Under The Knife

Your doctor says you need surgery, but you aren’t sure. How do you know if surgery is the right choice for you?

The good news is you have a choice in the matter. The American College of Surgeons (ACS) says patients today are more in control of their medical care than ever before.

“Thirty years ago, you probably would have agreed to have an operation with few questions asked. Back then, most patients did not feel comfortable questioning their doctors. Patients relied on their physicians to make medical decisions for them,” says ACS Executive Director Dr. Thomas R. Russell in his book, I Need an Operation… Now What?.

“Those days are gone. Today, health care is all about you,” says Russell.

Every year, between 15 and 25 million Americans undergo a surgical procedure, and most of those are considered elective surgery, simply meaning planned, according to ACS.

Should I?

“Elective surgery commonly refers to procedures done for reasons other than medical necessity,” says Dr. Kamal Sawan, chief of plastic surgery at the University of Oklahoma College Of Medicine. However, any surgery considered non-emergent is technically defined as elective, explains Dr. Fredrick Greene, clinical professor of surgery at the University Of North Carolina School Of Medicine and a fellow with the American College of Surgeons.

Think of it this way: If you are able to plan a surgery, you are electing an operation as your course for medical treatment.

“There are lots of options for patients nowadays,” says Greene.  “For most conditions, surgery should be the last option when other treatments have failed.”

Of course, surgeries for medical conditions such as cancer vary greatly from joint replacement surgery or an operation for a hernia repair, counters Greene. 

The ACS recommends asking yourself whether your medical condition will get better on its own or with nonsurgical treatment.

“Realistically ask yourself, ‘Will this procedure improve my outlook on life?’” says Greene. “Am I going to feel better if I have this surgery?”

Thinking surgery just might be the right choice for you? Your next step should be to do your homework.

“The most important thing you can do is to become an informed patient,” says Russell. “Research shows that patients who are well-informed about their treatment have better surgical outcomes and are more satisfied with their results.”

There are many books and pamphlets to help you be prepared. The web can also be a great way to learn what to expect from your operation, provided you seek reputable websites, says Greene.

Your surgeon is also a great source for information about your suggested procedure as long as you are willing to ask questions.

“Patients should feel free to ask their surgeon anything they want answered about the operation, including the surgeon’s competency to perform it,” advises Russell.

“I often get this question: ‘If it was your family member, what would you do?’” says Greene. “That’s the ultimate question.”

You’ll also want to think about post-surgery, as well.

“Be sure to ask about the effect of the operation on your quality of life,” says Russell. “Will it alter your lifestyle?”

The biggest benefit of an elective surgery is that you have time to plan. You have more freedom in the when, where, how and who.

“Elective surgery is not only elective, but should be selective,” says Sawan. “So choose your physician wisely and pick the ones who are honest in their evaluation of your desires and expectations and who are experienced in the type of procedure.”

This is where a second or third opinion may be necessary.

“You have to have faith and confidence with the physician you have consulted,” confirms Greene. “If you are uncertain about a procedure, it’s always a good idea to have a second opinion. Most surgeons will even encourage it.”

Russell points out that it’s important to remember a second opinion is simply an opinion and not necessarily better than the first. Therefore, trust is vital when choosing a surgeon. Training and credentials matter, but your feelings matter, too, writes Russell.

“You need to feel comfortable with your surgeon,” says Russell. “If you have a good doctor-patient relationship, you can more easily communicate with each other.”

Look for someone willing to listen to you, Greene advises.

“A good surgeon will tell the patient about all their options, then give a recommendation on which is the best option for them,” he says.

Financial concerns may factor into your decision whether to have a suggested surgery or not.

“Insurance may or may not pay for the procedure,” cautions Greene.

Talk with the hospitals billing department about the hospital’s charges. If you find that you cannot afford the procedure, talk frankly with your surgeon and the hospital’s financial advisor about options, suggests Russell.

Risks And Rewards

Elective or not, surgery is still surgery, and that carries some risk. 

“Just because it is elective surgery does not reduce the risks associated with it,” says Sawan. “Patients should be aware of the risks and potential complications.”

“There are certainly downsides to surgery,” says Greene. “(The risks) vary depending on the type of surgery. It is not an exact science. We try to do no harm.”

The process of choosing a surgery is often a balancing act that weighs the good versus the bad to make the right choice for the patient, Greene explains.

Risks can include infection, bleeding, wound complications and respiratory or cardiac problems associated with the surgery or anesthesia.

“It’s important to know what kind of anesthesia you will need,” says Greene. “The risk of an operation is generally tied to the type of anesthesia.”

“The healthier the patient is, the lower the risks,” Sawan says.

Smoking significantly increases risk of complications, says Greene.

“You should stop smoking for a surgery, even if it’s just for a short time,” he suggests

Also, if you have time, try to reach a healthier weight.

“Under your doctor’s supervision, start an exercise program or work out more regularly,” suggests Russell.

It is also important to have realistic expectations about what your surgery can do for you, says Sawan.

Every surgery is different depending on the individual’s condition and the physical response of each patient, writes Russell.

“A surgeon cannot guarantee results,” explains Greene.

“Elective surgery is on the rise, and there are thousands of happy, satisfied patients who made the right decision for themselves,” says Sawan. “It is all about you, the patient. You are in charge of your destiny.

“Choose wisely and have realistic expectations to avoid disappointment later,” he adds.



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