent to treatments for the patient . The health provider must talk to the patient and get consent from the patient if capable . If that patient is not capable to give or refuse consent , the health provider must turn to the patients SDM and not any written statement of wishes about future care .
Its the SDM that looks at any written wishes, values and beliefs and uses these as a guide to help the SDM make the decisions that patients might have wanted if the patient was capable. The SDM interprets the wishes and applies them to the decisions that need to be made after also getting all the information about the patients conditions and the risks, benefits , side affects and alternatives to the treatment options from the health provider . to then make an informed decision in context with all the information.
So its important that before surgery the patient do some advance care planning . I do agree with that . But the planning they need to do is making sure they understand who is their SDM , and choosing an SDM they want if they don’t want the automatic SDM . They should also TALK to that future SDM to discuss their wishes , values and beliefs so that eth SDM is prepared to make decisions for the patient should the patient be temporarily or long term not capable to speak for themselves.
Its important to stop using the word “advance directive” to explain this planning . First of all, in Ontario, a patient doesn’t have to WRITE DWN these wishes , values, and beliefs but can express them orally . That’s just as valid as writing them down . The only thin that a person MUST write down in a document is the appointment of an SDM if they don’t want the automatic SDM . That appointment of an SDM of choice must be done by a POAPC which is a written document .
Also the term “directive” is misunderstood by health professionals as something that they must take direction from when in fact , in Ontario, the advance care plan documents ( or oral statements) are NOT “directives” to the health providers but are communications to the patients future SDMs . In an emergency the health provider should follow any wishes as expressed by the patient when capable but for most decisions , the health providers must turn to the patients SDM if the patient becomes incapable. So then the SDM uses the oral or written wishes to help inform the SDM as to how to make decisions for the patient.
For more information on the law related to informed consent and advance care planning please see the research paper prepared by the law firms of Dykeman , Dewhurst, O’Brien and the Advocacy Centre for the Elderly on the website of the Law Commission of Ontario at
http://lco-cdo.org/en/capacity-guardianship-commissioned-paper-ace-ddo
ACE is working on a series of plain language explanations of health care consent , advance care planning , the role of SDMs etc that will be available in October on the ACE website at http://www.acelaw.ca
Judith Wahl, Barrister and Solicitor, Executive Director, Advocacy Centre for the Elderly wahlj@lao.on.ca
Thank you for your valuable comments. I know you have a great deal of expert knowledge in this area. So your thoughtful contribution is most welcome.
My intention was simply to raise the idea that patients should be thinking about what might happen to them if they can no longer speak for themselves.
A lot more can be said about this issue than what I mentioned here. That’s why I imbedded a link to the website of “Speak Up” for those who wanted additional information. http://advancecareplanning.ca
I am not sure what you think about Speak Up website. But I certainly agree your main point – it’s best for patients to appoint a substitute decision maker who can speak on their behalf.